What Is Heart Failure?
Heart failure is a clinical syndrome that occurs when the muscles in the heart fail to function properly. Diagnosis requires at least one of the following:
- Ejection Fraction (EF) < 50%
- Abnormal cardiac chamber enlargement
- E/E’ ratio > 15 (a marker of elevated left ventricular filling pressure)
- Moderate/severe ventricular hypertrophy
- Moderate/severe valvular obstruction or regurgitation
Additionally, diagnostics, imaging, or hemodynamic measurement must confirm objective evidence of elevated natriuretic peptide (BNP) levels or signs of pulmonary or systemic congestion.
Recognizing the Symptoms
Symptoms of heart failure can vary widely, but common indicators include:
Typical Symptoms:
- Breathlessness
- Orthopnea (difficulty breathing while lying down)
- Paroxysmal nocturnal dyspnea (waking up breathless at night)
- Reduced exercise tolerance
- Fatigue, tiredness
- Ankle swelling
Less Typical Symptoms:
- Nocturnal cough
- Wheezing
- Bloating, postprandial satiety
- Loss of appetite
- Cognitive decline, confusion (especially in the elderly)
- Dizziness or syncope (fainting)
Why The Definition Matters- and Proper Coding- Matters
With a Universal Definition, healthcare providers can more accurately diagnose heart failure, assess treatment effectiveness, and improve patient outcomes. However, proper clinical documentation and coding are equally important to ensure hospitals and providers secure earned revenue for the care they deliver.
Proper Documentation and Coding Supports
- Reimbursement – Ensuring hospitals receive full payment for the quality care provided.
- Quality Metrics – Supporting accurate hospital performance scores and patient outcome reporting.
- Compliance – Reducing the risk of denials, audits, and potential revenue loss.
With proper documentation, coding and clinical validation of heart failure reflecting the Universal Definition of Heart Failure, clinical teams, CDI professionals and coders work together to support complete and precise documentation to secure earned revenue for the quality care delivered.
