The recommended treatments of heart failure aim to make patients feel better and to improve their prognosis as much as possible. The effects of the treatments differ between patients with HFrEF, HFpEF or HFmrEF. The table below shows which favourable prognostic effects each treatment has demonstrated in clinical studies. An additional goal is to reduce readmissions of heart failure patients as much as possible. Of course, every heart failure patient still has a residual risk of hospitalisation or mortality despite optimal treatment.

• Decrease in symptoms (decrease in NYHA class, increase in exercise capacity, etc.).
• Increase in quality of life.
• Improvement of cardiac function. For example, increase in LVEF, improvement of filling pressures, decrease in fluid retention,…
• Reduction of hospitalizations for progressive heart failure and cardiac decompensation.
  
  This is a very important objective because these hospitalizations:

• • Are burdensome for the patient and the family, resulting in a lower quality of life.
  • Are a manifestation of disease progression and a worse prognosis. As the patient is hospitalized more frequently, the risk of mortality increases.
  • Are a high cost to health care and society. The cost of hospitalizations is about 50 to 60% of the total cost of treating heart failure.
    
    
• Reduction of mortality: all-cause mortality and cardiovascular mortality.
  
  Heart failure-related death is most commonly caused by:

• • Progressive heart failure (e.g. due to cardiac decompensation, cardiogenic shock, general deterioration and cardiac cachexia).
  • Sudden death due to cardiac arrhythmias (e.g. ventricular tachycardia or ventricular fibrillation).

* Diuretics are old drugs that have never been studied in large randomized placebo-controlled trials. They have been a basic treatment for heart failure for decades. Their effects on prognosis have therefore never been studied like more recent heart failure therapies. They are only indicated for fluid retention at the lowest effective dose to maintain euvolemia. Presumably, both a too low dose and a too high dose worsen the patient's prognosis. A too low dose leads to fluid retention, cardiac decompensation and hospitalizations. A too high dose leads to dehydration, renal failure and hospitalizations. Proper titration of the diuretic dose during the course of the disease is therefore crucial.

Despite optimal heart failure therapy, there is still a risk of hospitalizations due to heart failure and mortality: the residual risk. This is determined by many factors (the severity of the heart failure, the etiology of the heart failure, the LVEF, the NYHA class, co- morbidities, etc.). Due to improved treatments, this residual risk has decreased over the years.

Also read: The impact of heart failure