The management of heart failure (HF) with preserved ejection fraction (EF) is different than the management of HF with reduced EF.
Optimal pharmacotherapy is determined by EF and symptoms.
Symptoms of HF are managed with pharmacotherapy and lifestyle interventions.
Medication therapy management is imperative for achieving target doses of life-saving drugs in HF with reduced EF.
Heart failure (HF) may be defined as a clinical syndrome with typical signs and symptoms precipitated by abnormal function or structure of the heart. This abnormality impairs the ability of the ventricle to fill with or eject blood and results in the inability of the heart to meet the body's metabolic demands.1,2,3, and 4 The inability of the heart to eject blood optimally is termed heart failure with reduced ejection fraction (HFrEF) or systolic dysfunction. This is because of a reduction in myocardial contractility. HF may also be precipitated by impaired relaxation of the heart that prevents the ventricle from filling properly. This is termed HF with preserved ejection fraction (HFpEF) or diastolic dysfunction. Both HFrEF and HFpEF refer to disorders of the left ventricle of the heart. Although not as common, patients may develop right heart failure (RHF). This term is used to describe a syndrome caused by reduced output of the right ventricle.5 The HF subtypes described here do not always occur in isolation; that is, patients with HFrEF can also have diastolic dysfunction or signs or symptoms of RHF. The 3 major HF types are summarized in Table 25-1, and potential etiologies are listed in Table 25-2. Medications and substances that may cause or worsen HF are shown in Table 25-3.
Table 25-1.Heart Failure Definitions1, 3, 4 |Favorite Table|Download (.pdf) Table 25-1. Heart Failure Definitions1, 3, 4
|Heart failure with reduced ejection fraction ||Clinical syndrome typically with signs and symptoms of heart failure and an EF less than or equal to 40% |
|Heart failure with preserved ejection fraction ||Clinical syndrome with signs and symptoms of heart failure and an EF greater than 40% |
|Right heart failure ||Clinical syndrome of "right-sided" HF signs and symptoms and objective evidence of RV dysfunction |
Table 25-2.Causes of Heart Failure5 |Favorite Table|Download (.pdf) Table 25-2. Causes of Heart Failure5
Systolic dysfunction (decreased contractility)
Diastolic dysfunction (restriction in ventricular filling)