Cardiovascular Atlas
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Living with a new heart-failure diagnosis

A suggested order for reading this atlas, for an adult who has just been told they have heart failure, and for their family. It starts with what heart failure is and how doctors sort it into types, goes through the tests, then the medicines and the trials behind them, an implanted pressure sensor, and the gap between trial doses and everyday prescribing. It is not medical advice, it covers adults only, and it does not yet include rehabilitation pages.

  • Reading path
  • In this atlas

Overview

Technical summary

Ten steps. Each step explanation restates what the linked page's own records say and adds no claim of its own. Rehabilitation and the wider care pathway are not in this cluster, so the path stops at questions to take to a care team. A companion path for readers who also have high blood pressure is linked.

Who this is for

Adults who have just been told they have heart failure, and their families. It does not cover children or pregnancy.

Reading order

  1. Heart failure

    Heart failure means the heart cannot pump enough blood for the body's needs. It does not mean the heart has stopped. A US government patient page says it has no cure and that treatment is usually lifelong, but that treatment can extend life, keep people more active and ease symptoms. At home it advises taking medicines as prescribed and watching for rising weight, swollen ankles or worsening breathlessness, which can be signs that fluid is collecting, and asking the care team how often to weigh.

  2. Left ventricular ejection fraction (LVEF)

    The ejection fraction is the share of blood that the left ventricle pushes out on each beat. A US government patient page puts 40% or less in the reduced type, 50% or more in the preserved type, and 41% to 49% in a possible borderline group. A scan such as an echocardiogram measures it.

  3. BNP and NT-proBNP blood tests

    BNP and NT-proBNP blood tests help confirm or rule out heart failure in people who have symptoms. MedlinePlus says normal results usually mean heart failure is unlikely and that higher results usually lead to other tests. Kidney failure can raise the levels and obesity can lower them.

  4. Heart failure with reduced ejection fraction (HFrEF)

    The reduced type is the one where the left side of the heart is weak. A US government patient page lists several medicine groups as commonly used for it. Three trials in this atlas enrolled people with an ejection fraction of 40% or less.

  5. Heart failure with mildly reduced or preserved ejection fraction

    The preserved or mildly reduced type is the one where the heart is stiff. A US government patient page named diuretics as the main treatment in 2022. Two trials in this atlas tested an SGLT2 inhibitor in people with an ejection fraction above 40%.

  6. SGLT2 inhibitors (drug class)

    Four trials compared dapagliflozin or empagliflozin with placebo in adults with heart failure. In each, the drug group had a lower rate of cardiovascular death or worsening heart failure. In the trial of dapagliflozin above 40%, cardiovascular death on its own did not show a clear difference. In the trial of empagliflozin above 40%, the effect was mainly due to fewer hospital admissions. Genital tract infections, and in one trial low blood pressure, were reported more often with empagliflozin.

  7. Sacubitril/valsartan (combination)

    In a trial of this combination medicine, it was compared with enalapril in people with an ejection fraction of 40% or less. The trial was stopped early for benefit. Low blood pressure and nonserious angioedema were more common with the combination. Everyone first took part in a run-in on both medicines and had to tolerate the doses, so people who could not were not randomized.

  8. Mineralocorticoid receptor antagonists (drug class)

    This class includes spironolactone. A US government patient page says these medicines clear excess salt and water, and lists kidney problems and a high blood potassium level among possible side effects.

  9. CardioMEMS HF System

    This is a small sensor placed in a lung artery that measures pressure and sends the readings wirelessly. In the trial of this sensor, care guided by the readings led to fewer hospital admissions for heart failure over 6 months, in people with NYHA class III heart failure and a past admission. Only patients were masked in the trial, and a correction to the paper exists that was not read.

  10. Many people with HFrEF do not receive all recommended medicines at target doses

    A US registry found that many people who could take each recommended medicine class were not prescribed it and few were at target doses. Questions you could take to your care team: Which of these medicine groups am I taking, and at what dose? Do I know my ejection fraction? How often should I check my weight, and when should I call? They are questions, not advice, and this atlas does not give the answers.

Record details

Record id
cardio:reading-path-heart-failure
Content hash
2196f7a29039a2e83f3fd82ec8bf67b2e7d610e98a48c920cec080bedf7e1d19