Heart failure is a constellation of signs and symptoms originating from structural and functional abnormalities of the heart. It leads to a generalized maladaptive chronic inflammatory stress reaction in the body. It can be caused by common conditions such as high blood pressure, athero-arteriolosclerosis or exogenous factors such as viruses, alcohol, toxins. The manifestations of heart failure are either due to low blood flow or blood stasis in organs, secondary to deranged circulation. Because every organ is connected to heart via blood vessels, it is not uncommon for first signs of heart failure to show themselves in other organs such as lungs, liver, gastrointestinal tract and kidney. Therefore, at the end heart failure is the failure of whole body.

Depending on what stage it is, HF is treated by drugs, devices and transplantation from a living donor. Although dietary discretion and hygienic lifestyle is essential; dietary supplements, exercise, herbal therapies, alternative medicine have very limited role in HF management. Application of any therapy(s) requires methodical, algorithmic and multidisciplinary approach. Many recent advances in treatments prolonging lives have posed challenges to healthcare providers to stay abreast, especially in advanced heart failure field.

The heart itself can be imaged easily and its electrical, mechanical functions can be measured readily. HF However, is a syndrome involving the whole body. At any given stage different organs can be affected to different degrees variably.

This complex interaction can create a diagnostic dilemma. Health care providers should have analytic capability beyond routine clinical observations, measurements to determine the contribution of HF to any organ malfunction at a given time and vice versa. Therefore practically useful diagnosis of heart failure requires staging severity, determining cause, duration and attributes to the other organs.

Misdiagnosis or misallocation of Heart Failure happens more often than realized.

It also may lead to multiple organ disease, usually progressive. The end result may be death, more commonly prolonged hospitalizations, and poor quality of life, the later ones significantly contributing to rising global health care cost.

Cumulative effects on individual and society are immense for the fact that HF is the most chronic, recurring, progressive, debilitating disorder. The cost increases exponentially as the disease advances. In the current bundled, per-performance payment atmosphere, institutes will need to take drastic measures to enhance their performances in managing chronic diseases. All too often the missing link is practicing guidelines, evidence based medicine routinely within the current bureaucratic environment with its burden on providers.

HEART FAILURE FACTS, PROBLEMS INSTITUTES ARE TO FACE UNIQUE TO HEART FAILURE

Stage A – Carrying risk factors such as; hypertension, diabetes, dyslipidemia.
Stage B and C – Structural and clinical heart disease, yet potentially reversible.
Stage D – Refractory heart failure requiring advanced therapies such as assist devices, transplant or if appropriate hospice care.

Most recurrent hospitalizations are for late stage C and D heart failure, a population representing the tip of the iceberg. Within current institute-physician integration trends; efficacious, guidelines based management of heart failure from A to C will be a mandatory task for survival. Furthermore, timely recognition and referral of late stage C and D heart failure, almost always a multiorgan disease, to experienced centers will not only save cost but will improve the standing of any institute.