Editing Heart failure (section)

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{{short description|Failure of the heart to provide sufficient blood flow}}
{{distinguish|cardiac arrest|myocardial infarction|heart block}}
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{{Use dmy dates|date=January 2019}}
{{Infobox medical condition
| name = Heart failure
| image = Elevated JVP.JPG
| caption = A man with congestive heart failure and marked [[jugular venous distension]]. [[External jugular vein]] marked by an arrow.
| field = [[Cardiology]]
| synonyms = Congestive heart failure (CHF), congestive cardiac failure (CCF)<ref>{{cite book |vauthors=Harrison RN, Daly L |title=A Nurse's Survival Guide to Acute Medical Emergencies |date=2011 |publisher=Elsevier Health Sciences |isbn=978-0-7020-4900-2 |page=26 |url=https://books.google.com/books?id=Uk7wbaUWDRYC&pg=PA26 |language=en |access-date=25 August 2020 |archive-date=9 August 2023 |archive-url=https://web.archive.org/web/20230809061722/https://books.google.com/books?id=Uk7wbaUWDRYC&pg=PA26 |url-status=live }}</ref><ref>{{cite web |title=Congestive heart failure (CHF) |url=https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/congestive-heart-failure-chf |access-date=12 November 2018 |language=en |archive-date=6 April 2016 |archive-url=https://web.archive.org/web/20160406152646/https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/congestive-heart-failure-chf |url-status=live }}</ref>
| symptoms = [[Shortness of breath]], [[Fatigue (medical)|exhaustion]], [[edema|swollen legs]]<ref name="NICE2018ch2"/>
| onset = 
| duration = Lifetime
| causes = [[Myocardial infarction|Heart attack]], [[high blood pressure]], [[abnormal heart rhythm]], [[excessive alcohol use]], infection, heart damage<ref name="AHA2022"/>
| risks = Smoking, sedentary lifestyle, obesity, exposure to second-hand smoke<ref>{{cite journal | vauthors = Skipina TM, Upadhya B, Soliman EZ | title = Secondhand Smoke Exposure is Associated with Prevalent Heart Failure: Longitudinal Examination of the National Health and Nutrition Examination Survey | journal = Nicotine & Tobacco Research | volume = 23 | issue = 9 | pages = 1512–1517 | date = July 2021 | pmid = 34213549 | doi = 10.1093/ntr/ntab047 | publisher = [[Oxford University Press]] on behalf of the [[Society for Research on Nicotine and Tobacco]] | lccn = 00244999 | s2cid = 235707832 | eissn = 1469-994X | veditors = Munafò M | editor-link = Marcus Munafo }}</ref>
| diagnosis = [[Echocardiogram]]<ref name="ESC2021"/>
| differential = Kidney failure, thyroid disease, liver disease, anemia, obesity<ref name=NICE2010chp4/>
| treatment = 
| medication = [[Diuretics]], cardiac medications<ref name=AHA2022/><ref name=ESC2021/>
| frequency = 40 million (2015),<ref name=GBD2015Pre/> 1–2% of adults (developed countries)<ref name="ESC2021"/><ref name=Lancet2005/>
| deaths = 35% risk of death in the first year<ref name=NICE2010chp1/>
| complications = [[Cardiac arrest]]
}}
'''Heart failure''' ('''HF'''), also known as '''congestive heart failure''' ('''CHF'''), is a [[syndrome]] caused by an impairment in the [[heart]]'s ability to [[Cardiac cycle|fill with and pump]] [[blood]].

