AT RISK FOR HEART FAILURE HEART FAILURE

STAGE A STAGE B STAGE C STAGE D

At high risk for HF but without Structural heart disease but Structural heart disease with Refractory HF
structural heart disease or without signs or symptoms prior or current symptoms
symptoms of HF of HF of HF

e.g., Patients with:

e.g., Patients with: e.g., Patients with: • Marked HF symptoms at
e.g., Patients with: Refractory rest
• HTN • Previous MI
• Atherosclerotic disease • LV remodeling including LV • Known structural heart symptoms • Recurrent hospitalizations
• DM Hand low EF disease and of HF at rest, despite GDMT
• Obesity • Asymptomatic valvular • HF signs and symptoms despite GDMT
• Metabolic syndrome disease

OR
HFpEF HFr EF THERAPY
Patients Development
Goals
• Using cardiotoxins of symptoms
• With family history of of HF • Control symptoms
cardiomyopathy • Improve HRQOL
THERAPY THERAPY
• Reduce hospital
Goals Goals readmissions
THERAPY
• Control symptoms • Control symptoms • Establish patient’s end-of-
Goals • Improve HRQOL • Patient education life goals
Structural • Prevent HF symptoms • Prevent hospitalization • Prevent hospitalization
heart disease • Prevent further cardiac • Prevent mortality • Prevent mortality Options
remodeling • Advanced care measures
Strategies Drugs for routine use • Heart transplant
THERAPY Drugs • Identification of comorbidities • Chronic inotropes
• Diuretics for fluid retention
Goals • ACEI or ARB as appropriate • ACEI or ARB • Temporary or permanent
• Heart healthy lifestyle • Beta blockers as Treatment • Beta blockers MCS
• Prevent vascular, coronary appropriate • Diuresis to relieve symptoms • Aldosterone antagonists • Experimental surgery or
disease of congestion drugs
• Prevent LV structural In selected patients • Follow guideline driven • Palliative care and hospice
Drugs for use in selected
abnormalities • ICD indications for comorbidities, • ICD deactivation
patients
• Revascularization or e.g., HTN, AF, CAD, DM
• Hydralazine/isosorbide dinitrate
Drugs valvular surgery as • Revascularization or valvular
• ACEI and ARB
• ACEI or ARB in appropriate appropriate surgery as appropriate
• Digitalis
patients for vascular
disease or DM Inselected patients
• Statins as appropriate Stages in the development of HF and recommended therapy by stage. ACEI indicates angiotensin-converting
enzyme inhibitor; AF, atrial fibrillation; ARB, angiotensin-receptor blocker; CAD, coronary artery disease; • CRT
CRT, cardiac resynchronization therapy; DM, diabetes mellitus; EF, ejection fraction; GDMT, guideline-
directed medical therapy; HF, heart failure; HFpEF, heart failure with preserved ejection fraction; HFrEF,
• ICD
heart failure with reduced ejection fraction; HRQOL, health-related quality of life; HTN, hypertension; ICD, • Revascularization or valvular
implantable cardioverter-defibrillator; LV, left ventricular; LVH, left ventricular hypertrophy; MCS, mechanical
circulatory support; and MI, myocardial infarction. Adapted from Hunt et al.3
surgery as appropriate
Yancy CW et al., ACCF/AHA Guideline for the Management of Heart Failure, Circulation, 10/15/13.