HEART FAILURE-ACC OR AHA STAGING

SUMMARY

1. Stage A: asymptomatic patients with risk factors (HTN, arteriosclerosis, DM, obesity, metabolic syndrome, cardio-toxins). - Tx goals: control risk factors.
- Tx: manage risk factors with drugs, ACEI/ARB, statins.
2. Stage B: asymptomatic patients with structural disease (previous MI, LVH, low LVEF, asymptomatic valvular disease).
- Tx goals: prevent HF symptoms and prevent further cardiac remodelling.
- Tx: ACEI/ARB, statins. ICD & revascularization if indicated.

3. Stage C: symptomatic (dyspnea, fatigue, decreased effort tolerance) patients with structural disease.
- Tx goals: control symptoms, patient education, improved QOL, decrease morbidity & mortality.
- Tx: loop diuretics, hydralazine/ISDN, aldosterone-antagonists, ACEI/ARB, beta-blockers, statins. ICD & revascularization if indicated.

4. Stage D: end-stage with marked symptoms & frequent hospitalisations.
- Tx goal: improve QOL & establish end-of-life goals.
- Tx: extraordinary measures (heart transplant, mechanical circulatory support, palliative care), stage C drugs.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].