Use a 4-stage system to simplify the approach to heart failure

October 1, 2006

The more than 150 guidelines for recognizing and treating heart failure issued by the American College of Cardiologists (ACC) and American Heart Association (AHA) are way too numerous and complicated, said Theodore G. Ganiats, MD, of the University of California at San Diego.

The more than 150 guidelines for recognizing and treating heart failure issued by the American College of Cardiologists (ACC) and American Heart Association (AHA) are way too numerous and complicated, said Theodore G. Ganiats, MD, of the University of California at San Diego.

Instead of lugging around the AHA's 54-page "pocket" guide, Dr Ganiats told the audience of family physicians to keep in mind these 4 basic guidelines: heart failure is a progressive disease; treatment is determined by stage; most patients are treated with diuretics, ACE inhibitors or beta-blockers; and selected patients are treated with angiotensin-receptor blockers (ARBs), aldosterone antagonists, and digoxin.

Dr Ganiats counseled his colleagues to follow the definitions of the A-B-C-D stages to heart failure as defined in 2001. These guidelines treat the ailment more like a progressive disease like cancer:

A: At risk

B: Asymptomatic disease

C: Symptomatic disease

D: Refractory disease

Patients with stage A and B disease do not have a diagnosis of heart failure.

Those suffering from hypertension, obesity, metabolic syndrome, or who use cardiotoxins are defined as having class A disease. Patients should be encouraged to modify their risk factors, exercise, and they should be discouraged from smoking or using illicit drugs or alcohol. They can be treated with ACE inhibitors or ARBs.

Patients defined as having class B heart disease have had at least 1 previous MI or left ventricular remodeling. They should have the same treatment as patients categorized with class A disease but with the addition of beta-blocker treatment.

Although digoxin treatment has been standard for years, there's little data to support its effectiveness, Dr Ganiats said.