heart failure classification AHH/ACC
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Introduction
Classification of Heart Failure in parallel with NYHA classification.
Classification
- Stage A:
- no heart failure, but risk factors* for heart disease
- management: ACE inhibitor
- Stage B:
- structural heart disease, but no symptoms of heart failure
- management: ACE inhibitor plus beta-blocker
- Stage C:
- structural heart disease plus symptoms
- management:
- diuretics for fluid retention
- ACE inhibitor, unless contraindicated
- beta-blocker, if stable#
- digoxin as needed
- spironolactone for recent of recurrent symptoms at rest
- angiotensin receptor antagonist -] patients who cannot tolerate ACE inhibitor
- may combine with ACE inhibitor in patients NOT on beta-blocker
- isosorbide dinitrate plus hydralazine[2]
- cardiac resynchronization therapy or His bundle pacing[3]
- Stage D:
- refractory symptoms of heart failure, even at rest
- management:
- mechanical ventilatory support
- continuous inotropic infusions (dopamine, norepinephrine)
- heart transplantation?
AHH: American Heart Association
ACC: American College of Cardiology
NYHA: New York Heart Association
* Risk factors: hypertension, coronary artery disease, diabetes
# bisoprolol, carvedilol & sustained release metoprolol only beta-blockers with class 1 indication for stable HF with low LVEF[2]
More general terms
Additional terms
References
- ↑ Prescriber's Letter 8(12):67 2001
- ↑ 2.0 2.1 2.2 Hunt SA et al American College of Cardiology Foundation, American Heart Association. 2009 focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults [trunc]. J Am Coll Cardiol 2009 Apr 14;53(15):e1-e90. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19358937
Hunt SA et al Developed in Collaboration With the American College of Chest Physicians and the International Society for Heart and Lung Transplantation; Endorsed by the Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult-Summary Article A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol. 2005 Sep 20;46(6):1116-43. (No abstract) PMID: https://www.ncbi.nlm.nih.gov/pubmed/161683044 - ↑ 3.0 3.1 Vinther M et al. A randomized trial of His pacing versus biventricular pacing in symptomatic heart failure patients with left bundle branch block (His-Alternative). JACC Clin Electrophysiol 2021 Apr 25; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34167929 https://www.sciencedirect.com/science/article/abs/pii/S2405500X21003285