The management of heart failure (HF) with preserved ejection fraction (EF) is different from 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 (MTM) is imperative for achieving target doses of life-saving drugs in HF with reduced EF.
MTM providers should assess adherence with medications for HF at each visit, and identify reasons for nonadherence.
MTM providers should educate patients on lifestyle interventions for management of HF.
Heart failure (HF) is 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 metabolic demands of the body.1-5 The inability of the heart to eject blood optimally is termed heart failure with reduced ejection fraction (HFrEF) or systolic dysfunction. This is due to 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. The acronyms HFrEF and HFpEF both refer to disorders of the left ventricle of the heart. Less commonly, patients may develop right-heart failure (RHF). This term is used to describe a syndrome related to a reduced output of the right ventricle.5 It is important to note that HF subtypes described above do not always occur in isolation. That is, patients with HFrEF can also have diastolic dysfunction and/or signs or symptoms of RHF. The three 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 found in Table 25-3.
TABLE 25-1Heart Failure Definitions |Favorite Table|Download (.pdf) TABLE 25-1 Heart Failure Definitions
|Heart failure with reduced ejection fraction ||Clinical syndrome typically with signs and symptoms of heart failure and an EF of ≤40% |
|Heart failure with preserved ejection fraction ||Clinical syndrome with signs and symptoms of heart failure and an EF of >40% |
|Right-heart failure ||Clinical syndrome of “right-sided” HF signs and symptoms and objective evidence of RV dysfunction |
TABLE 25-2Causes of Heart Failure |Favorite Table|Download (.pdf) TABLE 25-2 Causes of Heart Failure
Systolic dysfunction (decreased contractility)
Reduction in muscle mass (eg, myocardial infarction)
Pressure overload (eg, systemic or pulmonary hypertension, and aortic or pulmonic valve stenosis)
Volume overload (eg, valvular regurgitation, shunts, and high-output states)
Diastolic dysfunction (restriction in ventricular filling)
Increased ventricular stiffness