Mildly symptomatic heart failure with reduced ejection fraction: diagnostic and therapeutic considerations
Abstract Aims Whereas up to about half of patients with heart failure with reduced ejection fraction (HFrEF) report no or only mild symptoms and are considered as clinically stable, the progressive nature of HFrEF, often silent, renders clinical stability a misleading situation, especially if diseas...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-08-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.12701 |
| _version_ | 1818455282455412736 |
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| author | Alexandra Arvanitaki Eleni Michou Andreas Kalogeropoulos Haralambos Karvounis George Giannakoulas |
| author_facet | Alexandra Arvanitaki Eleni Michou Andreas Kalogeropoulos Haralambos Karvounis George Giannakoulas |
| author_sort | Alexandra Arvanitaki |
| collection | DOAJ |
| description | Abstract Aims Whereas up to about half of patients with heart failure with reduced ejection fraction (HFrEF) report no or only mild symptoms and are considered as clinically stable, the progressive nature of HFrEF, often silent, renders clinical stability a misleading situation, especially if disease progression is unrecognized. We highlight the challenges in the definition of clinical stability and mild symptomatic status in HFrEF, outline clinical characteristics and available diagnostic tools, and discuss evidence and gaps in the current guidelines for the management of these patients. Methods and Results This is a state‐of‐the‐art review that focuses on clinical, diagnostic, and therapeutic aspects in mildly symptomatic HFrEF patients; summarizes the challenges; and proposes directions for future research in this group of patients. The New York Heart Association classification has been widely used as a measure of prognosis in HFrEF, but it lacks objectivity and reproducibility in terms of symptoms assessment. The definition of clinical stability as described in current guidelines is vague and may often lead to underdiagnosis of disease progression in patients who appear to be ‘stable' but in fact are at an increased risk of clinical worsening, hospitalization, or death. Although an increasing number of clinical trials proved that the efficacy of HFrEF therapies was unrelated to the symptomatic status of patients and led to their implementation early in the course of the disease, clinical inertia in terms of under‐prescription or underdosing of guideline‐recommended medications in mildly symptomatic HFrEF patients is still a challenging issue to deal with. Conclusions Mildly symptomatic status in a patient with HFrEF is very frequent; it should not be ignored and should not be regarded as an index of disease stability. The application of risk scores designed to predict mortality and mode of death should be engaged among mildly symptomatic patients, not only to identify the most suitable HF candidates for cardioverter defibrillator implantation, but also to identify patients who might benefit from early intensification of medical treatment before the implementation of more interventional approaches. |
| first_indexed | 2024-12-14T22:08:18Z |
| format | Article |
| id | doaj.art-e2d2eea6aae24efdb36abc61a6b439e7 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-12-14T22:08:18Z |
| publishDate | 2020-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-e2d2eea6aae24efdb36abc61a6b439e72022-12-21T22:45:49ZengWileyESC Heart Failure2055-58222020-08-01741477148710.1002/ehf2.12701Mildly symptomatic heart failure with reduced ejection fraction: diagnostic and therapeutic considerationsAlexandra Arvanitaki0Eleni Michou1Andreas Kalogeropoulos2Haralambos Karvounis3George Giannakoulas41st Department of Cardiology, AHEPA University Hospital, School of Medicine Aristotle University of Thessaloniki Thessaloniki 54636 Greece1st Department of Cardiology, AHEPA University Hospital, School of Medicine Aristotle University of Thessaloniki Thessaloniki 54636 GreeceDivision of Cardiology, Department of Medicine Stony Brook University, Stony Brook University Medical Center, Health Sciences Center Stony Brook NY 11794‐8167 USA1st Department of Cardiology, AHEPA University Hospital, School of Medicine Aristotle University of Thessaloniki Thessaloniki 54636 Greece1st Department of Cardiology, AHEPA University Hospital, School of Medicine Aristotle University of Thessaloniki Thessaloniki 54636 GreeceAbstract Aims Whereas up to about half of patients with heart failure with reduced ejection fraction (HFrEF) report no or only mild symptoms and are considered as clinically stable, the progressive nature of HFrEF, often silent, renders clinical stability a misleading situation, especially if disease progression is unrecognized. We highlight the challenges in the definition of clinical stability and mild symptomatic status in HFrEF, outline clinical characteristics and available diagnostic tools, and discuss evidence and gaps in the current guidelines for the management of these patients. Methods and Results This is a state‐of‐the‐art review that focuses on clinical, diagnostic, and therapeutic aspects in mildly symptomatic HFrEF patients; summarizes the challenges; and proposes directions for future research in this group of patients. The New York Heart Association classification has been widely used as a measure of prognosis in HFrEF, but it lacks objectivity and reproducibility in terms of symptoms assessment. The definition of clinical stability as described in current guidelines is vague and may often lead to underdiagnosis of disease progression in patients who appear to be ‘stable' but in fact are at an increased risk of clinical worsening, hospitalization, or death. Although an increasing number of clinical trials proved that the efficacy of HFrEF therapies was unrelated to the symptomatic status of patients and led to their implementation early in the course of the disease, clinical inertia in terms of under‐prescription or underdosing of guideline‐recommended medications in mildly symptomatic HFrEF patients is still a challenging issue to deal with. Conclusions Mildly symptomatic status in a patient with HFrEF is very frequent; it should not be ignored and should not be regarded as an index of disease stability. The application of risk scores designed to predict mortality and mode of death should be engaged among mildly symptomatic patients, not only to identify the most suitable HF candidates for cardioverter defibrillator implantation, but also to identify patients who might benefit from early intensification of medical treatment before the implementation of more interventional approaches.https://doi.org/10.1002/ehf2.12701Heart failure with reduced ejection fractionMildly symptomatic statusClinical stability |
| spellingShingle | Alexandra Arvanitaki Eleni Michou Andreas Kalogeropoulos Haralambos Karvounis George Giannakoulas Mildly symptomatic heart failure with reduced ejection fraction: diagnostic and therapeutic considerations ESC Heart Failure Heart failure with reduced ejection fraction Mildly symptomatic status Clinical stability |
| title | Mildly symptomatic heart failure with reduced ejection fraction: diagnostic and therapeutic considerations |
| title_full | Mildly symptomatic heart failure with reduced ejection fraction: diagnostic and therapeutic considerations |
| title_fullStr | Mildly symptomatic heart failure with reduced ejection fraction: diagnostic and therapeutic considerations |
| title_full_unstemmed | Mildly symptomatic heart failure with reduced ejection fraction: diagnostic and therapeutic considerations |
| title_short | Mildly symptomatic heart failure with reduced ejection fraction: diagnostic and therapeutic considerations |
| title_sort | mildly symptomatic heart failure with reduced ejection fraction diagnostic and therapeutic considerations |
| topic | Heart failure with reduced ejection fraction Mildly symptomatic status Clinical stability |
| url | https://doi.org/10.1002/ehf2.12701 |
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