Heart Failure Update: Diagnosis and Classification

Heart failure (HF) is a complex clinical condition. The newer guidelines have phased out the designations of systolic and diastolic HF and replaced them with the more physiologically applicable classifications of HF with reduced or preserved ejection fraction (EF). Although the numbers of new patients within these two groups are similar, patient characteristics and risk factors often differ. There also are differences in the incidence of HF among racial and ethnic groups, with blacks having the highest incidence. Although survival has improved over time among patients with reduced EF, no significant change in survival has been observed among those with preserved EF. Many models have been proposed to explain the underlying pathophysiology of HF, including the hemodynamic, neurohumoral, and cardiorenal models. The evaluation of a patient with signs and symptoms of and risk factors for HF includes a detailed history and physical examination, laboratory tests, chest x-ray, electrocardiography, and echocardiography. Serum natriuretic peptide levels are already in use, and other novel biomarkers reflecting the different pathophysiologic pathways are being investigated. The Seattle Heart Failure Model is a tool available for clinicians to use in estimating patient mortality risk.