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ACC/AHA Heart Failure Staging

Calculators  Cardiovascular
The American College of Cardiology (ACC)/American Heart Association(AHA) Heart Failure Staging describes the stages of heart failure and suggests appropriate therapy for each stage
Patient with CAD (coronary artery disease), history of hypertension, or diabetes
No 0
Yes 1
Patient using cardiotoxins
No 0
Yes 1
Patient having family history of cardiomyopathy
No 0
Yes 1
Patient with previous LV systolic dysfunction, Myocardial infarction (MI), or asymptomatic valvular disease
No 0
Yes 10
Patient with known shortness of breath, structural heart disease, and fatigue
Decreased exercise toleration.
No 0
Yes 10
Patient with marked cardiac failure signs at rest, despite intense therapy
Individuals who are repeatedly hospitalized or cannot be safely released from the hospital without specialized mediations.
No 0
Yes 10
Result:

Background

Measured Factor
ACC/AHA heart failure stage
Measured Factor Disease
  • Heart failure
  • End-stage heart failure
Measured Factor Detail
The ACC/AHA heart failure stage describes the stages of heart failure and suggests appropriate therapy for each stage. 

Stage N/A suggests no substantial risk for heart failure based on ACC/AHA staging guidelines.

Stage A describes high risk for heart failure without structural heart disease or symptoms of heart failure. Therapies for stage A target high blood pressure, lipid disorders, thyroid disorders, smoking cessation, use of Angiotensin Converting Enzyme (ACE) inhibitors in appropriate patients, regular exercise, alcohol/illicit drug avoidance, ventricular rate control in patients with supraventricular tachyarrhythmias, and periodic evaluation for signs and symptoms of heart failure.  

Stage B describes structural heart disease without symptoms of heart failure. Therapies for stage B include measures in stage A and beta blockers, ACE inhibitors, valve replacement or repair in appropriate patients.

Stage C describes structural heart disease with past or present symptoms of heart failure. Therapies for stage C include measures in stage A and B and ACE inhibitors, diuretics, beta blockers, digitalis, salt restriction Withdrawal of nonsteroidal anti-inflammatory drugs, most antiarrhythmic drugs, and most calcium channel blocking drugs is encouraged.

Stage D describes end-stage heart failure. Therapies for stage D include measures in stage A, B, and C and demands specialized treatment such as mechanical circulatory devices, heart transplantation, continuous IV inotropic infusions for palliation, or hospice care.
Speciality
Cardiologist
Body System
Cardiovascular
Measured Factor High Impact
  • Stages A-D requires treatments that prevent or treat heart failure.

Result Interpretation

Ranges Ranges
  • Critical High: Stage D
  • Normal: Stage N/A
  • Normal Adult Male: Stage N/A
  • Normal Adult Female: Stage N/A
  • Normal Geriatric Male: Stage N/A
  • Normal Geriatric Female: Stage N/A
Result High Conditions
  • End-stage heart failure

