Topic Discussion 1 HF Epidemiology and Diagnosis

Definition
o complex clinical syndrome that results from any structural or functional
impairment of ventricular filling or ejection of blood.
Symptoms
o Dyspnea, fatigue, exercise intolerance, pulmonary/splenic congestion, peripheral
edema
Epidemiology
o Lifetime risk = 20% for Americans >40yo
o >650,000 new cases each year
o Risk increases with age
o 1/9 deaths in US have HF included on Death Certificate
o Groups
Higher risk in African Americans
Worse function and QOL in women than men and hispanics > non-
hispanics
o Mortality 50% within 5 years of dx
o Primary Dx for >1million hospital admission per year
>25% rehospitalized w/in 30 days
.>$30 billion spent on HF per year, with 50% being hospitilaztions
Precipitating Factors
o Primarily from LV dysfunction (cardiomegaly)
Disorders of any/all of the following
Valves, myocardium, pericardium, endocardium, or greater
vessels
Not all LV dysfx/cardiomegaly is HF
o HTN
New AHA update recommends BP goal <130/80
Primary cause, in 60-90% in HFpEF
Long term tx of HTN can decrease HF dx by 50%
BUT lifetime risk of developing HTN in US is >75%
o DM, Metabolic syndrome, CAD all worsen risk of developing HF and worsen sxs
o Genetic conditions, Obesity, thyroid dx, acromegaly, alcoholism, cocaine, chemo,
other medications, tachycardia, inflammation, peripartum, iron overload,
sarcoidosis, Takotsubo (stress)
Diagnosis
o CXR
Non-invasive, quick, cheap
Detects heart size (cardiomegaly) and pulmonary congestion
o Echo Cardiogram
TTE and TEE
Assess ventricular function, size, wall thickness, wall motion, and valve
function
Can diagnosis HF earlier
o MRI reasonable if echocardiogram infeasible due to cardiac scarring
o CATH
Invasive. Used when echocardiogram inconclusive
o Diastolic vs Systolic
Preserved vs reduced EF
 Biomarkers
o BNP, pro-BNP
Risk of death higher with higher BNP
o Troponins
Elevated even with no sign of ischemia
Worse hemodynamics and mortality
HF Classification/Staging
o NYHA - classifies sxs and function
o AHA - classifies dx progression
o Can your HF classification/staging improve?

Self Care Education - Decreases HF readmissions

o Sodium Restriction
Reduce congestive sxs in symptomatic HF
o Fluid Restriction (<1.5-2L/day)
Stage D HF - reduce congestive sxs
o Cardiac Rehab - Exercise training and regular physical activity
Improve functional status