Heart Failure Explained
Heart failure means the heart is not pumping or filling as effectively as the body needs. It is a common, long-term condition with many causes. For heart failure with reduced ejection fraction in particular, several medication groups have been shown in large trials to improve symptoms, reduce hospital admissions and prolong life.
Written by Dr. Jan Niclas Strickling, DHA-licensed: Consultant Cardiology · Consultant Internal Medicine · Specialist Interventional Cardiology. General information only; it does not replace an individual assessment.
Diagnosis and Echocardiography
Diagnosis begins with a clinical assessment supported by blood tests and echocardiography. This helps determine the type of heart failure and underlying causes, such as coronary artery disease, high blood pressure, valve disease or cardiomyopathy.
Guideline-Directed Medical Therapy
For reduced ejection fraction, current ESC guidelines describe four main medication groups: ACE inhibitors or ARNI (sacubitril/valsartan), beta-blockers, mineralocorticoid receptor antagonists and SGLT2 inhibitors. For preserved ejection fraction, SGLT2 inhibitors have shown benefit in trials, and treatment otherwise focuses on symptoms and underlying causes. Medicines can have side effects and require monitoring, so treatment is individual.
- Clinical assessment and echocardiography
- Reduced and preserved ejection fraction
- Guideline-directed medical therapy
- Device therapy (ICD, CRT) in selected patients
- Monitoring of kidney function and electrolytes
- Lifestyle, fluid and weight monitoring
Device Therapy and Monitoring
For selected patients, device therapy such as CRT or an ICD may complement medication. Eligibility depends on ejection fraction, ECG findings, symptoms and overall health, and involves weighing expected benefit against procedural risks.
Frequently Asked Questions
- Common symptoms include breathlessness (on exertion or when lying flat), fatigue and swelling of the legs or ankles. These symptoms have many possible causes, so a medical assessment is needed for an accurate diagnosis. Sudden or severe breathlessness requires emergency care.
- Diagnosis usually combines a clinical assessment, blood tests including natriuretic peptides (BNP or NT-proBNP), an ECG and echocardiography to evaluate heart structure and function. Further tests may be used to find the underlying cause.
- Ejection fraction describes the proportion of blood the left ventricle pumps out with each beat. Heart failure can occur with a reduced ejection fraction (weakened heart muscle) or a preserved ejection fraction (the heart pumps normally but fills less effectively). The evidence for treatments differs between the two.
General information, not personal advice
These pages explain conditions and procedures in general terms. Whether a test, medicine or procedure is appropriate, and its alternatives and risks, can only be decided after an individual assessment by your own treating doctor. If you have chest pain, severe breathlessness or collapse, call emergency services immediately.
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