Stage

Definition of Stage

Usual Treatments

Stage A

People at high risk of developing heart failure (pre-heart failure), including people with:

• Hypertension
• Diabetes
• Coronary artery disease
• Metabolic syndrome
• History of cardiotoxic drug therapy
• History of alcohol abuse
• History of rheumatic fever
• Family history of cardiomyopathy

• Exercise regularly.
• Quit smoking
• Treat hypertension
• Treat lipid problems.
• Discontinue alcohol or illegal drug use.
• An angiotensin converting enzyme inhibitor (ACE inhibitor) or an angiotensin II receptor blocker (ARB) is prescribed if you've had a coronary artery disease or if you have diabetes, high blood pressure, or other vascular or cardiac conditions
• Beta blockers may be prescribed if you've had a previous heart attack.

Stage B

People diagnosed with systolic left ventricular dysfunction but who have never had symptoms of heart failure (pre-heart failure), including people with:

• Prior heart attack
• Valve disease
• Cardiomyopathy

The diagnosis is usually made when an ejection fraction of less than 40% is found during an echocardiogram test.

• Treatment methods above for Stage A apply.
• All patients should take an angiotensin converting enzyme inhibitor (ACE inhibitors) or angiotensin II receptor blocker (ARB)
• Beta-blockers and an aldosterone inhibitor should be prescribed for patients after a heart attack
• Surgery options for coronary artery repair and valve repair or replacement (as appropriate) should be discussed

If appropriate, surgery options should be discussed for patients who have had a heart attack

Stage C

Patients with known systolic heart failure and current or prior symptoms. Most common symptoms include:

• Shortness of breath
• Fatigue
• Reduced ability to exercise

• Treatment methods above for Stage A apply.
• All patients should take an angiotensin converting enzyme inhibitor (ACE inhibitors) and beta-blockers
• African-American patients may be prescribed a hydralazine/nitrate combination if symptoms persist
• Diuretics (water pills) and digoxin may be prescribed if symptoms persist
• An aldosterone inhibitor may be prescribed when symptoms remain severe with other therapies
• Restrict dietary sodium (salt)
• Monitor weight
• Restrict fluids (as appropriate)
• Drugs that worsen the condition should be discontinued
• As appropriate, cardiac resynchronization therapy (biventricular pacemaker) may be recommended
• An implantable cardiac defibrillator (ICD) may be recommended

Stage D

Patients with systolic heart failure and presence of advanced symptoms after receiving optimum medical care.

• Treatment methods for Stages A, B & C apply.
• Patient should be evaluated to determine if the following treatments are available options: heart transplant, ventricular assist devices, surgery options, research therapies, continuous infusion of intravenous inotropic drugs and end-of-life (palliative or hospice) care