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©2013 UpToDate ® Print Email ACC/AHA guideline summary: Prevention of chronic heart failure (HF): Patients at high risk of developing HF (stage A) Class I - There is evidence and/or general agreement that the following approaches are effective in the management of patients at high risk of developing HF: •  The following problems should be treated according to recommended guidelines: 1. Systolic and diastolic hypertension. 2. Lipid disorders. 3. Blood glucose control in diabetes mellitus. 4. The above and other secondary prevention measures in patients with atherosclerotic vascular disease. 5. Thyroid disorders. •  Avoidance of behaviors that may increase the risk of HF, such as smoking, excessive alcohol consumption, and illicit drug use. •  The ventricular rate should be controlled or sinus rhythm restored in patients with supraventricular tachyarrhythmias. •  Periodic evaluation for signs and symptoms of HF. •  Noninvasive determination of left ventricular ejection fraction in patients with a strong family history of cardiomyopathy or those treated with cardiotoxic interventions. Class IIa - The weight of evidence or opinion is in favor of the usefulness of the following approach for the management of patients at high risk of developing HF: •  Angiotensin converting enzyme inhibitors or angiotensin II receptor blockers to prevent HF in patients at high risk for developing HF due to a history of atherosclerotic vascular disease, diabetes mellitus, or hypertension with associated cardiovascular risk factors. •  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. Class III - There is evidence and/or general agreement that the following approach is not useful or may be harmful in the management of patients at high risk of developing HF: •  Routine use of nutritional supplements solely to prevent the development of structural heart disease.

•  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. Class III - There is evidence and/or general agreement that the following approach is not useful or may be harmful in the management of patients at high risk of developing HF: •  Routine use of nutritional supplements solely to prevent the development of structural heart disease. Data from Hunt, SA, Abraham, WT, Chin, MH, et al. 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; 112:e154. ACC/AHA guideline summary: Management of patients with asymptomatic left ventricular (LV) dysfunction or hypertrophy (heart failure stage B) Class I - There is evidence and/or general agreement that the following approaches are effective for the management of asymptomatic LV dysfunction •  Beta blockers and angiotensin converting enzyme (ACE) inhibitors if there is a recent or remote history of myocardial infarction (MI), regardless of left ventricular ejection fraction (LVEF). •  An angiotensin II receptor blocker (ARB) to post-MI patients who do not tolerate an ACE inhibitor and have a low LVEF. •  Beta blockers and ACE inhibitors in patients without a history of MI who have a reduced LVEF. •  Treatment of an acute MI according to current guidelines. •  Coronary revascularization according to current guidelines. •  Valve replacement or repair for hemodynamically significant valvular stenosis or regurgitation according to current guidelines Class IIa - The weight of evidence or opinion is in favor of the usefulness of the following approaches for the management of asymptomatic LV dysfunction •  ACE inhibitors or ARBs in patients with hypertension and LV hypertrophy. •  ARBs in patients with a low LVEF who are intolerant of ACE inhibitors.

•  Valve replacement or repair for hemodynamically significant valvular stenosis or regurgitation according to current guidelines Class IIa - The weight of evidence or opinion is in favor of the usefulness of the following approaches for the management of asymptomatic LV dysfunction •  ACE inhibitors or ARBs in patients with hypertension and LV hypertrophy. •  ARBs in patients with a low LVEF who are intolerant of ACE inhibitors. •  Placement of an ICD in patients with ischemic cardiomyopathy who are at least 40 days post-MI, have an LVEF of ≤30 percent, are NYHA functional class I on chronic optimal medical therapy, and have a reasonable expectation of survival with a good functional status for more than one year. Class IIb - The weight of evidence or opinion is less well established for the usefulness of the following approach for the management of asymptomatic LV dysfunction •  Placement of an ICD in patients with nonischemic cardiomyopathy who have an LVEF, are in New York Heart Association functional class I with chronic optimal medical therapy, and have a reasonable expectation of survival with good functional status for more than one year. Class III - There is evidence and/or general agreement that the following approaches are not useful or may be harmful for the management of asymptomatic LV dysfunction •  Digitalis in patients with a low LVEF and sinus rhythm, since the risk of harm is not balanced by any known benefit. •  Use of nutritional supplements to treat structural heart disease or prevent symptomatic heart failure •  Calcium channel blockers with negative inotropic activity may be harmful in post-MI patients who have a low LVEF. Data from Hunt SA, Abraham WT, Chin MH, et al. 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; 112:e154.

•  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. Class III - There is evidence and/or general agreement that the following approach is not useful or may be harmful in the management of patients at high risk of developing HF: •  Routine use of nutritional supplements solely to prevent the development of structural heart disease. Data from Hunt, SA, Abraham, WT, Chin, MH, et al. 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; 112:e154.