What are the Different Types of Heart Failure? An Expert Explains

What is heart failure, exactly, and what are its risk factors and symptoms? Contrary to what many people think, heart failure is not the same thing as a heart attack. According to experts, heart failure occurs when the heart is unable to pump blood around the body efficiently, while a heart attack is triggered by a loss of blood supply to the heart, usually from a blood clot, which causes the heart muscle to die.

“Heart failure is a clinical syndrome encompassing different symptoms and signs of structural and functional heart problems that prevent the heart from supplying the body with the amount of oxygen it requires,” explains Sandra Chaparro, M.D., cardiologist and director of the Advanced Heart Failure Program at Baptist Health Miami Cardiac & Vascular Institute. “It’s a serious condition that’s challenging to diagnose and there’s no outright cure,” she adds.

Dr. Chaparro says that heart failure affects an estimated 6.7 million U.S. adults, , and the rate of heart failure diagnoses is projected to climb to 8.7 million over the next two decades as the country’s population continues to age.

“The highest rate of heart failure occurs between 65 to 70 years of age. As comorbidities such as hypertension, diabetes and obesity tend to increase with age, so too does the prevalence of heart failure,” says Dr. Chaparro. And unlike with heart failure, which affects men and women  more or less evenly, “the majority of heart attack patients are male.”

The Symptoms and Stages of Heart Failure

Weakness, fatigue and shortness of breath are common symptoms of heart failure but as Dr. Chaparro points out, these are symptoms of many other conditions, too. “Heart failure is often misdiagnosed, so it requires a high degree of clinical suspicion when someone presents with these symptoms.”

The American Heart Association (AHA) and the American College of Cardiology (ACC) have classified four different stages of heart failure, and the ACC has established treatment protocols for each stage.

Stage A: At Risk for Heart Failure – People who are at risk for heart failure but do not yet have symptoms or structural or functional heart disease. Risk factors for people in this stage include hypertension, coronary vascular disease, diabetes, obesity, exposure to cardiotoxic agents, genetic variants for cardiomyopathy and family history of cardiomyopathy.

Stage B: Pre Heart Failure – People without current or previous symptoms of heart failure but with either structural heart disease, increased filling pressures in the heart or other risk factors.

Stage C: Symptomatic Heart Failure – People with current or previous symptoms of heart failure that interfere with daily life functions or lead to repeated hospitalizations. As a heart failure specialist, Dr. Chaparro sees stage C patients most often, she says.

Stage D: Advanced Heart Failure – People with severe symptoms that require multiple hospitalizations despite being on medications; those who aren’t responding to therapy; and those requiring advanced therapies such as transplant, mechanical circulatory support or palliative care. Dr. Chaparro says she gets a number of referrals for patients with stage D heart failure who need the advanced multidisciplinary care offered at Miami Cardiac & Vascular Institute.

The Risk Factors for Heart Failure

The most common cause of heart failure is coronary artery disease (CAD), which occurs when arteries that supply blood to the heart muscle become narrowed by buildups of fatty deposits called plaque. Obesity, diabetes and hypertension (high blood pressure) are also major risk factors for heart failure; however, those conditions can be modified and treated.

“A significant number of heart failure patients are hypertensive,” Dr. Chaparro notes. “In the U.S., 122 million people – 50 percent of all adults – have hypertension and are at risk for developing heart failure.”

Faulty heart valves, damage to the heart muscles, and abnormal heart rhythm are other key risk factors, she says. Survivors of heart attacks can also develop heart failure, which can be misdiagnosed or overlooked.

Treatment for Heart Failure

Primary care physicians and cardiologists typically are the ones who identify stage A or stage B patients in their clinical practice. For stage A patients, lifestyle modifications are recommended; these include getting adequate exercise and sleep; avoiding alcohol and tobacco; eating a healthy diet that includes whole grains, fruits, vegetables and non-processed foods; and maintaining a healthy weight.

For stage B patients, the physician will usually start them on a regimen of medications to decrease their risk of progression of coronary artery disease. These include aspirin, a blood thinner; a statin to help keep cholesterol levels in their target range, and possibly antiplatelets to reduce the possibility of blood clots.

Patients with stage C heart failure – by this time, they are typically short of breath because of fluid accumulating in their lungs, abdomen and legs – require more aggressive treatment that includes diuretics to help remove the fluid.

“At Miami Cardiac & Vascular Institute, we offer guideline-directed medical therapy based on extensive data,” Dr. Chaparro says. “We use four different classes of medications that target different pathways and allow the heart to recover.”

Medications for stage C patients typically include:

1.     A sodium-glucose cotransporter 2 (SGLT2) inhibitors such as dapagliflozin (Farxiga) or empagliflozin (Jardiance).

2.     A mineralocorticoid receptor antagonist (MRA) such as spironolactone, a diuretic, or eplerenone, an antihypertensive.

3.     A beta blocker such as metoprolol succinate which slows down the heart rate, relaxes blood vessels and lowers blood pressure by blocking the action of adrenaline and other hormones on nerve cells. 

4.     An angiotensin II receptor blocker (ARB) such as valsartan or losartan, or an angiotensin receptor-neprilysin inhibitor (ARNI) such as Entresto, which consists of two different blood pressure-lowering medications: valsartan and sacubitril, a neprilysin inhibitor.

“These medications are important because they not only make patients feel better but they are also reducing extremely expensive hospital admissions and improving patient mortality,” Dr. Chaparro says.

That said, she says “It’s not just about treating the patient with all these medicines” but discovering the reason behind their heart failure. “We now have great therapies for some specific cardiomyopathies, so when a patient comes to us we do a very detailed workup of their etiology. What that reveals can change the management of their disease,” Dr. Chaparro says.

For patients with stage D heart failure, Dr. Chaparro says treatment options include heart transplant, ventricular assist devices, surgical options, research therapies, continuous infusion of intravenous heart pump drugs, and palliative care.

Reducing Your Risk for Heart Failure

Dr. Chaparro says that Heart Failure Awareness Week, which is observed Feb. 9-15 to help increase education about the severity of this disease, is an opportunity to take steps today that can reduce your risk of heart failure.

Sandra Chaparro, M.D., cardiologist and director of the Advanced Heart Failure Program at Baptist Health Miami Cardiac & Vascular Institute

“Exercise and quitting smoking are the best ways to reduce one’s cardiovascular risk factors,” says Dr. Chaparro. She stresses the importance of following up with your primary care physician or cardiologist and “knowing your numbers,” meaning your blood pressure, glucose levels, cholesterol levels and weight.

“Many people with heart failure lead full and active lives when the condition is managed with a range of available medications – and when healthy lifestyle changes are adopted involving proper nutrition, weight management, being physically active and controlling the risk factors that eventually progress into heart failure,” says Dr. Chaparro.

Do You Know Your Coronary Calcium Score?  As part of Heart Month this February, many Baptist Health diagnostic imaging locations will be participating in our heart scan promotion. You may be eligible for a CT calcium scoring if you are 40-75 years old and meet certain cardiac risk factors. To learn more and request an appointment, visit BaptistHealth.net/HeartScan.