Acute heart failure prevention resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahmoud Sakr, M.D. [2]; Ayokunle Olubaniyi, M.B,B.S [3]

Prevention

Does the patient have stage A or stage B of heart failure according to the ACCF/AHA staging system?

Stage A ❑ At high risk for heart failure ❑ Patients with HTN, DM, obesity, CAD, metabolic syndrome ❑ Family history of cardiomyopathy ❑ Patients using cardiotoxins AND ❑ No structural heart disease AND ❑ No symptom of heart failure

Stage B ❑ Patients with structural heart disease This refers to patients with the following: ❑ Previous MI ❑ LV remodeling* (including LVH + low EF) ❑ Asymptomatic valvular disease AND ❑ No signs or symptoms of heart failure LV remodeling refers to the changes in size, shape and function of the heart resulting from cardiac load or injury

Neither stage A nor stage B

Yes, the patient has stage A Therapeutic goals: ❑ Promote healthy lifestyle ❑ Prevent CAD and comorbidities ❑ Prevent LV structural abnormalities

Yes, the patient has stage B Therapeutic goal: ❑ Prevent symptoms of heart failure

No preventive therapy is needed

❑ Control HTN and lipid disorders ❑ ACE inhibitors or (ARBs) in patients with vascular disease or DM ❑ Statins ❑ Minimize risk factors ❑ Dietary sodium restriction (2-3 g daily) ❑ Smoking cessation ❑ Alcohol abstinence (≤2 standard drinks per day for men; ≤1 for women) ❑ Encourage exercise/physical activity

❑ Administer ACE inhibitors or (ARBs) in patients with: ❑ Prior MI and LVEF ≤40% to prevent heart failure (Class I, level of evidence A) OR ❑ LVEF ≤40% (Class I, level of evidence A) ❑ Administer beta blockers in patients with: ❑ Prior MI and LVEF ≤ 40% to prevent heart failure (Class I, level of evidence B) ❑ LVEF ≤ 40% to prevent heart failure (Class I, level of evidence C) ❑ Statins ❑ Patients with MI (Class I, level of evidence A) ❑ Implantable cardioverter defibrillator (ICD) to prevent sudden death in: ❑ Asymptomatic ischemic cardiomyopathy (Class IIa, level of evidence B) ❑ ≥ 40 day post-MI ❑ LVEF ≤ 30% ❑ On GDMT ❑ The use of CCBs e.g., verapamil and diltiazem in patients with LVEF ≤ 30%

References

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