Studies

Study Validation 1
This study reviewed and discussed therapy recommendations in the American College of Cardiology (ACC)/American Heart Association (AHA) 2005 guideline updates through clinical trials, observational studies, and review articles. The guidelines recommended therapies for stages A and B when patients do not yet have clinical heart failure but are clearly at risk, and for stages C and D for patients with symptomatic heart failure. The guidelines emphasized the important role of angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-adrenergic blockers, and aldosterone antagonists. The guidelines also addressed the roles of combination therapy and selective addition of hydralazine and isosorbide dinitrate. The study concluded that the guidelines provided evidence-based therapy recommendations that were further clarified by recent clinical trial findings.
References: 2
Study Additional 1
Breast cancer treatments can cause heart failure in a subset of patients. The American College of Cardiology/American Heart Association (ACC/AHA) guidelines classify patients receiving cardiotoxic medications as stage A, which is a high risk stage for developing heart failure. Neuregulin, a cardioprotective growth factor, usually declines in patients with stages C and D of heart failure. A prospective study looked at the risk of heart failure development in 78 women with breast cancer and receiving either anthracycline or trastuzumab. Patients were predominately white with stage II breast cancer and a median age of 50 years.  Left ventricular ejection fraction (LVEF) and neuregulin levels were measured before chemotherapy, after completion of anthracycline therapy, and/or 3 months into trastuzumab therapy. A reduction greater than 10 absolute percentage points in LVEF was observed in 21.4% of patients, suggesting these patients were progressing from stage A to stage B or C of heart failure. A significant drop in neuregulin levels was observed in patients treated with anthracycline and/or trastuzumab (P < 0.001). Those with the greatest decline in LVEF had higher baseline neuregulin levels, suggesting that neuregulin might be a prognostic marker in early-stage hear failure.
References: 3
Study Additional 2
This study focused on predicting left ventricular (LV) dysfunction in heart failure patients using a combination of neurohormones and clinical factors. Data from 125 patients with N-Terminal pro-B-type natriuretic peptide (NT-proBNP) <100 were used in two models that predicted LV dysfunction and differentiated stage B from stage A and no heart failure. Model 1 with clinical factors and neurohormones showed lower false negative rate than model 2, which included only NT-proBNP (8.2% versus 13.7%). The study demonstrated that the combination of clinical factors and neurohormones may differentiate stage B from stage A or no heart failure.
References: 4
Study Additional 3
This study looked at the prevalence and predictors for leg edema in 274 patients at risk for heart failure but without structural heart disease or symptoms of heart failure (stage A). Among 33 patients (12.0%) seen with leg edema, 29 of them had leg edema involved only the ankle and foot. Compared with patients without leg edema, those with leg edema were older (74 ± 11 years vs 69 ± 12 years, P = 0.006), more likely to present with pulmonary crackles (52% vs 31%, P < 0.03), and more likely to have varicose veins (55% vs 15%, P < 0.001).  Both leg edema and varicose veins were seen in 19 patients. Multivariate analysis showed that varicose veins were the only independent predictor of leg edema (odds ratio: 8.18, 95% confidence interval: 3.92-17.1, P < 0.001). The study concluded that leg edema may be evaluated in heart failure patients, even when patients are only at risk for heart failure.
References: 5

Authors

Sharon Hunt
MD, 1972
https://profiles.stanford.edu/sharon-hunt, Sharon Hunt, MD, is a professor of medicine and physician at Stanford University. Her teaching focuses on cardiovascular medicine

References

  1. Hunt SA, Baker DW, Chin MH, Cinquegrani MP, Feldman AM, Francis GS, et al.; American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure); International Society for Heart and Lung Transplantation; Heart Failure Society of America. ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure): Developed in Collaboration With the International Society for Heart and Lung Transplantation; Endorsed by the Heart Failure Society of America.Circulation. 2001 Dec 11;104(24):2996-3007.
  2. Howard PA, Cheng JW, Crouch MA, Colucci VJ, Kalus JS, Spinler SA, et al. Drug therapy recommendations from the 2005 ACC/AHA guidelines for treatment of chronic heart failure. Ann Pharmacother. 2006 Sep;40(9):1607-17. Epub 2006 Aug 8.
  3. Geisberg CA, Abdallah WM, da Silva M, Silverstein C, Smith HM, Abramson V, et al. Circulating neuregulin during the transition from stage A to stage B/C heart failure in a breast cancer cohort. J Card Fail. 2013 Jan;19(1):10-5.
  4. Poppe KK, Whalley GA, Richards AM, Wright SP, Triggs CM, Doughty RN. Prediction of ACC/AHA Stage B heart failure by clinical and neurohormonal profiling among patients in the community. J Card Fail. 2010 Dec;16(12):957-63.
  5. Kataoka H. Clinical characteristics of lower-extremity edema in stage A cardiovascular disease status defined by the ACC/AHA 2001 Chronic Heart Failure Guidelines. Clin Cardiol. 2013 Sep;36(9):555-9.