Epidemiology

Approximately 900,000 people in the UK have heart failure; 5% of all adult emergency hospital admissions in the UK are caused or complicated by acute heart failure.[2][3] Outside of the UK, prevalence of heart disease is about 1.3% in China, 6.7% in Malaysia, 1% in Japan, 4.5% in Singapore, 0.12% to 0.44% in India, 1% in South America, and 1% to 2% in Australia.[4]

The National Heart Failure Audit 2018/2019, which included 89% of patients admitted to hospital with acute heart failure in England and Wales, showed a mean age of 78 years overall; this was slightly lower for men and higher for women. There were more men at all ages, apart from the ≥85 years group in which women were a majority.[5]

Risk factors

Coronary heart disease is the most common cause of heart failure.[9]

Prevalence of heart failure is ≥10% in people >70 years of age.[1]

In patients hospitalised for acute heart failure, around 75% have a history of prior heart failure.[10]

Related directly to ischaemia and renal failure.

A risk factor for acute heart failure.[9]

The association between alcohol intake and the risk of developing new-onset heart failure is U-shaped; the lowest risk is with modest alcohol consumption (up to 7 drinks/week).[1]

The epidemiological associations of smoking with the development of cardiovascular disease suggest that smoking cessation would be beneficial.[1]

Cardiac arrhythmias, including tachyarrhythmia and bradyarrhythmia, are risk factors for acute heart failure.

Conditions that are associated with heart failure include sarcoidosis and haemochromatosis.

A risk factor for heart failure.

Non-adherence to medication is a precipitating factor in patients with chronic heart failure. Drugs that may exacerbate heart failure include non-steroidal anti-inflammatory drugs, steroids, diltiazem, and verapamil.[9] 

Hypertension is associated with an increased risk of developing heart failure. Antihypertensive therapy markedly reduces the incidence of heart failure; however, alpha-adrenoceptor blockers are less effective than other antihypertensives in preventing heart failure.[1]

Both significant stenotic and regurgitate lesions can lead to heart failure.

Although rheumatic valvular disease is now rarely found in western countries, calcific valvular heart disease (in particular, aortic stenosis) is commonly encountered.

In patients with significant valvular disease, the heart failure will not improve until the underlying valvular disease has been corrected.

A large pericardial effusion can present with symptoms or signs of acute heart failure.

Pericardial constriction, such as tuberculosis pericarditis or the effects of radiotherapy, can also present with acute heart failure.

There are many causes of myocarditis, of which a viral aetiology appears to be the most common. There is usually a prodrome of a non-specific illness characterised by fatigue, mild dyspnoea, and myalgias.

Noted in 22% of people with heart failure.[11]

Can be caused by phaeochromocytoma or subarachnoid haemorrhage.[12]

Both hypothyroidism and thyrotoxicosis can be associated with heart failure.[13][14]

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