Heart failure

Heart failure in brief

Heart failure is a chronic and progressive disease which can be attributed to a structural and/or functional abnormality of the heart that results in inadequate cardiac output at rest and/or during exercise.¹ More than 64 million people worldwide are affected by heart failure.²

Despite considerable improvements in treatment, morbidity and mortality remain high: around 15% of patients die within a year, and around 50% within 5 years of diagnosis.³ This means that the survival rate is worse than for some of the most common cancers.⁴

In Switzerland, around 200,000 people suffer from heart failure, with around 5,000 to 10,000 new cases occurring every year.⁵ The risk of heart failure increases with age and the prevalence in elderly people (≥85 years) is up to 21%.⁶

The most common causes in Europe, responsible for the development of heart failure in around 70-90% of cases, are coronary heart disease and arterial hypertension.⁷

Many heart failure patients suffer from concomitant diseases that have a negative impact on their prognosis:^8-10

More than 40% of heart failure patients have chronic kidney disease⁸
Around 30% of heart failure patients also suffer from type 2 diabetes⁹

Incidence

In Switzerland, 200,000 people suffer from heart failure⁵

Mortality

The 5-year mortality rate is 50%³

Life-threatening

Heart failure is just as life-threatening as some of the most common cancers⁴

Graphic Image Representing Heart Failure Symptoms

Symptoms of heart failure

The cardinal symptoms of heart failure are shortness of breath, ankle oedema, fatigue and reduced physical resilience. In addition, other signs may occur, e.g. increased jugular venous pressure, pulmonary crackles and peripheral oedema.¹ Less typical symptoms also include nocturnal coughing, loss of appetite, confusion, depression, dizziness and fainting.¹

Diagnosis

The diagnosis of heart failure requires the presence of symptoms and/or signs of heart failure as well as objective evidence of cardiac dysfunction.¹A clinical examination, ECG, measurement of natriuretic peptides and echocardiography are required to establish the diagnosis.¹ A chest X-ray is also recommended to rule out other possible causes of breathlessness.¹

If the diagnosis of heart failure is confirmed, the phenotype is determined by measuring the left ventricular ejection fraction.

A distinction is made between HFrEF (heart failure with reduced ejection fraction), HFmrEF (heart failure with mildly reduced ejection fraction) and HFpEF (heart failure with preserved ejection fraction).¹

Treatment

The treatment of heart failure patients aims to reduce mortality, prevent recurrent hospitalisations due to a deterioration in cardiac insufficiency and to improve the patients' clinical condition, functional capacity and quality of life.¹

In heart failure patients with a reduced or mildly reduced left ventricular ejection fraction (LVEF ≤40% or 41%-49%), treatment consisting of ACE-I/ARNI, beta blockers, MRA, SGLT2 inhibitors and a loop diuretic (if necessary) is recommended.¹

For a long time, symptoms could only be alleviated in patients with preserved ejection fraction (≥50%).¹ Since 2023, the ESC heart failure

guidelines recommend SGLT2 inhibitors across the entire range of ejection fraction.¹¹ A loop diuretic (if necessary) is also recommended, as well as treatment of the underlying aetiology and comorbidities.¹¹

ACE-I: angiotensin-converting enzyme inhibitor; ARNI: angiotensin receptor neprilysin inhibitor; ESC: European Society of Cardiology; LVEF: left ventricular ejection fraction; MRA: mineralocorticoid receptor antagonist; SGLT-2 I: sodium-glucose co-transporter-2 inhibitor.

References:

McDonagh TA, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-3726.
Savarese G, et al. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res. 2023 Jan 18;118(17):3272-3287.
Jones NR, et al. Survival of patients with chronic heart failure in the community: a systematic review and meta-analysis. Eur J Heart Fail. 2019;21(11):1306-1325.
Mamas MA, et al. Do patients have worse outcomes in heart failure than in cancer? A primary care-based cohort study with 10-year follow-up in Scotland. Eur J Heart Fail. 2017;19(9):1095-104.
Mohacsi PJ, et al. Positionspapier "Herzinsuffizienz" of the SGK heart failure working group. Published on 17/01/2018. Available online at: https://cvm.swisshealthweb.ch/en/article/doi/cvm.2018.00537/. Last accessed on: 30/04/2024.
Bosch L, et al. Heart failure in primary care: prevalence related to age and comorbidity. Prim Health Care Res Dev. 2019 Jul 29;20:e79.
A. Rosemann. Guideline on Heart Failure. Institute of Family Medicine at the University of Zurich. Published in 04/2021. Available online at: https://www.guidelines.fmh.ch/downloads/19222870/download-en.pdf. Last accessed on: 30/04/2024.
Shiba N, Shimokawa H. Chronic kidney disease and heart failure--Bidirectional close link and common therapeutic goal. J Cardiol. 2011 Jan;57(1):8-17.
Seferović PM, et al. Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2018 May;20(5):853-872.
Birkeland KI, et al. Heart failure and chronic kidney disease manifestation and mortality risk associations in type 2 diabetes: A large multinational cohort study. Diabetes Obes Metab. 2020 Sep;22(9):1607-1618.
McDonagh TA, et al. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2023 Oct 1;44(37):3627-3639.

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CH-12946-Revision date 06/2026