Heart Failure ( stages )

Heart failure has been recently classified into four stages that represent a progression of the disease. Further details about this staging system are described below.
Definition of Stage
Usual Treatments
Stage A
People at high risk of developing heart failure (pre heart failure), including people with:
  • Hypertension
  • Diabetes
  • Coronary artery disease
  • Metabolic syndrome
  • History of cardiotoxic drug therapy
  • History of alcohol abuse
  • History of rheumatic fever
  • Family history of cardiomyopathy
  • Exercise regularly
  • Quit smoking
  • Treat hypertension
  • Treat lipid disorders
  • Discontinue alcohol or illegal drug use
  • An angiotensin converting enzyme inhibitor (ACE-I) or an angiotensin II receptor blocker (ARB) is prescribed if you’ve had a coronary artery disease or if you have diabetes, high blood pressure or other vascular or cardiac condition
  • Beta-blockers may be prescribed if you have high blood pressure
Stage B
People diagnosed with systolic left ventricular dysfunction ( Weak or stiff heart ) but who have never had symptoms of heart failure (pre heart failure), including people with:
  • Prior heart attack
  • Valve disease
  • Cardiomyopathy
The diagnosis is usually made when an ejection fraction of less than 40% is found during an echocardiogram test.
·        Treatment methods above for Stage A apply
·        All patients should take an angiotensin converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB)
·        Beta-blockers and an aldosterone inhibitor (eplerenone) should be      prescribed for patients after a heart attack 
·        Surgery options for coronary artery repair and valve repair or replacement (as appropriate) should be discussed
·        If appropriate, surgery options should be discussed for patients who have had a heart attack
Stage C

Patients with known systolic heart failure and current or prior symptoms. 

Most common symptoms include:

  • Shortness of breath

  • Fatigue

  • Reduced ability to exercise

Treatment methods above for Stage B apply

  • All patients should take an angiotensin converting enzyme inhibitor (ACE-I) and beta-blockers

  • African-American patients may be prescribed a hydralazine/nitrate combination if symptoms persist

  • Diuretics (water pills) and digoxin may be prescribed if symptoms persist

  • An aldosterone inhibitor may be prescribed when symptoms remain severe with other therapies

  • Restrict dietary sodium

  • Monitor weight

  • Restrict fluids (as appropriate)

  • Drugs that worsen the condition should be discontinued

  • As appropriate, cardiac resynchronization therapy (biventricular pacemaker) may be recommended

  • An implantable cardiac defibrillator (ICD) may be recommended

Stage D
Patients with systolic heart failure and presence of advanced symptoms after receiving optimum medical care.
Treatment methods for Stages A, B & C apply
Patient should be evaluated to determine if the following treatments are available options: heart transplant, ventricular assist devices, surgery options, research therapies, continuous infusion of intravenous inotropic drugs and end-of-life (palliative or hospice) care





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