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heart failure classification AHH/ACC

Classification of Heart Failure in parallel with NYHA classification. Classification: 1) Stage A: - no heart failure, but risk factors* for heart disease - management: ACE inhibitor 2) Stage B: - structural heart disease, but no symptoms of heart failure - management: ACE inhibitor plus beta-blocker 3) 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] 4) 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]

Related

New York Heart Association classification of heart failure

General

classification

References

  1. Prescriber's Letter 8(12):67 2001
  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: 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: 161683044
  3. 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: 34167929 https://www.sciencedirect.com/science/article/abs/pii/S2405500X21003285