CLINICAL DEFINITIONS, EPIDEMIOLOGY, AND PHENOTYPES
Heart failure (HF) is a common final pathway for most chronic cardiovascular diseases including hypertension, coronary artery disease, and valvular heart disease. The American College of Cardiology Foundation/American Heart Association (ACCF/AHA) and Heart Failure Society of America (HFSA) guidelines define HF as a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood leading to cardinal manifestations of dyspnea, fatigue, and fluid retention. The European Society of Cardiology’s (ESC) definition emphasizes typical symptoms (e.g., breathlessness, ankle swelling, and fatigue) and signs (e.g., elevated jugular venous pressure, pulmonary crackles, and peripheral edema) caused by a structural and/or functional cardiac abnormality, resulting in a reduced cardiac output and/or elevated intracardiac pressures at rest or during stress. Because some patients present without signs or symptoms of volume overload, the term heart failure is preferred over the older term congestive heart failure. Cardiomyopathy and left ventricular dysfunction are more general terms that describe disorders of myocardial structure and/or function, which may lead to HF. In pathophysiologic terms, HF has been defined as a syndrome characterized by elevated cardiac filling pressure and/or inadequate peripheral oxygen delivery, at rest or during stress, caused by cardiac dysfunction.
Chronic heart failure describes patients with longstanding (e.g., months to years) symptoms and/or signs of HF typically treated with medical and device therapy as described in Chap. 258. Acute heart failure, previously termed acute decompensated HF, refers to the rapid onset or worsening of symptoms of HF. Most episodes of acute HF result from worsening of chronic HF, but ~20% are due to new-onset HF that can occur in the setting of acute coronary syndrome, acute valvular dysfunction, hypertensive urgency, or postcardiotomy syndrome. Similarly, acute pulmonary edema in HF describes a clinical scenario in which a patient presents with rapidly worsening signs and symptoms of pulmonary congestion, typically due to severe elevation of left heart filling pressure.
Global Incidence and Prevalence
HF is a major cause of morbidity and mortality worldwide. An estimated 6.2 million American adults are being treated for HF, with >600,000 new cases diagnosed each year. Globally, >26 million people are affected by HF. The prevalence of HF increases significantly with age, occurring in 1–2% of the population aged 40–59 years and up to 12% of adults >80 years old (Fig. 257-1). The lifetime risk of HF at age 55 years is 33% for men and 28% for women. Projections show that the prevalence of HF in the United States will increase by 46% from 2012 to 2030. Between 1980 and 2000, the number of HF hospitalizations rose steadily in both men and women to ~1 million per year. However, according to the most recent AHA statistics, hospitalizations decreased from 1,020,000 in 2006 to 809,000 in 2016. While prevalence ...