CHF

Congestive Heart Failure

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Congestive Heart Failure, CHF, Heart Failure, Dropsy

  • See Also
  1. Systolic Dysfunction
  2. Diastolic Dysfunction
  3. Heart Failure Causes
  4. Framingham Heart Failure Diagnostic Criteria
  5. Congestive Heart Failure Exacerbation Management
  6. Congestive Heart Failure Exacerbation Decision Rule
  7. Ottawa Heart Failure Risk Score
  • Epidemiology
  1. Lifetime risk: 20% in U.S.
  2. Prevalence: 5.2 Million with CHF in the United States
  3. Incidence: 400,000 cases CHF diagnosed per year
  4. Morbidity: 870,000 hospitalizations (estimates in 2013 approach 1 Million)
    1. Re-hospitalization rate within 30 days approaches 20%
  5. Mortality: 200,000 patients die from CHF per year
  6. CHF costs
    1. Accounts for 5-10% of all hospital admissions
    2. Annual U.S. Cost: $38.1 billion ($44.6 billion by 2015)
  • Pathophysiology
  1. Heart Failure is a syndrome, not a disease
    1. Heart Failure is a final common pathway
    2. Maximize treatment of the underlying causes
    3. Control the causes and prevent end organ damage
  • Precautions
  1. Heart Failure is a clinical diagnosis best made by an astute clinician with history and exam
  2. Labs (e.g. BNP) and diagnostics (e.g. Echocardiogram) should be adjunctive only to confirm and follow the diagnosis
  • Evaluation
  1. See Systolic Dysfunction
  2. See Diastolic Dysfunction
  3. See Framingham Heart Failure Diagnostic Criteria
  • Causes
  1. See Heart Failure Causes
  • Types
  1. Systolic Dysfunction (60-70% of Heart Failure cases)
    1. Decreased contractility
    2. Decreased Left Ventricular Ejection Fraction
  2. Diastolic Dysfunction (30-40% of Heart Failure cases)
    1. Decreased compliance
    2. Decreased filling
    3. Variable Left Ventricular Ejection Fraction
  • Labs
  1. See Systolic Heart Failure
  • Diagnostics
  1. See Chest XRay in Congestive Heart Failure
  2. See Echocardiogram in Congestive Heart Failure
    1. All CHF patients should undergo Echocardiogram
  • Classification
  • Congestive Heart Failure
  1. See NYHA Heart Failure Classification
  • Management
  1. See Systolic Dysfunction
  2. See Diastolic Dysfunction
  3. See Congestive Heart Failure Exacerbation Management
  4. See Congestive Heart Failure Exacerbation Decision Rule
  5. Exercise based Cardiac Rehabilitation benefits both HFrEF and HFpEF
    1. Decreases all cause hospital admission rates
    2. Improves short term quality of life
    3. Does NOT decrease short-term all cause mortality
    4. Dibben (2021) Cochrane Database Syst Rev 11(11):CD001800 +PMID: 34741536 [PubMed]
  • Resources
  1. American Heart Association CHF Website
    1. http://www.americanheart.org/chf
  • Associated Conditions
  1. Central Sleep Apnea (60% pretest probability)
  • References
  1. Hunt (2009) Circulation 119(14):e391-479 [PubMed]
  2. King (2012) Am Fam Physician 85(12): 1161-8 [PubMed]
  3. Hoyt (2001) Am Fam Physician 63(8):1593-8 [PubMed]
  4. Senni (1997) Mayo Clin Proc 72:453-60 [PubMed]
  5. (1995) Circulation 92:2764-84 [PubMed]
  6. (1999) J Card Fail 5:357-82 [PubMed]