Chapter 69: The Epidemiology of Heart Failure
A 56-year-old man presents to your clinic to follow up a recent hospitalization for acute decompensated heart failure (HF). During his hospitalization, he was noted to have an ischemic cardiomyopathy with a left ventricular (LV) ejection fraction (EF) of 30%. He is currently able to do his activities of daily living, and he denies exertional dyspnea or functional limitation. What is his American Heart Association heart failure stage?
The answer is C. (Hurst’s The Heart, 14th Edition, Chap. 69). Heart failure is typically a progressive syndrome resulting from risk factors (stage A) that lead to asymptomatic abnormalities of cardiac structure and function (stage B), then eventually transitioning to symptomatic HF (stage C) and decompensations/refractory symptoms (stage D) (Figure 69-1).1 This staging system formulated by the AHA and the ACC highlights the potential importance of risk factor modification through lifestyle and pharmacologic means to prevent progression to symptomatic HF. The patient in question has a history of symptomatic heart failure, with a prior hospitalization, and has evidence for structural heart disease, with a reduced ejection fraction. Thus, he is stage C.
FIGURE 69-1. American Heart Association/American College of Cardiology stages of heart failure (HF).
Abbreviations: ACEI = angiotensin-converting enzyme inhibitor; AF = atrial fibrillation; ARB = angiotensin receptor blocker; CAD = coronary artery disease; CRT = cardiac resynchronization therapy; DM = diabetes mellitus; EF = ejection fraction; GDMT = guideline-directed medical therapy; HFpEF = heart failure with preserved ejection fraction; HFrEF = heart failure with reduced ejection fraction; HRQOL = health-related quality of life; HTN = hypertension; ICD = implantable cardioverter-defibrillator; LV = left ventricular; LVH = left ventricular hypertrophy; MCS = mechanical circulatory support. MI = myocardial infarction.
(Reproduced with permission from Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, J Am Coll Cardiol. 2013 Oct 15;62(16):e147-e239.)
A 53-year-old man is transferred to your hospital for acute decompensated heart failure. He is currently stable on inotrope therapy but remains orthopneic at rest, continues to be volume overloaded, and has a rising serum creatinine. What is his INTERMACS profile?