Heart failure
Heart failure means the heart cannot pump enough blood to meet the body's needs. It does not mean the heart has stopped. It can come on suddenly or build up over time, and most often another condition has damaged the heart. NHLBI says it has no cure, but that treatment can extend life, keep people more active and ease symptoms. This page links to the two main types, which are sorted by how much blood the left ventricle pumps out with each beat, and to the tests, medicines, devices and trials in this atlas.
Also called Congestive heart failure · Cardiac failure · CHF
- Condition
- In this atlas
Overview
Technical summary
Parent page for the heart-failure types in this atlas: heart failure with reduced ejection fraction, and heart failure with mildly reduced or preserved ejection fraction. Definition, causes, diagnosis, treatment and self-care come from NHLBI heart failure pages last updated on 2022-03-24 and from a MedlinePlus health topic. The NHLBI treatment page, dated 2022, says the use of SGLT2 inhibitors in heart failure was still being studied; the four SGLT2 inhibitor trials are shown separately in this atlas. NHLBI and the trials use different ejection fraction cut-offs (see the ejection fraction page). The MeSH heading D006333 is an exact match.
Recognition
NHLBI says there may be no symptoms at first. Later, people may notice tiredness, breathlessness and fluid build-up in the lower body, the abdomen or the neck.
Assessment
NHLBI says the diagnosis draws on the person's own and family medical history, an examination, and the results of imaging and blood tests. Blood tests can include BNP, and an echocardiogram or other imaging measures the ejection fraction.
Burden
The NHLBI heart failure page puts the number of US adults living with heart failure at over 6 million, a figure it credits to the CDC.
Applies to Adult- Adults. NHLBI says this health topic is about adult heart failure and that children can be affected too.
- Not applicable (a description of the condition and its care).
- United States (the prevalence figure is for US adults; the page names no other country).
- Adults.
- Certainty method
- Not assessed
- Limitations
- A figure quoted on a government health page, not read at its CDC source (CDC pages return an error to scripts). The page gives no year for the figure or the method. The NHLBI page was last updated on March 24, 2022, so the count may be out of date.
- Last checked
- 2026-10-14
- Next evidence check due
- Not scheduled
Sources and citations (2)
-
Supports NHLBI: Heart Failure: What Is Heart Failure?
- Locator
- What Is Heart Failure, paragraph 2
- How it applies
- The prevalence figure, which NHLBI attributes to the CDC. NHLBI page last updated March 24, 2022 according to the page; cite only, so this atlas restates it in its own words.
- Retrieved
- Source effective date
- 2022-03-24
- Source state
- Current
- Snapshot hash
4e59e74eba4d438ff7f30fa018e8b0a1804ed03c12023b22684a4b78ac146557- Reuse basis
- NHLBI web page. The page states no reuse terms, and the NHLBI Website, Privacy, and Accessibility page (fetched as ce-nhlbi-website-privacy-accessibility.html, sha256 4a2dc26d04f8c22437502b5215031c1fb652759638b50552690d8b1383dd723c) does not either. The NIH web policies page returned HTTP 403 (ce-nih-web-policies.html) and was not worked around. Reuse terms are therefore unverified, and this atlas treats the page as cite only: the facts are stated in its own words with the citation and link. Only the hash is kept.
-
Background NHLBI: Heart Failure: What Is Heart Failure?
- Locator
- What Is Heart Failure, paragraph 2, last sentence
- How it applies
- The page focuses on adults.
- Retrieved
- Source effective date
- 2022-03-24
- Source state
- Current
- Snapshot hash
4e59e74eba4d438ff7f30fa018e8b0a1804ed03c12023b22684a4b78ac146557- Reuse basis
- NHLBI web page. The page states no reuse terms, and the NHLBI Website, Privacy, and Accessibility page (fetched as ce-nhlbi-website-privacy-accessibility.html, sha256 4a2dc26d04f8c22437502b5215031c1fb652759638b50552690d8b1383dd723c) does not either. The NIH web policies page returned HTTP 403 (ce-nih-web-policies.html) and was not worked around. Reuse terms are therefore unverified, and this atlas treats the page as cite only: the facts are stated in its own words with the citation and link. Only the hash is kept.
Claims and evidence
Context Adults with heart failure, as described by NHLBI (heart failure health topic)
- Recipient
- Adult
- Population
- Adults. NHLBI says this health topic is about adult heart failure and that children can be affected too.
- Care setting
- Not applicable (a description of the condition and its care).
- Geography
- United States (the prevalence figure is for US adults; the page names no other country).
- Life stage
- Adults.
- Follow-up
- Not applicable.
Eligibility: 1 inclusion criterion; exclusion criteria not stated
- Included
- Adults with heart failure
- Excluded
- None stated
NHLBI says treatment for heart failure is usually lifelong, and that the condition often worsens over time even when it is treated. For care at home, it advises taking medicines as prescribed and reporting side effects, and being alert to rising weight, swollen ankles or worsening breathlessness, which can be signs that fluid is collecting. It advises asking the provider how often to weigh and when to report changes.
