Heart Failure (cont.)

How Is Heart Failure Treated?

Today there are more options available for heart failure than ever before. Tight control over your medications and lifestyle coupled with careful monitoring are the first steps. As the condition progresses, doctors specializing in the treatment of heart failure can offer more advanced treatment options.

The goals of treating heart failure are primarily to decrease the likelihood of disease progression (thereby decreasing the risk of death and the need for hospitalization), to lessen symptoms and to improve quality of life.

Together, you and your doctor can determine the best course of treatment for you.

Stages of Heart Failure

In 2001, the American Heart Association (AHA) and American College of Cardiology (ACC) developed the "Stages of Heart Failure." These stages, which were updated in 2005, will help you understand that heart failure is often a progressive condition and can worsen over time. They will also help you understand why a new medication was added to your treatment plan and may help you understand why lifestyle changes and other treatments are needed.

The stages classified by the AHA and ACC are different than the New York Heart Association (NYHA) clinical classifications of heart failure that rank patients as class I-II-III-IV, according to the degree of symptoms or functional limits. Ask your doctor what stage of heart failure you are in.

Check the table below to see if your therapy matches what the AHA and ACC recommend. Note that you cannot go backward in stage, only forward.

The table below outlines a basic plan of care that may or may not apply to you, based on the cause of your heart failure and your special needs. Ask your doctor to explain therapies that are listed if you do not understand why you are or are not receiving them.

Stage

Definition of Stage

Usual Treatments

Stage A

People at high risk of developing heart failure (pre-heart failure), including people with:

 

  • Exercise regularly.
  • Quit smoking
  • Treat hypertension
  • Treat lipid problems.
  • Discontinue alcohol or illegal drug use.
  • An angiotensin converting enzyme inhibitor (ACE inhibitor) 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 conditions
  • Beta blockers may be prescribed if you've had a previous heart attack.

Stage B

People diagnosed with systolic left ventricular dysfunction 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 inhibitors) or angiotensin II receptor blocker (ARB)
  • Beta-blockers and an aldosterone inhibitor 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 A apply.
  • All patients should take an angiotensin converting enzyme inhibitor (ACE inhibitors) 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 (salt)
  • 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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