What is heart failure?
Heart failure is a condition in which the heart cannot pump blood efficiently enough to meet the body's needs. It does not mean the heart has stopped — it means the heart is weakened or stiffened. Heart failure affects approximately 6.5 million Americans and is classified by ejection fraction: HFrEF (reduced EF, below 40%), HFmrEF (mildly reduced, 40-49%), and HFpEF (preserved EF, 50% or above). Symptoms include shortness of breath, fatigue, swelling in legs and ankles, and exercise intolerance.
The complete answer.
Heart failure treatment depends on the type and cause. Medical therapy is the foundation: ACE inhibitors/ARBs/ARNI, beta-blockers, mineralocorticoid receptor antagonists, and SGLT2 inhibitors (the "four pillars" of HFrEF therapy). Surgical options include coronary bypass (if ischemic cause), valve surgery (if valvular cause), LVAD (left ventricular assist device) as destination therapy or bridge to transplant, and heart transplantation. CRT (cardiac resynchronization therapy) benefits patients with wide QRS complex and reduced EF. The PARADIGM-HF trial established sacubitril/valsartan as superior to enalapril, and the DAPA-HF trial established dapagliflozin benefit across HFrEF patients.
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