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Heart Failure (HF)

Brief Overview: According to the American Heart Association, “Heart failure is a condition in which the heart muscle can’t pump enough blood to meet the body’s needs for blood and oxygen. Basically, the heart can’t keep up with its workload. HF is a lifelong condition, but you may have HF remission with treatment and healthy lifestyle changes.”

Prevalence: According to Cleveland Clinic, “More than 6 million people in the United States have congestive heart failure. It’s the leading cause of hospitalization in people older than 65.”

Etiology: According to the NHS, “Heart failure is often the result of a number of problems affecting the heart at the same time.

Conditions that can lead to heart failure include:

Sometimes obesity, anaemia, drinking too much alcohol, an overactive thyroid or high pressure in the lungs (pulmonary hypertension) can also lead to heart failure.”

Risk Factors: According to the CDC, “Certain medical conditions can increase your risk for heart failure, including:

Unhealthy behaviors can also increase your risk for heart failure, especially for people who have one of the conditions listed above. Unhealthy behaviors include:

  • Smoking tobacco.
  • Eating foods high in fat, cholesterol, and sodium(salt).
  • Not getting enough physical activity.
  • Excessive alcohol intake.”

Commonly Associated Conditions:

  • Coronary artery disease
  • Atrial fibrillation
  • Chronic kidney disease
  • Hypertension
  • Diabetes mellitus
  • Sleep apnea
  • Depression and anxiety
  • Frailty and sarcopenia

Common Medications:

Medication therapy aims to improve symptoms, reduce hospitalizations, and improve survival, particularly in HFrEF.

  • Guideline-directed medical therapy (HFrEF):
    • ACE inhibitors: lisinopril, enalapril, ramipril
    • ARBs: losartan, valsartan, candesartan (if ACE inhibitor–intolerant)
    • ARNI: sacubitril/valsartan
    • Beta-blockers: carvedilol, metoprolol succinate, bisoprolol
    • Mineralocorticoid receptor antagonists: spironolactone, eplerenone
    • SGLT2 inhibitors: dapagliflozin, empagliflozin, canagliflozin
  • Symptom management:
    • Loop diuretics: furosemide, bumetanide, torsemide
    • Thiazide-type diuretics (selected patients for diuretic resistance)
  • Additional agents (selected patients):
    • Hydralazine/isosorbide dinitrate
    • Digoxin – rarely used
    • Ivabradine
    • Vericiguat - rarely used

Common Labs, Imaging, and Tests:

  • Basic metabolic panel (renal function, electrolytes)
  • BNP or NT-proBNP
  • Complete blood count
  • Liver function tests
  • Electrocardiogram (ECG)
  • Echocardiogram (key test to assess ejection fraction and structure)
  • Chest X-ray (pulmonary congestion, cardiomegaly)
  • Cardiac stress testing or catheterization (selected patients)

Common Symptoms:

  • Shortness of breath (with exertion or at rest)
  • Orthopnea (shortness of breath when lying flat)
  • Paroxysmal nocturnal dyspnea
  • Fatigue and weakness
  • Lower extremity edema
  • Rapid weight gain from fluid retention
  • Reduced exercise tolerance
  • Nocturia

Common Treatments:

  • Medications (see above)
  • Lifestyle changes
  • Sodium and fluid management
  • Daily weight monitoring
  • Cardiac rehab
  • Treatment of any underlying conditions and comorbidities
  • Implantable devices (ICD, CRT) may be indicated
  • LVAD, transplant may be indicated

Physical Findings:

  • Peripheral edema
  • Jugular venous distention
  • Crackles on lung auscultation
  • S3 heart sound
  • Hepatomegaly or ascites (advanced disease)
  • Cool extremities in severe cases

Potential Complications and Contraindications:

  • Potential complications:
    • Acute decompensated heart failure
    • Recurrent hospitalizations
    • Arrhythmias and sudden cardiac death
    • Worsening renal function
    • Thromboembolism
    • Reduced quality of life and functional decline
  • Contraindications / cautions:
    • Hypotension or renal dysfunction with certain HF medications
    • Electrolyte abnormalities with diuretics and MRAs
    • NSAIDs may worsen fluid retention
    • Medication nonadherence can precipitate exacerbations

General Health and Lifestyle Guidance:

  • Monitor daily weights and report rapid gains
  • Follow low-sodium diet, as directed by healthcare provider
  • Adhere to fluid restrictions if prescribed
  • Take medications consistently as prescribed
  • Avoid NSAIDs unless approved by healthcare provider
  • Engage in appropriate physical activity as tolerated and approved by healthcare provider
  • Stay up to date on vaccinations as directed by healthcare provider
  • Recognize early signs of fluid overload
  • Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.  

Suggested Questions to Ask Patients:

  • Have you noticed any sudden weight gain or swelling?
  • Are you more short of breath than usual?
  • How many pillows do you sleep with at night?
  • Are you taking your heart medications every day?
  • Any dizziness, lightheadedness, or falls?
  • Any recent ER visits or hospitalizations?
  • Are you following a low-sodium diet?

Suggested Talking Points:

  • Heart failure is chronic, but symptoms can often be well controlled.
  • Daily weights help catch fluid buildup early.
  • Medications protect your heart even when you feel okay.
  • Limiting salt and taking medications consistently reduces flare-ups.
  • Call early if symptoms worsen—your healthcare provider may be able to prevent hospitalization.
  • Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.  

Sources:

This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.