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Heart failure - chronic - Background information
What is it?

  • Heart failure is a complex syndrome in which the ability of the heart to maintain the circulation of blood is impaired. This results in breathlessness; fatigue; and signs of fluid retention, such as increased jugular venous pressure, pulmonary crepitations, and peripheral oedema [European Society of Cardiology, 2008; National Clinical Guideline Centre for Acute and Chronic Conditions, 2010].
  • Several definitions have been used to describe heart failure. Throughout this topic, CKS uses the definitions recommended by the National Institute for Health and Clinical Excellence (NICE). These include:
    • Heart failure with left ventricular systolic dysfunction
      • A little more than half of the people with heart failure have evidence of left ventricular systolic dysfunction, such as reduced left ventricular ejection fraction (LVEF) on echocardiography.
    • Heart failure with preserved ejection fraction
      • A little less than half of the people with heart failure have good contraction of the heart muscle (LVEF) on echocardiography [Sanderson, 2007]. This is called heart failure with preserved ejection fraction (HFPEF).
      • There is no agreement on what level should be used to separate normal from abnormal LVEF: the usual cut-off is about 40–50%, although many clinical trials have used a cut-off of 35%.
      • In most cases, HFPEF is probably caused by diastolic dysfunction (due to decreased left ventricular filling, with abnormal left ventricular relaxation or distensibility during diastole) [Sanderson, 2007; European Society of Cardiology, 2008; Sanderson and Yip, 2009].
      • Most people with reduced LVEF also have diastolic dysfunction.
  • Other terms used to describe heart failure, but are not used in this CKS topic, include:

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