Chronic heart failure

Overview

Incidence of chronic heart failure (HF) is increasing steadily in all developed countries, predominantly due to population ageing. The prevalence of HF in population is 1–2%, reaching up to 10% in higher age categories. At present HF is classified according to left ventricular ejection fraction (EF) value to HF with reduced EF (formerly systolic HF) and HF with preserved EF (formerly diastolic HF). Coronary artery disease dominates in the aetiology of HF with reduced EF (about 70%), especially status post myocardial infarction. Pathophysiology of HF with preserved EF is very complex and still not fully understood. Multiple comorbidities play an important role, especially hypertension and diabetes mellitus. HF with preserved EF represents about half of all HF cases and its rate is slowly increasing. Morbidity expressed as hospitalization rate is comparable in patients with both types of HF, whereas mortality is a little bit lower in patients with HF with preserved EF. But in patients with HF and preserved EF the prevailing causes of both, the hospitalizations and the deaths are non-cardiovascular.

Diagnosis of HF is relatively simple in fully manifested cases, but it could be a problem in milder forms especially of the HF with preserved EF in elderly patients with multiple comorbidities. For the definite diagnosis of HF the patient has to have typical symptoms and clinical signs as well as objectively documented left ventricular dysfunction, usually by echocardiography. According to the EF value the type of HF is determined. In HF with preserved EF an evidence of a structural heart impairment and/or left ventricular diastolic dysfunction is also necessary. Plasma levels of natriuretic peptides could be helpful for determination of correct diagnosis, particularly in untreated patients. Basic examination of patients with suspected HF is completed by ECG and some laboratory parameters (e.g. renal function, ions, red blood count).

Treatment of HF with reduced EF is based on evidence from many clinical trials. It is complex and consists on non-pharmacological interventions, pharmacotherapy (ACE inhibitors, sartans, betablockers, mineralocortikoid receptor blockers, in specific situations also ivabradine and digoxin), surgery and devices. There is no evidence-based treatment for HF with preserved EF, therefore it still remains empiric.

Keywords:
chronic heart failure – heart failure with reduced ejection fraction – heart failure with preserved ejection fraction – natriuretic peptides