Management of chronic heart failure

Heart failure (HF) is a clinical syndrome characterized by reduced exercise tolerance, dyspnoea and peripheral oedema, which is confirmed with imaging evidence of ventricular dysfunction and, if available, cardiac biomarkers. HF is one of the major cardiovascular causes of morbidity and mortality worldwide. It has a prevalence of 1–2%, rising with age to >10% in those over 70 years old.

Pharmacological and device-based therapy for HF with reduced ejection fraction (HFrEF) has dramatically improved over the last 30 years, resulting in significantly better outcomes for patients, in terms of improvements in quality of life, and reduction in morbidity and mortality. However, some patients remain highly symptomatic despite these measures and for a select few, advanced therapies (e.g. mechanical circulatory support devices and cardiac transplantation) might be suitable. This article provides an overview of contemporary management of patients with HFrEF.