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 • Improve HRQOL
life goals
Structural • Patient education • Patient education
• Prevent HF symptoms • Prevent hospitalization
heart disease • Prevent further cardiac • Prevent hospitalization
• Prevent mortality Options
• Prevent mortality
remodeling • Advanced care measures
Strategies Drugs for routine use • Heart transplant
THERAPY Drugs • Diuretics for fluid retention • Chronic inotropes
• Identification of comorbidities
Goals • ACEI or ARB as appropriate • ACEI or ARB • Temporary or permanent
• Beta blockers as Treatment • ARNI MCS
• Heart healthy lifestyle • Beta blockers
• Prevent vascular, coronary appropriate • Diuresis to relieve symptoms • Experimental surgery or
• Aldosterone antagonists
disease of congestion drugs
• Prevent LV structural In selected patients • Follow guideline driven • Palliative care and hospice
indications for comorbidities, Drugs for use in selected
abnormalities • ICD • ICD deactivation
patients
• Revascularization or e.g., HTN, AF, CAD, DM
• Revascularization or valvular • Hydralazine/isosorbide dinitrate
Drugs valvular surgery as • ACEI and ARB
appropriate surgery as appropriate
• ACEI or ARB in appropriate • Ivabradine
patients for vascular • Digoxin
disease or DM
• Statins as appropriate
Stages in the development of HF and recommended therapy by stage. ACEI indicates angiotensin-converting Inselected patients
enzyme inhibitor; AF, atrial fibrillation; ARB, angiotensin-receptor blocker; CAD, coronary artery disease;
CRT, cardiac resynchronization therapy; DM, diabetes mellitus; EF, ejection fraction; GDMT, guideline- • CRT
directed medical therapy; HF, heart failure; HFpEF, heart failure with preserved ejection fraction; HFrEF,
heart failure with reduced ejection fraction; HRQOL, health-related quality of life; HTN, hypertension; ICD, • ICD
implantable cardioverter-defibrillator; LV, left ventricular; LVH, left ventricular hypertrophy; MCS, mechanical • Revascularization or valvular
circulatory support; and MI, myocardial infarction. Adapted from Hunt et al.3
Yancy CW et al., ACCF/AHA Guideline for the Management of Heart Failure, Circulation, 10/15/13. surgery as appropriate
Yancy CW et al., 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management
of Heart Failure, Circulation, 08/08/2017.