Heart Failure
Sharon A. Hunt and Mariell Jessup
13
Guidelines for the diagnosis and management of
chronic heart failure in the adult
Review
Recommendations for the diagnosis and management
of chronic heart failure in the adult
Initial and serial clinical assessment of patients
presenting with HF
Recommendations for the initial clinical assessment of
patients presenting with HF
Recommendations for serial clinical assessment of
patients presenting with HF
Therapy for heart failure
Recommendations for Stage A – patients at high risk
for developing HF
Recommendations for Stage B – patients with cardiac
structural abnormalities or remodeling who have
not developed HF symptoms
Stage C – patients with current or prior symptoms of
HF
Recommendations for patients with reduced LVEF
Recommendations for patients with HF and normal
LVEF
Recommendations for Stage D – patients with
refractory end-stage HF
Tr e a t m e n t of special populations
Recommendations
Patients with HF who have concomitant disorders
Recommendations
End-of-life considerations
Recommendations
Performance measures and standards
A comparison of the ACC/AHA Guidelines with other
recommendations
Future directions
Guidelines for the diagnosis and
management of chronic heart failure in
the adult [1]
Review
Heart failure (HF) is a major and growing public
health problem in the United States. Approximately
5.3 million patients in this country have HF, and
660,000 patients are diagnosed with HF for the fi rst
time each year. The disorder is the primary reason for
3.4 million offi ce visits and 5.5 million hospital days
each year. From 1990 to 1999, the annual number of
hospitalizations has increased from approximately
720,000 to over 1 million for HF as a primary diag-
nosis and 4.2 million for HF all-listed diagnosis. In
2004, over 284,000 patients died of HF as total
mention mortality. The number of total mention HF
deaths in 1994 was as high as it was in 2004.
Heart failure is primarily a condition of the
elderly, and thus the widely recognized “aging of the
population” also contributes to the increasing inci-
dence of HF. The incidence of HF approaches 10 per
1000 population after age 65, and approximately
80% of patients hospitalized with HF are more than
65 years old. Heart failure is the most common
Medicare diagnosis-related group (i.e., hospital dis-
charge diagnosis), and more Medicare dollars are
spent for the diagnosis and treatment of HF than for
any other diagnosis. It has been estimated that in
2008, the total direct and indirect cost of HF in the
US will be equal to $34.8 billion.Recommendations for the diagnosis and
management of chronic heart failure
in the adult
Classifi cation of Recommendations and Level of
Evidence are expressed in the ACC/AHA format
and shown in Table 13.1. Recommendations areThe AHA Guidelines and Scientific Statements Handbook
Edited by Valentin Fuster © 2009 American Heart Association
ISBN: 978 -1-405-18463-2