Applies to Adult- Adults. NHLBI says this health topic is about adult heart failure and that children can be affected too.
- Not applicable (a description of the condition and its care).
- United States (the prevalence figure is for US adults; the page names no other country).
- Adults.
- Certainty method
- Not assessed
- Limitations
- General patient information from a government health page that was last updated on March 24, 2022. It is not an individual care plan, and it states no numbers or thresholds for weight change. The page is cite only, so no wording is quoted here.
- Last checked
- 2026-10-14
- Next evidence check due
- Not scheduled
Sources and citations (3)
-
Supports NHLBI: Heart Failure: Living With Heart Failure
- Locator
- Living With Heart Failure, opening paragraph
- How it applies
- Lifelong treatment plan, and that heart failure often worsens. NHLBI page last updated March 24, 2022 according to the page; cite only, so this atlas restates it in its own words.
- Retrieved
- Source effective date
- 2022-03-24
- Source state
- Current
- Snapshot hash
651571275085363a83dc08dad88362ab1b6a2fbfa8ec038ded61f961a5fb8c0c- Reuse basis
- NHLBI web page. The page states no reuse terms, and the NHLBI Website, Privacy, and Accessibility page (fetched as ce-nhlbi-website-privacy-accessibility.html, sha256 4a2dc26d04f8c22437502b5215031c1fb652759638b50552690d8b1383dd723c) does not either. The NIH web policies page returned HTTP 403 (ce-nih-web-policies.html) and was not worked around. Reuse terms are therefore unverified, and this atlas treats the page as cite only: the facts are stated in its own words with the citation and link. Only the hash is kept.
-
Supports NHLBI: Heart Failure: Living With Heart Failure
- Locator
- Home care section, medicines
- How it applies
- Take medicines as prescribed and report side effects. NHLBI page last updated March 24, 2022 according to the page; cite only, so this atlas restates it in its own words.
- Retrieved
- Source effective date
- 2022-03-24
- Source state
- Current
- Snapshot hash
651571275085363a83dc08dad88362ab1b6a2fbfa8ec038ded61f961a5fb8c0c- Reuse basis
- NHLBI web page. The page states no reuse terms, and the NHLBI Website, Privacy, and Accessibility page (fetched as ce-nhlbi-website-privacy-accessibility.html, sha256 4a2dc26d04f8c22437502b5215031c1fb652759638b50552690d8b1383dd723c) does not either. The NIH web policies page returned HTTP 403 (ce-nih-web-policies.html) and was not worked around. Reuse terms are therefore unverified, and this atlas treats the page as cite only: the facts are stated in its own words with the citation and link. Only the hash is kept.
-
Supports NHLBI: Heart Failure: Living With Heart Failure
- Locator
- Know when to seek help
- How it applies
- Warning signs of fluid build-up and weight checks. NHLBI page last updated March 24, 2022 according to the page; cite only, so this atlas restates it in its own words.
- Retrieved
- Source effective date
- 2022-03-24
- Source state
- Current
- Snapshot hash
651571275085363a83dc08dad88362ab1b6a2fbfa8ec038ded61f961a5fb8c0c- Reuse basis
- NHLBI web page. The page states no reuse terms, and the NHLBI Website, Privacy, and Accessibility page (fetched as ce-nhlbi-website-privacy-accessibility.html, sha256 4a2dc26d04f8c22437502b5215031c1fb652759638b50552690d8b1383dd723c) does not either. The NIH web policies page returned HTTP 403 (ce-nih-web-policies.html) and was not worked around. Reuse terms are therefore unverified, and this atlas treats the page as cite only: the facts are stated in its own words with the citation and link. Only the hash is kept.
Clinical links
Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.
-
Claim, not a settled fact Evaluated for this: BNP and NT-proBNP blood tests
Applies to Recipient not specified- People who have symptoms that could mean heart failure, such as shortness of breath, swelling in the abdomen, feet, legs or neck veins, fatigue or weakness, coughing, inability to sleep lying flat, a need to urinate a lot at night, or loss of appetite and nausea. The page also describes uses in people already diagnosed with heart failure and, in certain cases, in people who have had a heart attack or have unstable angina.
- Outpatient or hospital blood test (venous blood; a fingerstick may be used in hospital).
- Not stated. MedlinePlus is a US government site but the page does not name a country.
- Not stated. The page does not restrict the test by age, and says that what a level means depends on age and sex.
