Congestive heart failure treatment of patients at high risk for developing heart failure (Stage A)
Heart failure | |
ICD-10 | I50.0 |
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ICD-9 | 428.0 |
DiseasesDB | 16209 |
MedlinePlus | 000158 |
eMedicine | med/3552 |
MeSH | D006333 |
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Overview of Treatment of Patients at High Risk for Developing Heart Failure (Stage A)
Control of Risk
Various conditions or behaviors associated with risk of Heart Failure (HF) can be identified and dealt with before the patients showing any evidence of structural heart disease. Dealing with those conditions is becoming one of the most important approach of HF treatment, since it allows us to provide the earliest opportunity to reduce the impact of HF on public and individual health.
Treatment of hypertension
Controlling both systolic and diastolic hypertension has been proved to greatly reduce the risk of HF.[1]In fact, a large number of studies have quite uniformly demonstrated that the control of blood pressure in an optimal way, helps to decrease the risk of new HF by approximately 50%. Various structural abnormalities that occurs with hypertensive patients such as LVH or MI are linked to multiple complications such as strokes, sudden death and HF.[2]In the Framingham heart study, hypertension was present in 39% of HF cases in men and in 59% of women. Those numbers emphasize the importance of managing hypertension at an early stage in an effort of avoiding severe complications as HF. Lowering both systolic and diastolic blood pressure in accordance with the recommendations provided in published guidelines has proven its effectiveness in lowering systemic vascular resistance, ventricular remodeling and decreasing hemodynamic load on the failing ventricle in patients with established HF. The treatment of Hypertension in patients with HF should take into consideration the type of heart failure that is present: In systolic dysfunction the biggest problem is the impaired contractility whereas in diastolic dysfunction, the main issue is the limitation of diastolic filling and therefore abnormal forward output due to increased ventricular stiffness. When any anti-hypertensive regimen is prescribed, an important aspect to keep in mind is the presence of concomitant medical problems as CAD, Diabetes, renal disease, pulmonary disease in many patients suffering from HF, which requires the health care providers to keep in mind the priority of lowering blood pressure while trying not to affect the treatment of those diseases. Diuretic-based antihypertensive therapy has repeatedly been shown to prevent HF in a wide range of target populations.[3]Patients may also benefit from the usage of ACE inhibitors(ACEIs) and beta blockers, which are proven to be effective in preventing HF in hypertensive individuals. However, ACEIs and beta blockers, as single therapies, are not superior to other antihypertensive drug classes in the reduction of all cardiovascular outcomes. Nevertheless, among patients with diabetes and other cardiovascular complications, ACEIs have shown to reduce the onset of HF and new-onset diabetes.[4]Another significant reduction of HF incidence in comparison to Placebo in patients with type 2 diabetes mellitus and nephropathy has been achieved by the usage of ARB’s losartan and irbesartan.[5] As previously mentioned an ultimate and appropriate hypertensive treatment would take under consideration all the concomitant diseases in an HF patient, and would involve multiple drugs used in combination.
Treatment of diabetes
Diabetes increases the risk of HF in all patients groups whether coronary heart disease or hypertension is present and it may cause cardiomyopathy.[6] A gender difference in terms of HF risk in diabetic patients is present, since the increase of HF for diabetic men’s is 3 times less than diabetic women’s.[7] In a study of patients with type 2 diabetes mellitus over 50 years old, with urinary albumin greater than 20 mg/l, 4% of patients developed HF over the study period, of whom 36 % died.[8] Health care providers should closely monitor hyperglycemia and target a certain blood glucose level to avoid end-organ complications in such patients.[9][10]ACEIs and ARBs have been proven to reduce the development of end-organ disease and the occurrence of clinical events in diabetic patients even when hypertension is not present. Long term treatment with ACEIs and ARBs has been shown to lower various dangerous complications in diabetic patients such as renal disease and prolonged treatment with ACEI ramipril has been shown to decrease the event of cardiovascular death, MI, and HF. ARBs long term therapy has also been proven to lower cardiovascular complication, decreasing the incidence of first HF hospitalization and improving renal function in diabetic patients.[11]
ACC / AHA Guidelines- Treatment of Patients at High Risk for Developing Heart Failure (Stage A) (DO NOT EDIT) [12]
