Heart FailureKristie Hankins ACNP-BC

What is Heart Failure?Heart failure is a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood.

Heart Failure Statistics• 5 million people in U.S. with heart failure• 670,000 people diagnosed with heart failure each year.• Heart failure is the primary reason for 12-15 million office

visits and 6.5 million hospital days each year• Approximately 80% of patients hospitalized with heart

failure are >65• Heart failure is the most common Medicare DRG• About 277,000 deaths per year related to heart failure• Rehospitalization rates are very high. Up to 50% at 6

months• Heart failure accounts for 34% of cardiovascular-related

deaths

PrognosisIn general, the mortality following hospitalization for patients with heart failure is 10.4% at 30 days, 22% at 1 year, and 42.3% at 5 years, despite marked improvement in medical and device therapy . Each rehospitalization increases mortality by about 20-22%

Mortality is greater than 50% for patients with NYHA class IV, ACC/AHA stage D heart failure. Heart failure associated with acute MI has an inpatient mortality of 20-40%; mortality approaches 80% in patients who are also hypotensive (cardiogenic shock)

Signs & Symptoms of Heart Failure• Dyspnea• Fatigue• Activity Intolerance• Fluid Retention• Peripheral Edema• Orthopnea• PND• Common noncardiac signs and symptoms of heart failure

include anorexia, nausea, weight loss, bloating, fatigue, weakness, oliguria, nocturia, and cerebral symptoms of varying severity, ranging from anxiety to memory impairment and confusion.

Causes of Heart Failure• Coronary Artery Disease• Hypertension• Dilated Cardiomyopathy• Valvular Heart Disease• Arrhythmia• Peripartum• Drug Use (recreational or precribed)

• ETOH, Cocaine or cardiotoxic drugs (ex. Adriamycin

• Infections or Inflammation• Congenital• Idiopathic

Diagnosis of Heart Failure

• There is not one single diagnostic test to identify Heart Failure!

• Labs• Full baseline labs including BNP

• CXR• EKG• Echocardiogram• Ischemic evaluation

Treatment

Simple to complex• Dietary restrictions• Fluid restrictions• Pharmacologic therapies include the use of

diuretics, vasodilators, inotropic agents, anticoagulants, beta-blockers, and digoxin.

• Invasive therapies for heart failure include electrophysiologic intervention such as cardiac resynchronization therapy (CRT), pacemakers, and implantable cardioverter-defibrillators (ICDs)

Treatment continued• Revascularization procedures such as coronary

artery bypass grafting (CABG) and percutaneous coronary intervention (PCI); valve replacement or repair.

• Ventricular Assist Device/Transplant

References

American College of CardiologyAmerican Heart Association