Heart failure is classified as either:
1. Cardiac failure with Left Ventricular Systolic Dysfunction, (LVSD) (as seen on echocardiography)
Or
2. Diastolic heart failure (with echocardiographic evidence of an ejection fraction of greater than 40-50%) also known as heart failure with:
- Preserved ejection fraction or
- Preserved systolic function or
- Normal ejection fraction (‘HFNEF’)
Diastolic heart failure may occur in patients with hypertension, hypertrophic cardiomyopathy or aortic stenosis.
Cardiac failure can be described by stage according to the New York Heart Association (NYHA) classification:
NYHA Class |
Symptoms |
I. |
Cardiac disease not limiting physical activity; no symptoms with ordinary activity |
II. |
Symptom-free at rest; slight limitation of physical activity; symptoms with ordinary activity but resolve with rest |
III. |
Symptom-free at rest; ordinary activity markedly limited due to symptoms |
IV. |
Symptomatic at rest. Unable to carry out ordinary activity |
50% of patients with heart failure (all classes) die within 4 years and 50% of those with class IV heart failure die within 1 year.
Symptoms:
The physical and psychological symptom burden from heart failure in the dying phase is similar to that in the cancer patient in the dying phase.
Their frequency: Pain (78%), dyspnoea (61%), depression (59&), insomnia (45%), anorexia (43%), anxiety (30%), constipation (37%), nausea/vomiting (32%), fatigue (62-70%), difficulty ambulating, and oedema.