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Class I1. In patients at high risk for developing HF, systolic and diastolic hypertension should be controlled in accordance with contemporary guidelines. (Level of Evidence: A) 2. In patients at high risk for developing HF, lipid disorders should be treated in accordance with contemporary guidelines. (Level of Evidence: A) 3. For patients with diabetes mellitus (who are all at high risk for developing HF), blood sugar should be controlled in accordance with contemporary guidelines. (Level of Evidence: C) 4. Patients at high risk for developing HF should be counseled to avoid behaviors that may increase the risk of HF (e.g., smoking, excessive alcohol consumption, and illicit drug use). (Level of Evidence: C) 5. Ventricular rate should be controlled or sinus rhythm restored in patients with supraventricular tachyarrhythmias who are at high risk for developing HF. (Level of Evidence: B) 6. Thyroid disorders should be treated in accordance with contemporary guidelines in patients at high risk for developing HF. (Level of Evidence: C) 7. Healthcare providers should perform periodic evaluation for signs and symptoms of HF in patients at high risk for developing HF. (Level of Evidence: C) 8. In patients at high risk for developing HF who have known atherosclerotic vascular disease, healthcare providers should follow current guidelines for secondary prevention. (Level of Evidence: C) 9. Healthcare providers should perform a noninvasive evaluation of LV function (i.e., LVEF) in patients with a strong family history of cardiomyopathy or in those receiving cardiotoxic interventions. (Level of Evidence: C) Class IIa1. Angiotensin converting enzyme inhibitors can be useful to prevent HF in patients at high risk for developing HF who have a history of atherosclerotic vascular disease, diabetes mellitus, or hypertension with associated cardiovascular risk factors. (Level of Evidence: A) 2. Angiotensin II receptor blockers can be useful to prevent HF in patients at high risk for developing HF who have a history of atherosclerotic vascular disease, diabetes mellitus, or hypertension with associated cardiovascular risk factors. (Level of Evidence: C) Class III1. Routine use of nutritional supplements solely to prevent the development of structural heart disease should not be recommended for patients at high risk for developing HF. (Level of Evidence: C) |
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See Also
Sources
- The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult [12]
References
- ↑ Kostis JB, Davis BR, Cutler J, Grimm RH, Berge KG, Cohen JD, Lacy CR, Perry HM, Blaufox MD, Wassertheil-Smoller S, Black HR, Schron E, Berkson DM, Curb JD, Smith WM, McDonald R, Applegate WB (1997). "Prevention of heart failure by antihypertensive drug treatment in older persons with isolated systolic hypertension. SHEP Cooperative Research Group". JAMA : the Journal of the American Medical Association. 278 (3): 212–6. PMID 9218667. Unknown parameter
|month=
ignored (help);|access-date=
requires|url=
(help) - ↑ Swamy RS, Lang RM (2010). "Echocardiographic quantification of left ventricular mass: prognostic implications". Current Cardiology Reports. 12 (3): 277–82. doi:10.1007/s11886-010-0104-y. PMID 20424973. Retrieved 2011-03-28. Unknown parameter
|month=
ignored (help) - ↑ Staessen JA, Wang JG, Thijs L (2003). "Cardiovascular prevention and blood pressure reduction: a quantitative overview updated until 1 March 2003". Journal of Hypertension. 21 (6): 1055–76. doi:10.1097/01.hjh.0000059044.65882.db. PMID 12777939. Retrieved 2011-03-28. Unknown parameter
|month=
ignored (help) - ↑ Fox KM (2003). "Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study)". Lancet. 362 (9386): 782–8. PMID 13678872. Retrieved 2011-03-28. Unknown parameter
|month=
ignored (help) - ↑ Berl T, Hunsicker LG, Lewis JB, Pfeffer MA, Porush JG, Rouleau JL, Drury PL, Esmatjes E, Hricik D, Parikh CR, Raz I, Vanhille P, Wiegmann TB, Wolfe BM, Locatelli F, Goldhaber SZ, Lewis EJ (2003). "Cardiovascular outcomes in the Irbesartan Diabetic Nephropathy Trial of patients with type 2 diabetes and overt nephropathy". Annals of Internal Medicine. 138 (7): 542–9. PMID 12667024. Retrieved 2011-03-28. Unknown parameter
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ignored (help) - ↑ Taegtmeyer H, McNulty P, Young ME (2002). "Adaptation and maladaptation of the heart in diabetes: Part I: general concepts". Circulation. 105 (14): 1727–33. PMID 11940554. Retrieved 2011-03-29. Unknown parameter
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ignored (help) - ↑ Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK (1996). "The progression from hypertension to congestive heart failure". JAMA : the Journal of the American Medical Association. 275 (20): 1557–62. PMID 8622246.
|access-date=
requires|url=
(help) - ↑ Vaur L, Gueret P, Lievre M, Chabaud S, Passa P (2003). "Development of congestive heart failure in type 2 diabetic patients with microalbuminuria or proteinuria: observations from the DIABHYCAR (type 2 DIABetes, Hypertension, CArdiovascular Events and Ramipril) study". Diabetes Care. 26 (3): 855–60. PMID 12610049. Retrieved 2011-03-29. Unknown parameter
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ignored (help) - ↑ Kasiske BL, Kalil RS, Ma JZ, Liao M, Keane WF (1993). "Effect of antihypertensive therapy on the kidney in patients with diabetes: a meta-regression analysis". Annals of Internal Medicine. 118 (2): 129–38. PMID 8416309. Retrieved 2011-03-29. Unknown parameter
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ignored (help) - ↑ Lewis EJ, Hunsicker LG, Bain RP, Rohde RD (1993). "The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. The Collaborative Study Group". The New England Journal of Medicine. 329 (20): 1456–62. doi:10.1056/NEJM199311113292004. PMID 8413456. Retrieved 2011-03-29. Unknown parameter
|month=
ignored (help) - ↑ Fox KM (2003). "Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study)". Lancet. 362 (9386): 782–8. Retrieved 2011-03-29. Unknown parameter
|month=
ignored (help) - ↑ 12.0 12.1 Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: 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): 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. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202