Although symptoms vary based on which side of the heart is affected, HF typically presents with [[shortness of breath]], [[Fatigue (medical)|excessive fatigue]], and bilateral [[peripheral edema|leg swelling]].<ref name="NICE2018ch2">{{Cite book |last=National Guideline Centre (UK) |url=http://www.ncbi.nlm.nih.gov/books/NBK536089/ |title=Chronic Heart Failure in Adults: Diagnosis and Management |chapter=2. Introduction |date=September 2018 |publisher=National Institute for Health and Care Excellence (NICE) |isbn=978-1-4731-3093-7 |series=National Institute for Health and Care Excellence: Guidelines |location=London |pmid=30645061 |access-date=11 February 2023 |archive-date=20 March 2023 |archive-url=https://web.archive.org/web/20230320160417/http://www.ncbi.nlm.nih.gov/books/NBK536089/ |url-status=live }}</ref> The severity of the heart failure is mainly decided based on [[ejection fraction]] and also measured by the severity of symptoms.<ref name="NICE2010chp4" /> Other conditions that have symptoms similar to heart failure include [[obesity]], [[kidney failure]], [[liver disease]], [[anemia]], and [[thyroid disease]].<ref name="NICE2010chp4">{{cite book | title = Chronic Heart Failure: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care: Partial Update |publisher=National Clinical Guideline Centre | pages = 38–70 | date = Aug 2010 | pmid = 22741186 |author1=<!-- --> }}</ref>

Common causes of heart failure include [[coronary artery disease]], [[heart attack]], [[hypertension|high blood pressure]], [[atrial fibrillation]], [[valvular heart disease]], [[alcohol use disorder|excessive alcohol consumption]], [[infection]], and [[cardiomyopathy]].<ref name="AHA2022"/><ref name="ESC2021"/> These cause heart failure by altering the structure or the function of the heart or in some cases both.<ref name="ESC2021"/> There are different types of heart failure: [[right-sided heart failure]], which affects the [[right heart]], [[left-sided heart failure]], which affects the [[left heart]], and biventricular heart failure, which affects both sides of the heart.<ref name="HeartOrg">{{cite web |title=What is Heart Failure? |url=https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure |website=www.heart.org |access-date=11 August 2022 |language=en |archive-date=10 August 2022 |archive-url=https://web.archive.org/web/20220810060401/https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure |url-status=live }}</ref> Left-sided heart failure may be present with a reduced [[ejection fraction]] or with a [[heart failure with preserved ejection fraction|preserved ejection fraction]].<ref name=NICE2010chp1/> Heart failure is not the same as [[cardiac arrest]], in which blood flow stops completely due to the failure of the heart to pump.<ref>{{cite book|title=Willard & Spackman's occupational therapy.|date=2014|publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-1-4511-1080-7|page=1124|url=https://books.google.com/books?id=zLh3h6v5O_0C&pg=PA1124 }}</ref><ref>{{cite book|title=The Cardiac Care Unit Survival Guide|date=2012|publisher=Lippincott Williams & Wilkins|isbn=978-1-4511-7746-6|page=98|url=https://books.google.com/books?id=ZvkUJZCoi2EC&pg=PA98 }}</ref>

Diagnosis is based on symptoms, physical findings, and [[echocardiography]].<ref name="ESC2021"/> [[Blood test]]s, and a [[chest radiography|chest x-ray]] may be useful to determine the underlying cause.<ref name="NICE2018ch1">{{Cite book |last=National Guideline Centre (UK) |url=http://www.ncbi.nlm.nih.gov/books/NBK536098/ |title=Chronic Heart Failure in Adults: Diagnosis and Management |chapter=1. Guideline summary |date=September 2018 |publisher=National Institute for Health and Care Excellence (NICE) |isbn=978-1-4731-3093-7 |series=National Institute for Health and Care Excellence: Guidelines |location=London |pmid=30645061 |access-date=11 February 2023 |archive-date=20 March 2023 |archive-url=https://web.archive.org/web/20230320152908/http://www.ncbi.nlm.nih.gov/books/NBK536098/ |url-status=live }}</ref> Treatment depends on severity and case.