Heart Failure and Cardiomyopathy

Heart failure is a clinical syndrome in which the heart cannot pump or fill adequately to meet the body's metabolic demands, producing symptoms such as breathlessness, fatigue, and fluid retention. Cardiomyopathies are diseases of the heart muscle itself that are an important cause of heart failure. For nurses, the syndrome dominates much of cardiovascular care because it drives frequent hospital admissions and demands sustained monitoring, education, and self-management support.

Definition

Heart failure (MeSH descriptor Heart Failure) is a syndrome of symptoms and signs caused by a structural or functional cardiac abnormality, commonly classified by left ventricular ejection fraction into reduced (HFrEF), mildly reduced (HFmrEF), and preserved (HFpEF) categories; cardiomyopathies are primary disorders of the myocardium that may underlie it.

Scope

This topic covers what heart failure and cardiomyopathy are, how they are classified, the mechanisms that produce symptoms, and the evidence base that guides their management. It frames the nursing relevance of monitoring, symptom recognition, and patient education in reference terms, without prescribing individualized assessments or treatments.

Core questions

• What distinguishes heart failure with reduced, mildly reduced, and preserved ejection fraction?
• How do cardiomyopathies relate to the heart failure syndrome?
• How do guideline frameworks shape monitoring, education, and self-management support?

Key concepts

• Ejection fraction classification (HFrEF, HFmrEF, HFpEF)
• Congestion and fluid overload
• Neurohormonal activation
• Natriuretic peptides as biomarkers
• Acute decompensation versus chronic stable disease
• Dilated, hypertrophic, and restrictive cardiomyopathy
• Self-management and symptom monitoring

Mechanisms

Heart failure arises when cardiac injury or overload reduces the heart's ability to eject blood (systolic dysfunction) or to fill at normal pressures (diastolic dysfunction). The resulting fall in cardiac output activates compensatory neurohormonal systems — the sympathetic nervous system and the renin-angiotensin-aldosterone axis — which initially preserve perfusion but over time promote fluid retention, vasoconstriction, and adverse remodelling of the ventricle. Cardiomyopathies contribute by directly altering the structure and function of the myocardium (Metra & Teerlink, 2017; Arbelo et al., 2023). Congestion produces the breathlessness and oedema that nurses commonly assess and monitor.

Clinical relevance

Heart failure is a major cause of hospital admission and readmission, and nursing roles in monitoring weight, symptoms, and fluid status, and in supporting self-management and adherence, are embedded in guideline care pathways. This entry describes the condition and the evidence framework around it for reference and education; it is not a substitute for individualized clinical assessment or management.

Epidemiology

Heart failure affects a large and growing population, with prevalence increasing in older age groups; it is associated with high rates of hospitalisation, reduced quality of life, and substantial mortality. The major guidelines describe it as one of the most common and costly cardiovascular syndromes (McDonagh et al., 2021; Heidenreich et al., 2022).

Evidence & guidelines

Contemporary management is defined by the 2021 ESC heart failure guidelines and the 2022 AHA/ACC/HFSA heart failure guideline, which set out classification by ejection fraction, diagnostic use of natriuretic peptides and imaging, and multidisciplinary management including nursing-led monitoring and education (McDonagh et al., 2021; Heidenreich et al., 2022). The 2023 ESC cardiomyopathy guidelines address the myocardial diseases that can underlie heart failure (Arbelo et al., 2023).

Seminal works

• mcdonagh-2021
• heidenreich-2022
• metra-2017

Frequently asked questions

How is heart failure classified?

It is commonly categorised by left ventricular ejection fraction into heart failure with reduced (HFrEF), mildly reduced (HFmrEF), and preserved (HFpEF) ejection fraction, a framework set out in current ESC and AHA/ACC/HFSA guidelines.

How are heart failure and cardiomyopathy related?

Cardiomyopathies are diseases of the heart muscle itself and are an important underlying cause of the heart failure syndrome, though heart failure can also result from coronary, valvular, hypertensive, and other conditions.