- Gestational age Not reported
- Postnatal age Not reported
MedlinePlus says that natriuretic peptide tests (BNP and NT-proBNP) measure proteins the heart and blood vessels make, and are mainly used to help confirm or rule out heart failure in people who have symptoms. It says normal results usually mean a person is unlikely to have heart failure, that higher than normal levels mean a person could have heart failure, and that the provider will probably order other heart health tests to make a final diagnosis. It adds that a result alone cannot diagnose the cause of symptoms, that other conditions such as kidney failure can also raise levels, and that obesity can make levels lower than they really are.Limitations. General patient information from a government health page, not a diagnostic rule. The page gives no cut-off values, no sensitivity or specificity, and no study data, and says that what a result means depends on age, sex and other test results. This claim is descriptive and not a finding from a trial.
-
Claim, not a settled fact Evaluated for this: SGLT2 inhibitors (drug class)
Applies to Adult- Adults with chronic heart failure in four separate trials: DAPA-HF and EMPEROR-Reduced (ejection fraction of 40% or less) and EMPEROR-Preserved and DELIVER (ejection fraction of more than 40%). Each trial added the SGLT2 inhibitor or placebo to recommended or usual therapy. The abstracts say findings were similar or consistent in people with and without diabetes. This context joins four trials for comparison and is not a pooled analysis.
- Not stated in the abstract. The registry record is not read for setting.
- Multinational trials.
- Adults.
In four separate placebo-controlled trials in adults with chronic heart failure, the primary outcome was lower with an SGLT2 inhibitor than with placebo. The primary outcome was a composite of cardiovascular death and worsening heart failure, defined slightly differently in each trial. The hazard ratios (95% confidence intervals) were: DAPA-HF, dapagliflozin, ejection fraction 40% or less, 0.74 (0.65 to 0.85); EMPEROR-Reduced, empagliflozin, 40% or less, 0.75 (0.65 to 0.86); EMPEROR-Preserved, empagliflozin, above 40%, 0.79 (0.69 to 0.90); DELIVER, dapagliflozin, above 40%, 0.82 (0.73 to 0.92). The abstracts report the benefit or its consistency in people with and without diabetes. In DELIVER, cardiovascular death on its own had a hazard ratio of 0.88 (0.74 to 1.05), and in EMPEROR-Preserved the effect was mainly related to fewer hospitalizations for heart failure. This lists four trial results side by side. It is not a pooled analysis.Limitations. The hazard ratios are the trials' own and were not pooled or re-analysed. The trials differ in entry criteria, in the drug, in the definition of the primary outcome and in follow-up. All four were funded by the drug makers. Numbers come from the PubMed abstracts; full texts were not read. Harms differ by trial and are given on the trial claims (genital and urinary tract infections and low blood pressure with empagliflozin in EMPEROR-Preserved; genital tract infection with empagliflozin in EMPEROR-Reduced). No certainty rating was assessed.
-
Claim, not a settled fact Evaluated for this: CardioMEMS HF System
Applies to Adult- Patients with New York Heart Association class III heart failure, irrespective of ejection fraction, and a previous hospital admission for heart failure. The registry gives a minimum age of 18 years.
- Enrolled at 64 centres in the USA (abstract). The abstract does not say whether they were hospitals or outpatient clinics.
- United States (abstract and registry).
- Adults, 18 years and over (registry minimum age). The abstract gives no mean age.
In CHAMPION, people with New York Heart Association class III heart failure, irrespective of ejection fraction, and a previous hospital admission for heart failure were randomly assigned to management with a wireless implantable haemodynamic monitoring system (treatment group) or to a control group, for at least 6 months. In the treatment group, clinicians used daily pulmonary artery pressure readings in addition to standard care; the control group had standard care alone. Only patients were masked to their group. At 6 months there were 83 heart-failure-related hospitalisations in the treatment group (270 people) and 120 in the control group (280 people), a rate of 0.31 against 0.44 (hazard ratio 0.70, 95% CI 0.60 to 0.84). Over the whole follow-up, with a mean of 15 months, there were 153 such hospitalisations in the treatment group against 253 in the control group (hazard ratio 0.64, 95% CI 0.55 to 0.75). Eight patients had a device-related or system-related complication; freedom from these was 98.6% (95% CI 97.3 to 99.4) against a prespecified criterion of 80%, and freedom from pressure-sensor failure was 100% (99.3 to 100.0).Source problem. A cited source is corrected. Check the sources before relying on this claim.
Limitations. One single-blind trial: only patients were masked, so clinicians were not. The comparison counts hospitalisations as events, not people. The abstract names CardioMEMS as the funder, and the device studied is the CardioMEMS system. PubMed links an erratum to the paper (Lancet 2012;379:412), and Crossref lists an erratum with DOI 10.1016/s0140-6736(12)60193-7 dated 2012-02-04. The erratum text could not be read, so it is unknown whether it changes any figure here. The numbers come from the PubMed abstract; the full text and registry results were not read. The abstract gives no result on deaths. No certainty rating was assessed.
Record details
- Record id
cardio:heart-failure- Content hash
65a002ba4aea9ee05865fb9498a500bdd763a6a08e65e3b22db18dc965ea2b34