Heart Failure Basics
by Dr. Elspeth Pearce
uploaded by Matthew Lam, MS2
Heart Failure for the Resuscitationist: The Basics
I don’t have to tell you that heart failure is a common condition in the general population and in patients presenting to the emergency department (ED). We see it on a daily basis. Even with this familiarity, there are still some conundrums in the care of these patients. My personal opinion is that a lot of the confusion starts with how we define and refer to these patients. When I say “acute decompensated heart failure,” you get a picture of a patient in your mind, but your “heart failure” patient might be someone else’s “flash pulmonary edema” patient. Language matters in how we talk to our colleagues, consultants, and the patients. In this post, I hope to identify clear definitions for heart failure exacerbations. The goal being that we can dissect the workup and treatment of the different presentation phenotypes.
Acute Decompensated Heart Failure
HFrEF and HFpEF
So, what are these cute little names that we give to the different types of heart failure? HFrEF (typically pronounced hef-ref) stands for heart failure with reduced ejection fraction (EF ≤40%), and HFpEF (typically pronounced huf-puf) stands for heart failure with preserved ejection fraction (EF ≥55%). The main reason for these distinctions is because this is how we study heart failure patients. We have good data for therapies that improve mortality in patients with HFrEF. At this time we don’t have specific therapies for HFpEF, we target the underlying comorbid conditions.
I know these phenotypes do not have great names or acronyms associated with them, so they would be cumbersome to use day to day on a shift, which is why we have the common names like cardiogenic shock and flash pulmonary edema. What I would encourage is getting away from using ADHF unless you clarify it with the perfusion status, the volume status, and the underlying etiology if you have all that information. For example, when admitting to the cardiology unit, you could tell them that you have a patient with HFrEF coming in with decompensated heart failure with significant volume overload but good perfusion.
Rayner-hartley E, Virani S, Toma M. Update on the management of acute heart failure. Curr Opin Cardiol. 2018;33(2):225-231.