Heart Failure Types
| Type | Ejection Fraction | Mechanism | Key Drugs |
|---|---|---|---|
| HFrEF | <40% | Systolic dysfunction — heart can't squeeze | ACEi/ARB/sacubitril-valsartan; beta-blocker; MRA; SGLT2i |
| HFmrEF | 40–49% | Mildly reduced EF | Similar to HFrEF |
| HFpEF | ≥50% | Diastolic dysfunction — heart can't relax | SGLT2i; treat comorbidities; diuretics for symptoms |
The 4-Pillar Medical Therapy (HFrEF)
| Pillar | Drug Class | Example | Mortality Benefit |
|---|---|---|---|
| 1 | ACEi / ARB or sacubitril-valsartan (ARNI) | Sacubitril-valsartan (Entresto) | ~20–25% reduction |
| 2 | Beta-blocker (cardioselective) | Carvedilol, bisoprolol | ~35% reduction |
| 3 | Mineralocorticoid receptor antagonist (MRA) | Spironolactone, eplerenone | ~15–25% reduction |
| 4 | SGLT2 inhibitor | Empagliflozin, dapagliflozin | ~25% reduction in HF hospitalisation |
Weigh DailyDaily morning weight is the most sensitive early warning sign of fluid accumulation in heart failure. A gain of >2 kg in 3 days indicates fluid retention — contact your heart failure nurse or GP to adjust diuretics.
Acute DecompensationSudden worsening breathlessness, unable to lie flat, coughing pink frothy sputum — acute pulmonary oedema. Call 999/911 immediately. This is a medical emergency requiring IV diuretics and oxygen.
What is ejection fraction?
The percentage of blood the heart ejects with each beat. Normal is 55–70%. EF <40% indicates the heart is not pumping effectively (HFrEF). EF can be measured by echocardiogram, cardiac MRI, or nuclear scan.
What are NYHA functional classes?
Class I: no symptoms with normal activity. Class II: slight limitation — comfortable at rest. Class III: marked limitation — comfortable at rest only. Class IV: symptoms at rest — unable to carry out any activity without discomfort.
Can heart failure be cured?
In some cases: if caused by a reversible cause (e.g., viral myocarditis, thyroid disease, alcohol), recovery is possible. Most HFrEF is chronic but highly manageable. Advanced refractory failure may require mechanical assistance (LVAD) or heart transplant.
What is BNP used for in heart failure?
BNP/NT-proBNP is elevated in heart failure and correlates with severity. It's used to diagnose heart failure in patients with breathlessness, monitor response to treatment, and guide prognosis. Falling BNP with treatment indicates response.
Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.