Acute and Chronic Disease Reports
Open Access

Chronic and Progressive Clinical Syndrome of Heart Failure

Mark Twain^{* *}Correspondence: Mark Twain, Department of Medicine, LMU University Hospital, Munich, Germany, Email:

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Description

Heart Failure (HF) is a chronic and deteriorating clinical syndrome brought on by structural or functional cardiac abnormalities exhibiting either a reduced (in HF with reduced ejection fraction HFrEF) or preserved in HF with preserved ejection fraction HFpEF Left Ventricular Ejection Fraction (LVEF). Elevated cardiac filling pressures are a result of cardiac dysfunction both at rest and under stress. Dyspnea (shortness of breath), weariness, and common clinical manifestations such pulmonary rales peripheral oedema, or swollen jugular veins are all indicators of HF.

The significant decrease in short-term mortality for patients with a variety of cardiac conditions, especially acute coronary syndromes and congenital heart disease, and the relevant improvement in long-term survival for patients with HFrEF (due to the widespread use of efficient disease-modifying oral therapies and devices), combined with a number of demographic changes, such as an extended life expectancy, have significantly increased the number of patients with HF. A significant public health issue in affluent nations, HF affects 2% of the adult population and has increased the number of hospital admissions since the 1990s.

Acute Heart Failure (AHF) is the most common reason for unscheduled hospital admission in people over 65 years of age and is characterised as the onset of new symptoms or a worsening of existing ones. From a clinical standpoint, we distinguish between acutely decompensated HF (ADHF), in which symptoms worsen in patients with previously diagnosed chronic HF, and HF, in which symptoms appear in patients without a prior history of HF. This classification primarily has clinical implications but adds to our understanding of the pathophysiology of AHF HF requires a more extensive diagnostic process to investigate the underlying cardiac pathology than ADHF). Since HF is a chronic and progressive condition, AHF accounts for the bulk of hospitalizations.

The majority of the symptoms and signs associated with systemic congestion characterise the clinical presentation of AHF (that is, extracellular fluid accumulation, initiated by increased biventricular cardiac filling pressures). Therefore, non-invasive ventilation and intravenous diuretics, which are given either alone or, more frequently in Europe and Asia, in combination with short-acting vasodilators, make up the initial course of treatment for the majority of patients with AHF. The critical condition known as cardiogenic shock, which affects only a small percentage of patients with AHF, is characterised by the presence of clinical signs of peripheral tissue hypoperfusion. Cardiogenic shock has a tenfold higher in-hospital mortality than AHF without shock and calls for particular treatments. AHF is still linked to poor outcomes, with 90-day readmission rates and 1- year mortality reaching 10-30%, despite significant advancements in the management of chronic HFrEF. The majority of patients continue to only receive decongestive drugs, at best tailored according to the initial haemodynamic status with little regard to the underlying pathophysiological particularities, despite the fact that AHF is not a specific disease but rather the shared clinical presentation of various, heterogeneous cardiac abnormalities. This method may have been a factor in the large number of neutral or unfavourable clinical studies examining the impact of decongestive therapies on survival as well as the persistence of unfavourable outcomes in AHF.

In order to improve long-term outcomes, there is a need for greater individualization and treatment continuation after hospital discharge. The goal of this primer is to stimulate advancements in clinical practise and research to improve patient outcomes. By reviewing current concepts in epidemiology, pathophysiology, diagnosis, and management of AHF. Cardiogenic shock is not covered in this Primer because it is a distinct entity with unique characteristics.