ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult

Peak oxygen uptake in relation to total heart volume discriminates heart failure patients from healthy volunteers and athletes

“…The present study suggests that assessment of VO 2 peak in relation to THV for determination of a VO 2 peak/THV ratio can be of potential use even in non-terminal and early stage HF, maybe even before the patient exhibit symptoms, such as in stage A HF [4]. Another possible application of a VO 2 peak/THV ratio is in management of patients with a history of endurance training and a sudden change in exercise capacity.…”

“…According to the definition of HF, patients should exhibit typical symptoms or signs such as breathlessness or fatigue at rest or during exercise, pulmonary congestion or ankle swelling, and objective evidence of cardiac dysfunction at rest [1]. However, ACC/AHA have identified 4 stages (A-D) with emphasis on the evolution and progression of HF, where stage A defines patients who are at high risk for developing HF but has no structural disorder of the heart and no signs or symptoms of HF [4]. Thus, there is a need for diagnostic methods that can objectify early signs of decreased cardiac performance in order to optimize management and treatment to prevent or delay progression of the disease and consequently improve patient prognosis.…”

Guideline Recommended Medical Therapy for Cardiovascular Diseases in the Obese: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking (CART) Program

“…Fourth, the study cohort comprised patients undergoing elective PCI from 2007 to 2012, possibly reflecting differences in guideline‐recommended therapy from current practice. However, national societal guidelines for HF and AF have been stable in their recommendation since prior to the study period,16, 21 and contemporaneous clinical trial data and other clinical practice guidelines for diabetes mellitus, coronary, and peripheral arterial and cerebrovascular disease supported the use of statin therapy in these patients 20, 22, 23, 24. Fifth, we are limited by a lack of data on ejection fraction, and are thus unable to discern between HF with preserved ejection fraction and HF with reduced ejection fraction.…”

“…We defined patients as “β‐blocker eligible” if they had a history of HF or prior MI prior to PCI, “statin eligible” if they had a diagnosis of CAD or a CAD equivalent (diabetes mellitus, peripheral arterial disease, or cerebrovascular disease) prior to PCI, “anticoagulant eligible” if they had a history of AF and a CHADS 2 score of >1 (defined by the presence of 1 or more components of the CHADS 2 score in the patient's history: HF, hypertension, age ≥70 years of age, diabetes mellitus, or history of cerebrovascular disease31) prior to PCI, and “ACE or ARB eligible” if they had a history of HF15, 16, 17, 18, 19, 21 prior to PCI. Patients were deemed not eligible for specific medications if they had documented contraindications.…”

“…Current and prior guidelines for cardiovascular care recommend the use of specific medical therapies for established atherosclerotic disease and its equivalents, heart failure (HF), atrial fibrillation (AF), and myocardial infarction (MI)15, 16, 17, 18, 19, 20, 21, 22, 23, 24 to reduce morbidity and mortality. A treatment difference in use of guideline‐recommended medications in the overweight and obese would represent a missed opportunity for secondary prevention.…”