Figure 1.
Natural history of heart failure (HF). Diagram demonstrates a 3-phase process once HF is diagnosed. The natural history of HF is chronological progression of left ventricular remodeling, manifesting with symptoms, physical morbidity, and early death. HF readmissions, presenting as acute decompensation, have greatest risks in the transition and palliative phases. The transition forward to more advanced phases is influenced by rate of recovery and normalization of LV function in correlation to the starting point of prior screening (black arrow), early treatment (blue arrow), and through its natural history (read arrow), and the type of cardiomyopathy, energetic defects > toxins > inflammatory causes. The slope of the arrows highlights the trajectory and prolongations toward death. Terminology: (1) Normalization of LV function, defined as an EF ⩾50%; (2) recovery of LV function, defined as an improvement in LF ejection fraction from 5% to 15 %; normalization occurs less frequently than recovery of LV function.