Overview of Heart Failure

Oleh:
dr. Kurniawan

Program Pendidikan Dokter Spesialis Ilmu Penyakit Dalam

Fakultas Kedokteran Universitas Udayana/RSUP Sanglah
Definition
 Definition
• HF  clinical syndrome characterized by typical symptoms (e.g. breathlessness, ankle swelling and
fatigue) that may be accompanied by signs (e.g. elevated jugular venous pressure, pulmonary crackles and
peripheral oedema) + objective evidence of structural and/or functional cardiac abnormality
• Structural and/or functional cardiac abnormality reduced cardiac output and/or elevated
intracardiac pressures.
• The cardinal manifestations of HF :
- dyspnea and fatigue  limit exercise tolerance
- fluid retention  pulmonary and/ or splanchnic congestion and/or peripheral edema.
• Term “Congestive heart failure” is no longer preferred, because many patients do not have overt
congestion at evaluation

• Yancy CW, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll
Cardiol. 2013 Oct 15;62(16):e147-239.
• Ponikowski P, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016 Jul 14;37(27):2129-2200.
 EPIDEMIOLOGY
• The global burden HF are approaching epidemic proportions, as evidenced by the increase in
the HF hospitalizations, mortality, and health care cost.

• The overall prevalence of HF is thought to be increasing, in part because current therapies for
cardiac disorders are allowing patients to survive longer.

• HF affects almost 23 million people worldwide. In The US its estimated 5.7 million people
have HF and its estimated that by 2030 the prevalence will incrase 25%

• The prevalence of HF rises exponentially with age.

Januzzi Jr JL, Mann DL. Approach to the Patient with Heart Failure. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF (eds). Braunwald’s Heart Disease a Textbook of
Cardiovascular Medicine. 11th eds. Philladelphia, PA, Elsevier; 2019.
Classification
• Stage: ACC/AHA staging
• Functional Classification: New York Heart Association (NYHA) class
• Onset: Acute vs Chronic
• Type of HF (ejection fraction): Preserved EF, Mid-range EF, Reduced EF

Januzzi Jr JL, Mann DL. Approach to the Patient with Heart Failure. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF (eds). Braunwald’s Heart Disease a Textbook
of Cardiovascular Medicine. 11th eds. Philladelphia, PA, Elsevier; 2019.
CLASSIFICATION

https://heart-failure.net/
Clinical manifestation
• Ponikowski P, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016 Jul
14;37(27):2129-2200.
• King M, Kingery J, Casey B. Diagnosis and evaluation of heart failure. Am Fam Physician. 2012 Jun 15;85(12):1161-8
Diagnosis chronic hf
Ezekowitz, Justin A. et al. 2017 Comprehensive Update of the CCS Guidelines for
the Management of Heart Failure. Can J Cardiol 2017;33:1342-1433.
Management
 Updated
Management
of CHF

McDonald M, et al. CCS/CHFS Heart Failure Guidelines Update: Defining a New

Pharmacologic Standard of Care for Heart Failure With Reduced Ejection Fraction.
Can J Cardiol. 2021 Apr;37(4):531-546.
Acute heart failure
 AHF
Classification A B

D C

• Ponikowski P, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016 Jul 14;37(27):2129-2200.
Ezekowitz, Justin A. et al. 2017 Comprehensive Update of the CCS Guidelines for the Management of Heart Failure. Can J Cardiol 2017;33:1342-1433.
 Management of ahf

Ponikowski P, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J.
2016 Jul 14;37(27):2129-2200.
Ezekowitz, Justin A. et al. 2017 Comprehensive Update of the CCS Guidelines for the Management of Heart Failure. Can
J Cardiol 2017;33:1342-1433.
Conclusion
• HF is a clinical syndrome characterized by typical symptoms + signs + objective evidence of
structural and/or functional cardiac abnormality.

• The cardinal manifestations of HF :

- dyspnea and fatigue  limit exercise tolerance

- fluid retention  pulmonary and/ or splanchnic congestion and/or peripheral
edema.

• Term “Congestive heart failure” is no longer preferred, because many patients do not have
overt congestion at evaluation.

• ARNI + Beta Blocker + MRA + SGLT-2 now is became a 4 pillar of management of CHF.
Terima Kasih