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Stages of Heart Failure (New Classification)

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Stages A thru D

Stage A
At high risk for HF (heart failure) but without structural heart
disease or symptoms of HF

e.g., Patients with:
-  hypertension
-  atherosclerotic disease
-  diabetes  -  obesity
-  metabolic syndrome
-  using cardiotoxins
-  with family history of cardiomyopathy.
-  Treat hypertension
-  Encourage smoking cessation
-  Treat lipid disorders
-  Encourage regular exercise
-  Discourage alcohol intake, illicit drug use
-  Control metabolic syndrome Drugs
-  ACEI or ARB in appropriate patients (discussed later) for vascular
disease or diabetes.
Stage B
Structural heart disease but without signs or symptoms of HF
e.g., Patients with:
-  previous MI
-  LV remodeling including LVH and low EF
-  asymptomatic valvular disease
-  All measures under Stage A
-  ACEI or ARB in appropriate patients
(discussed later)
-  Beta-blockers in appropriate patients (discussed later)
Devices in Selected Patients
-  Implantable defibrillators
Stage C
Structural heart disease with prior or current symptoms of HF
e.g., Patients with:
-  known structural heart disease
-  shortness of breath and fatigue, reduced
exercise tolerance
-  All measures under Stages A and B
-  Dietary salt restriction
Drugs for Routine Use
-  Diuretics for fluid retention
-  Beta-blockers
Drugs in Selected Patients
-  Aldosterone antagonist
-  ARBs
-  Digitalis
-  Hydralazine/nitrates
Devices in Selected Patients
-  Biventricular pacing
-  Implantable defibrillators
Stage D
Refractory HF (heart failure) requiring specialized interventions
e.g., Patients who have marked symptoms at rest despite maximal medical
therapy e.g., those who are recurrently hospitalized or cannot be safely
discharged from the hospital without specialized interventions)
Therapy Goals
-  Appropriate measures under Stages A, B, C
-  Decision re: appropriate level of care
-  Compassionate end-of-life care/hospice
-  Extraordinary measures
-  heart transplant
-  chronic inotropes
-  permanent mechanical support
-  experimental surgery or drugs


Direct quotes from this valuable reference:
Hunt SA, Abraham WT, Chin MH, Feldman AM, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20;112(12):e154-235. Epub 2005.


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Stages of Heart Failure (New Classification)