Heart failure (HF) is defined clinically as a syndrome in which patients have typical symptoms (e.g. breathlessness, ankle-swelling and fatigue), and signs (e.g. elevated jugular venous pressure), resulting from an abnormality of cardiac structure or function.1 Its prevalence is high and increasing due to the increasing age of the population, improved survival rates post-infarction and better medical care. Patients with HF have a poor quality of life, and reduced life expectancy. There are wide variations in the management of HF across the UK.2
Patients can present with acute heart failure, when the pathophysiology of the condition can usually be understood in terms of abnormal haemodynamics, but the pathophysiology of chronic heart failure, especially when treated, is more complex.
HF is often described in relation to left ventricular ejection fraction (EF).
Systolic HF is HF with a reduced ejection fraction (EF) or HeFREF. Some patients appear to have HF but have a normal EF (see figure 1). Such patients are variously labelled as having HeFNEF, HeFPEF (where the P stands for “preserved”) or “diastolic HF” (see figure 2).