60
Stage A
At high risk for heart failure,
but without structural heart
disease or symptoms of HF
Stage B
Structural heart disease,
but without signs or
symptoms of HF
Stage C
Structural heart disease
with prior or current
symptoms of HF
Stage D
Refractory HF
requiring specialized
interventions
E.g. Patients with
- hypertension
- coronary artery disease
- metabolic syndrome
- diabetes mellitus
- obesity
or
Patients
- using cardiotoxins
- with FHx CM
E.g. Patients with
- Previous MI
- LV remodeling incl.
LVH & low EF
- Asymptomatic
- Valvular disease
E.g. Patients with:
- Known structural
heart disease
- Shortness of breath
and fatigue, reduced
exercise tolerance
E.g. Patients who have
marked symptoms at rest
despite maximal medical
therapy (e.g. those who are
recurrently hospitalized or
cannot be safely discharged
from the hospital without
specialized interventions)
Structural
heart
disease
Development
of symptoms of
HF at rest
Refractory
symptoms
of HF at rest
Therapy
- Appropriate measures under
stages A,B, and C
- Decision re: appropriate level
of care
- Extraordinary Care
Heart transplant
Chronic inotropes
Permanent mechanical support
- Experimental surgery/drugs
- Hospice/end of life care
Therapy
- Treat hypertension
- Encourage smoking
cessation
- Treat lipid disorders
- Encourage regular
exercise
- Discourage alcohol intake,
illicit drug use
- Control metabolic
syndrome
-
Therapy
- All measures under
stage A
- ACE inhibitors in
appropriate patients*
- Beta-blockers in
appropriate patients*
Therapy
- All measures under Stage A & B
- Dietary Salt Restriction
- Drugs for routine use*:
Diuretics
ACE inhibitors
Beta-blockers
Digitals
- Drugs in Selected patients*:
Aldosterone antagonisists
ARB’s,
Digitalis,
Hydralizine
Nitrates
- Devices in Selected Patients
Biventricular Pacing
Implantable defibrillator
NEW YORK HEART ASSOCIATION HEART FAILURE DISEASE CLASSIFICATION:
Class I Asymptomatic (Patients with cardiac disease but without resulting limitations of physical activity. Ordinary physical activity does not cause undo fatigue, palpitations, dyspnea, or anginal pain)
Class II Mildly symptomatic (Patients with cardiac disease resulting in slight limitation of physical activity. Comfortable at rest, ordinary physical activity results in fatigue, palpitation, dyspnea or
anginal pain)
Class III Moderately symptomatic (Patients with cardiac disease resulting in marked limitation of physical activity. Comfortable at rest, less than ordinary activity causes fatigue, palpitation, dyspnea or
anginal pain)
Class IV Severe symptoms at rest (Patients with cardiac disease resulting in an inability on any physical activity)
This table of suggested guidelines has been developed from the ACC/AHA 2005 Chronic Heart Failure Guideline Update. It is intended to provide guidance to practitioners to reduce risks associated
with CHF, increase awareness of CHF, and to optimize disease management. It contains guidelines only and should never supersede clinical judgment. The practitioner, in conjunction with the patient or
responsible party, should decide whether these or other recommended services should be performed more frequently, less frequently, or not at all. As with all services provided to Bravo Health
Members, the clinical judgment and the discussion around it should be documented in the medical record. *ACC/AHA full text guideline available at; http://circ.ahajournals.org/cgi/reprint/112/12/e154
