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STAGES OF HEART
FAILURE
- STAGE A :
Px at risk developing HF co morbid
condition.
No sympt and sign.
No structural & functional abnormality.
ex: HTN, CAD, DM
- STAGE B :
structural HD strongly assc HF.
no sympt and sign. Ec LVH, valvular heart
disease, previous MI
Stage of HF cont..
Stage C :
Goals:
Heart healthy lifestyle
Prevent vascular,
coronary disease
Prevent LV structural
abnormalities
Drugs:
ACEI or ARB in
appropriate patients for
vascular disease
Statins as appropriate
Stage B
Structural heart
disease but without
signs or symptoms
of HF
Patients with:
Previous MI
LV remodeling including
LVH and low EF
Asymptomatic valvular
disease
Developme
nt of
symptoms
of HF
Goals:
Prevent HF
symptoms
Prevent further
cardiac remodeling
Drugs:
ACEI or ARB as
appropriate
Beta blockers as
appropriate
In selected
patients:
ICD
Revascularization
or valvular surgery
as appropriate
HF
Preserved
EF
Goals:
Control symptoms
Improve HRQOL
Prevent hospitalization
Prevent Mortality
Strategies:
Identification of
comorbidities
Treatment:
Diuresis to relieve
symptoms of congestion
Follow guideline driven
indications for
comorbidities, e.g.,
HTN, AF, CAD, DM
HF
Reduced
EF
Goals:
Control symptoms
Patient education
Prevent hospitalization
Prevent Mortality
Drugs for routine use:
Diuretics for fluid
retention
ACEI or ARB
Beta blockers
Aldosterone
antagonists
Drugs for use in selected
patients:
Hydralazine/ISDN
ACEI and ARB
Digitalis
In selected patients:
CRT
ICD
Revascularization or
valvular surgery as
appropriate
- Diuretics
Diuretics patients fluid retention, unless
contraindicated, to improve symptoms.
- ACE Inhibitor
ACE inhibitors patients current or prior
symptoms, unless contraindicated, to reduce
morbidity and mortality
-Beta Blocker
Use of 1 of the 3 beta blockers proven to reduce
mortality (e.g., bisoprolol, carvedilol, and sustainedrelease metoprolol succinate)
- Angiotensin Receptor Blocker (ARB)
-Aldosterone receptor antagonists
-ISOSORBIDE DINITRATE
-DIGOXIN
Stage D
Refractory
HF
Goals
Control symptoms
Improve HRQOL
Reduce hospital
readmissions
Establish patients end
of-life goals
Options
Advanced care
measures
Heart transplant
Chronic inotropes
Temporary or permanent
MCS
Experimental surgery or
drugs
Palliative care and
hospice
ICD deactivation