<ref name=NICE2010chp3/> For people with chronic, stable, or mild heart failure, treatment usually consists of lifestyle changes, such as [[smoking cessation|not smoking]], [[physical exercise]], and dietary changes, as well as medications.<ref name="NICE2018ch6">{{Cite book |last=National Guideline Centre (UK) |url=http://www.ncbi.nlm.nih.gov/books/NBK536070/ |title=Chronic Heart Failure in Adults: Diagnosis and Management |chapter=6. Treating heart failure |date=September 2018 |publisher=National Institute for Health and Care Excellence (NICE) |isbn=978-1-4731-3093-7 |series=National Institute for Health and Care Excellence: Guidelines |location=London |pmid=30645061 |access-date=12 February 2023 |archive-date=19 March 2023 |archive-url=https://web.archive.org/web/20230319162359/http://www.ncbi.nlm.nih.gov/books/NBK536070/ |url-status=live }}</ref><ref name="NICE2018ch7">{{Cite book |last=National Guideline Centre (UK) |url=http://www.ncbi.nlm.nih.gov/books/NBK536079/ |title=Chronic Heart Failure in Adults: Diagnosis and Management |chapter=7. Rehabilitation in chronic heart failure |date=September 2018 |publisher=National Institute for Health and Care Excellence (NICE) |isbn=978-1-4731-3093-7 |series=National Institute for Health and Care Excellence: Guidelines |location=London |pmid=30645061 |access-date=12 February 2023 |archive-date=21 March 2023 |archive-url=https://web.archive.org/web/20230321013541/http://www.ncbi.nlm.nih.gov/books/NBK536079/ |url-status=live }}</ref><ref name=":0">{{cite journal | vauthors = Molloy C, Long L, Mordi IR, Bridges C, Sagar VA, Davies EJ, Coats AJ, Dalal H, Rees K, Singh SJ, Taylor RS | title = Exercise-based cardiac rehabilitation for adults with heart failure | journal = The Cochrane Database of Systematic Reviews | volume = 2024 | issue = 3 | pages = CD003331 | date = March 2024 | pmid = 38451843 | pmc = 10919451 | doi = 10.1002/14651858.CD003331.pub6 }}</ref> In heart failure due to left ventricular dysfunction, [[angiotensin-converting-enzyme inhibitor]]s, [[angiotensin II receptor blocker]]s (ARBs), or [[sacubitril/valsartan|angiotensin receptor-neprilysin inhibitors]], along with [[beta blockers]], [[mineralocorticoid receptor antagonist]]s and [[SGLT2 inhibitor]]s are recommended.<ref name="ESC2021"/> [[Diuretics]] may also be prescribed to prevent fluid retention and the resulting shortness of breath.<ref name=NICE2010chp5/> Depending on the case, an implanted device such as a [[Artificial cardiac pacemaker|pacemaker]] or [[implantable cardiac defibrillator]] <!-- (ICD) --> may sometimes be recommended.<ref name=NICE2010chp3>{{cite book | title = Chronic Heart Failure: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care: Partial Update |publisher=National Clinical Guideline Centre | pages = 34–47 | date = Aug 2010 | pmid = 22741186 |author1=<!-- --> }}</ref> In some moderate or more severe cases, [[cardiac resynchronization therapy]] (CRT)<ref name="Guidelines rhythm-abnormalities">{{cite journal | vauthors = Tracy CM, Epstein AE, Darbar D, DiMarco JP, Dunbar SB, Estes NA, Ferguson TB, Hammill SC, Karasik PE, Link MS, Marine JE, Schoenfeld MH, Shanker AJ, Silka MJ, Stevenson LW, Stevenson WG, Varosy PD, Ellenbogen KA, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hayes DL, Page RL, Stevenson LW, Sweeney MO | title = 2012 ACCF/AHA/HRS focused update of the 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. [corrected] | journal = Circulation | volume = 126 | issue = 14 | pages = 1784–800 | date = October 2012 | pmid = 22965336 | doi = 10.1161/CIR.0b013e3182618569 | doi-access = free }}</ref> or [[cardiac contractility modulation]] may be beneficial.<ref name="Kuck 2013">{{cite journal | vauthors = Kuck KH, Bordachar P, Borggrefe M, Boriani G, Burri H, Leyva F, Schauerte P, Theuns D, Thibault B, Kirchhof P, Hasenfuss G, Dickstein K, Leclercq C, Linde C, Tavazzi L, Ruschitzka F | title = New devices in heart failure: a European Heart Rhythm Association report: developed by the European Heart Rhythm Association; endorsed by the Heart Failure Association | journal = Europace | volume = 16 | issue = 1 | pages = 109–28 | date = January 2014 | pmid = 24265466 | doi = 10.1093/europace/eut311 | doi-access = free }}</ref> In severe disease that persists despite all other measures, a cardiac assist device [[ventricular assist device]], or, occasionally, [[heart transplantation]] may be recommended.<ref name=NICE2010chp5>{{cite book | title = Chronic Heart Failure: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care: Partial Update |publisher=National Clinical Guideline Centre | pages = 71–153 | date = Aug 2010 | pmid = 22741186 |author1=<!-- --> }}</ref>

