STAGE PRECIPITATING SYMPTOMS DRUG TREATMENT FURTHER ACTION

FACTORS
Stage A Hypertension High risk ACE inhibitor Treat risk factors
Atherosclerosis No symptoms of HF Angiotensin receptor Lifestyle changes
Obesity or structural heart blocker
Metabolic disease Statins
syndrome
Use of
cardiotoxins
Family history of
cardiomyopathy
Stage B Previous MI Structural heart ACE inhibitors Implantable
Left ventricular disease ARBs Cardioverter
modeling Asymptomatic + Defibrillator (ICD)
LVH With Beta Blockers if Revascularization
Low EF appropriate Valvular surgery
Asymptomatic
valvular disease Statins if MI or ACS to
prevent symptomatic HF
and CV events
Stage C Structural heart Known structural Diuresis – relieves Revascularization
HFpEF disease heart disease congestion Valvular surgery
Prior/current HF signs and
symptoms of HF symptoms: Beta blockers- biso, Monitor potassium,
Preserved carvediol, metaprolol renal function,
ejection fraction LEFT: succinate reduce diuretic dosing
Dyspnea mortality carefully
Orthopnea
Hemoptesis ARB recommended IF: Identify
Paroxysmal NYHA 2-4 comorbidities
nocturnal dyspnea LVEF < 35%
K+ < 5.0mEq/L
Don’t Open Her Creatinine > 2.0-2.5
Purse GFR > 30ml/min

DO NOT COMBINE ACE,

ARB OR ALDOSTERONE
ANTAG

Stage C Reduced RIGHT: Digoxin + Cardiac

HFrEF ejection fraction Ankle edema Spironolactone – Resynchronisation
Abdominal pain diuretics for fluid Therapy
Ascites retention
Anorexia Implantable
ACEi + diuretics + Beta Cardioverter
AAAA (current blocker Defibrillator (ICD)
mood)
 Revascularization
ARBs and ACE therapy
CONTRAINDICATED:
Drug intolerance
Hypotension
Renal insufficiency

SELECTED:
Hydralazine + Isosorbide
dinitrate comination –
reduces morbidity

Chronic HF with atrial

fibrillation + risk for
cardioembolic stroke:
-Chronic anticoagulant
therapy
Eg. Warfarin, apixaban

Neutral endopeptidase
inhibitors:
-sacubitril and valsartan
for HFrEF
-omapatrilat,
sampatrilat are
vasopeptidase inhibitors

Stage D Refractory HF Marked HF Inotropes + ACEi + Palliative therapy

symptoms at rest diuretics Heart transplant
Recurrent Digoxin + Beta blocker Experimental
hospitalization Spironolactone treatment
despite Guideline ICD deactivation
Determined Medical Mechanical
Therapy Circulatory Support