Heart Failure - high yield

Universal Definition and Classification of Heart Failure:

Heart Failure is a clinical syndrome with current or prior symptoms and/or signs caused by structural and/or functional cardiac abnormality
Corroborate by at least 1 of the following:
- high natriuretic peptide levels
- objective evidence of cardiogenic pulmonary or systemic congestion

Heart Failure stages have been revised to emphasize the symptomatic nature of HF as a clinical syndrome

At risk for HF (Stage A):

Patients at risk of HF but w/o current or prior symptoms or signs of HF and w/o structural cardiac changes or high biomarkers of heart disease

Pre‐HF (new) (Stage B):

Patients w/o current or prior symptoms or signs of HF w/ evidence: structural heart disease, abnormal cardiac function, high natriuretic peptide or troponin

Symptomatic HF (Stage C):

Patients with current or prior symptoms or signs of HF caused by a structural and/or functional cardiac abnormality

Advanced HF (Stage D): Severe symptoms and/or signs of HF at rest, recurrent hospitalization despite GDMT, refractory or intolerant to GDMT, requiring advanced therapies, mechanical circulatory support, or palliative care

Classification by Ejection Fraction

HF w/ reduced EF (HFrEF) is HF with LVEF < 40%
HF w/ mildly reduced EF (HFmrEF) is HF with LVEF 41-49%
HF w/ preserved EF (HFpEF) is HF w/ LVEF > 50%
HF w/ improved EF (HFimpEF) is HF w/ baseline LVEF of <40% , a 10-point increase from baseline LVEF, and a 2nd LVEF of > 40%

Acute decompensated heart failure - key point

What are the three most common loop diuretics for acute decompensated heart failure?

Answer: Furosemide, Torsemide, Bumetanide

Different strategies to monitor short-term responsiveness to IV loop diuretics

Urine output (goal > 150 ml/hr)
Urine sodium (goal > 50-70 mEq/L)
If the goal urine output is < 150 ml/hr or the spot urine sodium is < 50 mEq/L two hours after the initial IV diuretic dose, then the dose should be doubled and the parameters re-checked.
When the goals are met, the same dose can be administered every 6-12 hours until volume overload resolves.

Heart Failure - high yield ​

​​

Universal Definition and Classification of Heart Failure:

Classification by Ejection Fraction

HF w/ reduced EF (HFrEF) is HF with LVEF < 40%

HF w/ mildly reduced EF (HFmrEF) is HF with LVEF 41-49%

HF w﻿/ preserved EF (HFpEF) is HF w/ LVEF > 50%

HF w/ improved EF (HFimpEF) is HF w/ baseline LVEF of <40% , a 10-point increase from baseline LVEF, and a 2nd LVEF of > 40%

Acute decompensated heart failure - key point

What are the three most common loop diuretics for acute decompensated heart failure?

​

Answer: Furosemide, Torsemide, Bumetanide

Different strategies to monitor short-term responsiveness to IV loop diuretics

Urine output (goal > 150 ml/hr)

Urine sodium (goal > 50-70 mEq/L)

If the goal urine output is < 150 ml/hr or the spot urine sodium is < 50 mEq/L two hours after the initial IV diuretic dose, then the dose should be doubled and the parameters re-checked.

When the goals are met, the same dose can be administered every 6-12 hours until volume overload resolves.

Heart Failure - high yield

HF w/ preserved EF (HFpEF) is HF w/ LVEF > 50%