Clinical Guidelines for Heart Failure

An overview

The guidelines are written for medical people, so the language is technical. It focuses on clinical information. But understanding the basics of the guidelines can help you take a more active role in your treatment. You’ll be able to ask questions that can help you receive the best care.

The guidelines offer information for doctors about doing a thorough checkup to find heart failure and evaluate how serious it is. They guide the doctor in what symptoms to look for and what screenings may be needed, such as lab or exercise tests.

According to the guidelines, there are four stages of the disease:

• Stage A: At Risk for HF. A person who is at high risk for heart failure but has no problem with their heart structure and does not have symptoms of heart failure

• Stage B: Pre-HF. A person who has evidence of a problem with their heart structure. This can be increased filling pressures or risk factors from stage A and increased levels of levels of B-type natriuretic peptide (BNP). It can also be persistently elevated cardiac troponin. This indicates your heart muscle is injured. They do not have symptoms of heart failure.

• Stage C: Symptomatic HF. A person who already has, or who has had in the past, heart failure symptoms that are related to structural heart disease.

• Stage D: Advanced HF. A person who has serious HF symptoms that interfere with daily life. They also have repeated hospitalizations despite treatment. This is the most serious stage.

People in stages C and D are already in heart failure. There is an added set of categories for managing these people. It's called the New York Heart Association functional classification. Don't confuse it with the ACC/AHA staging method above.

The guidelines suggest specific treatments and actions for each stage. Once you know the stage you are in you can learn which treatments the guidelines suggest. For example, people in Stage A focus on treating risk factors. They include high blood pressure, smoking, and drinking. The guidelines suggest specific medicines and certain medical tests or procedures for all stages.

The guidelines also advise doctors to take a multidisciplinary approach to your care. This means your doctor teams up with other health care specialists to treat you. These include nurses, exercise physiologists, and smoking-cessation experts. Your health care team may suggest that you join support groups or visit certain specialists to help you make lifestyle changes.

Take a proactive role

The guidelines are designed to apply to most people in most cases. They give doctors a range of treatment choices. The main decisions rest with you and your doctor. You are the most important member of your health care team. Asking questions about your treatment is smart and responsible. It’s your right to know your health care team’s goals for you and how clinical guidelines compare with your care plan. It's important that you understand the approach to your care plan and that you arrive at it together with your doctor.