Treatment
d
Figure 3. Stages in the Development of HF and Recommended
Therapy by Stage
At Risk for Heart Failure
STAGE A
At high risk for HF but without
structural heart disease or
symptoms of HF
eg, Patients with:
•Hypertension
•Atherosclerotic disease
•Diabetes mellitus
•Obesity
•Metabolic syndrome
or
Patients:
•Using cardiotoxins
•With family history of
cardiomyopathy
THERAPY
Goals
•Heart-healthy lifestyle
•Prevent vascular,
coronary disease
•Prevent LV structural
abnormalities
Drugs
•ACEI or ARB in
appropriate patients
for vascular disease or
diabetes mellitus
•Statins as appropriate
Structural
heart disease
STAGE B
Structural heart disease but
without signs or symptoms
of HF
eg, Patients with:
•Previous MI
•LV remodeling
including LVH
and low EF
•Asymptomatic
valvular disease
THERAPY
Goals
•Prevent HF symptoms
•Prevent further cardiac
remodeling
Drugs
•ACEI or ARB as
appropriate
•Beta blockers as appropriate
In selected patients
•ICD
•Revascularization or
valvular surgery as
appropriate
Adapted from Hunt SA, et al. J Am Coll Cardiol. 2009;53:e1-e90.
38
Development
of symptoms
of HF