Heart failure is a common, costly, and potentially fatal condition,<ref name="Lancet2017"/> and is the leading cause of hospitalization and readmission in older adults.<ref>{{cite journal | vauthors = Retrum JH, Boggs J, Hersh A, Wright L, Main DS, Magid DJ, Allen LA | title = Patient-identified factors related to heart failure readmissions | journal = Circulation: Cardiovascular Quality and Outcomes | volume = 6 | issue = 2 | pages = 171–177 | date = March 2013 | pmid = 23386663 | pmc = 4082819 | doi = 10.1161/CIRCOUTCOMES.112.967356 }}</ref><ref>{{cite journal | vauthors = Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Makuc DM, Marcus GM, Marelli A, Matchar DB, Moy CS, Mozaffarian D, Mussolino ME, Nichol G, Paynter NP, Soliman EZ, Sorlie PD, Sotoodehnia N, Turan TN, Virani SS, Wong ND, Woo D, Turner MB | title = Heart disease and stroke statistics--2012 update: a report from the American Heart Association | journal = Circulation | volume = 125 | issue = 1 | pages = e2–e220 | date = January 2012 | pmid = 22179539 | pmc = 4440543 | doi = 10.1161/cir.0b013e31823ac046 }}</ref> Heart failure often leads to more drastic health impairments than the failure of other, similarly complex [[organs]] such as the kidneys or liver.<ref>{{Cite web |date=2010-03-16 |title=Do we expect the body to be a "One Hoss Shay"? |url=https://evmedreview.com/do-we-expect-the-body-to-be-a-one-hoss-shay/ |access-date=2022-04-28 |website=The Evolution and Medicine Review |language=en-US |archive-date=4 July 2022 |archive-url=https://web.archive.org/web/20220704213458/https://evmedreview.com/do-we-expect-the-body-to-be-a-one-hoss-shay/ |url-status=live }}</ref> In 2015, it affected about 40 million people worldwide.<ref name=GBD2015Pre>{{cite journal | vauthors = ((GBD 2015 Disease and Injury Incidence and Prevalence Collaborators)) | title = Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1545–1602 | date = October 2016 | pmid = 27733282 | pmc = 5055577 | doi = 10.1016/S0140-6736(16)31678-6 }}</ref> Overall, heart failure affects about 2% of adults,<ref name=Lancet2017>{{cite journal | vauthors = Metra M, Teerlink JR | title = Heart failure | journal = Lancet | volume = 390 | issue = 10106 | pages = 1981–1995 | date = October 2017 | pmid = 28460827 | doi = 10.1016/S0140-6736(17)31071-1 | s2cid = 34893221 }}</ref> and more than 10% of those over the age of 70.<ref name="ESC2021"/> Rates are predicted to increase.<ref name=Lancet2017/>

The risk of [[death]] in the first year after diagnosis is about 35%, while the risk of death in the second year is less than 10% in those still alive.<ref name=NICE2010chp1/> The risk of death is comparable to that of some cancers.<ref name=NICE2010chp1/> In the United Kingdom, the disease is the reason for 5% of emergency hospital admissions.<ref name=NICE2010chp1>{{cite book |title=Chronic heart failure: National clinical guideline for diagnosis and management in primary and secondary care: Partial update |publisher=National Clinical Guideline Centre |pages=19–24 |date=August 2010 |pmid=22741186 |author=National Clinical Guideline Centre (UK)}}</ref> Heart failure has been known since ancient times in [[Ancient Egypt|Egypt]]; it is mentioned in the [[Ebers Papyrus]] around 1550 BCE.<ref name=McD2011>{{cite book |vauthors=McDonagh TA |title=Oxford textbook of heart failure |date=2011 |publisher=Oxford University Press |location=Oxford |isbn=978-0-19-957772-9 |page=3 |url=https://books.google.com/books?id=r8wowXxC1voC&pg=PP1 |access-date=27 December 2021 |archive-date=9 August 2023 |archive-url=https://web.archive.org/web/20230809061722/https://books.google.com/books?id=r8wowXxC1voC&pg=PP1 |url-status=live }}</ref>
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