Well, heart failure really is an epidemic.

6.6 million adults in the US
700 K new diagnoses per year
300K deaths per year
Most common cause of admissions for patients over 65

So, what is heart failure?

I like to tell my patients that the heart is just just a pump.
We surgeons aren't very bright, so we like to simplify things.
So, the pump can fail in a couple of ways, and in most people, both ways are in effect to one degree or another.

Usually, the predominant form of failure is just that the heart is not pumping enough blood to the body. The ejection fraction in patients with serious heart failure is 25% or less. Compare that to the normal situation, where the ejection fraction is more like 60 or 70%.

The other mode of heart failure is when the pump needs a lot of pressure to fill. Now, this pressure needed to fill the left ventricle backs up into the lungs, causing congestion.

Patients with bad heart failure, class IV, stage D, heart failure, typically have very low ejection fraction, big, dilated hearts, and symptoms like shortness of breath with minimal exertion or even at rest. These symptoms persist or worsen despite optimal medical therapy, and these folks usually have about six months to live.

So, to avoid the thrombosis and the embolic strokes, we anticoagulate, and so there's a risk of bleeding.

A little less than one event per patient year, about half of them are GI bleeds.