Stage | Definition | Examples | Therapy |
A | Patients with increased risk of developing HF, but with normal cardiac function and chamber size | - Exposure to cardiotoxic agents
- Family history of heritable cardiomyopathy
- Univentricular heart
- Congenitally corrected transposition of the great arteries
| None |
B | Patients with abnormal cardiac morphology or function, with no symptoms of HF, past or present | - Aortic insufficiency with LV enlargement
- History of anthracycline exposure with decreased LV systolic function
| - ACE inhibitor for patients with systemic ventricular dysfunction
|
C | Patients with structural or functional heart disease, and past or current symptoms of HF | - Symptomatic cardiomyopathy
- Congenital heart defect with ventricular pump dysfunction
| - ACE inhibitor and an aldosterone antagonist; oral diuretic therapy as needed for fluid overload; low-dose digoxin if needed for additional symptom relief
- After a few weeks of stability, a beta blocker is added in patients with persistent LV dilation and dysfunction
|
D | Patients with end-stage HF requiring specialized interventions | - Marked symptoms at rest despite maximal medical therapy
| - Pharmacologic therapy consists of intravenous diuretics and/or inotropes
- Other interventions may include positive pressure ventilation, cardiac resynchronization therapy, mechanical circulatory support, and heart transplantation
|