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)

Hunt, Sharon A.; Baker, David W.; Chin, Marshall H.; Cinquegrani, Michael; Feldmanmd, Arthur M.; Francis, Gary S.; Ganiats, Théodore G.; Goldstein, Sidney; Jessup, Mariell; Noble, RalphA.; Packer, Milton; Silver, Marc A.; Stevenson, Lynne Warner; Gibbons, Raymond J.; Antman, Elliott M.; Alpert, Joseph S.; Faxon, David P.; Fuster, Valentı́n; Gregoratos, Gabriel; Jacobs, Alice K.; Hiratzka, Loren F.; Russell, Richard O.; Smith, Sidney C.

doi:10.1161/hc4901.102568

Cited by 1,630 publications

(1,265 citation statements)

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“…12 In adults at high risk of HF, but without structural heart disease or symptoms of HF (stage A), the guidelines recommend aggressive risk-factor reduction, including smoking cessation, exercise, and treatment of hypertension. In patients with structural heart disease, but without symptoms of HF (stage B), the guidelines specifically recommend therapy with angiotensin-converting enzyme inhibitors and β blockers.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Prognosis of Asymptomatic Left Ventricular Diastolic Dysfunction in Ambulatory Patients With Coronary Heart Disease

Ren

Ristow

et al. 2007

The American Journal of Cardiology

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The association of asymptomatic left ventricular (LV) diastolic dysfunction with cardiovascular outcomes in ambulatory patients with coronary heart disease (CHD) and no history of heart failure (HF) was examined. LV diastolic HF predicts adverse cardiovascular outcomes. However, the prevalence and prognosis of asymptomatic LV diastolic dysfunction in patients with established CHD in the absence of clinical HF is unknown. Six hundred ninety-three patients with stable CHD, normal systolic function (LV ejection fraction ≥50%), and no history of HF were evaluated. Echocardiography was used to classify LV diastolic function, and Cox proportional hazards models were used to evaluate the association of LV diastolic dysfunction with cardiovascular outcomes during 3 years of follow-up. Of 693 subjects with normal systolic function and no history of HF, 455 (66%) had normal LV diastolic function, 166 (24%) had mild LV diastolic dysfunction, and 72 (10%) had moderate to severe LV diastolic dysfunction. After multivariable adjustment, the presence of moderate to severe LV diastolic dysfunction was strongly predictive of incident hospitalization for HF (hazard ratio 6.3, 95% confidence interval 2.4 to 16.1, p = 0.0003) and death from heart disease (HR 3.9, 95% confidence interval 1.0 to 14.8, p = 0.05). In conclusion, moderate to severe LV diastolic dysfunction was present in 10% of patients with stable CHD with normal ejection fraction and no history of HF and predicts subsequent hospitalization for HF and death from heart disease. Patients with asymptomatic LV diastolic dysfunction may benefit from more aggressive therapy to prevent or delay the development of HF.Left ventricular (LV) diastolic heart failure (HF) accounts for nearly half of all HF diagnoses and is associated with increased morbidity and mortality. [1][2][3] The prevalence and prognosis of asymptomatic LV diastolic dysfunction is unclear because most studies of the association between LV diastolic dysfunction and adverse outcomes examined patients with clinical HF. 1-3 One previous study examined the association of LV diastolic dysfunction with cardiovascular outcomes in patients without known heart disease, 4 but the prevalence and *Corresponding author: Tel.: 415-377-1404; fax: 415-563-5939., xiushui@yahoo.com (X. Ren). NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript prognosis of asymptomatic LV diastolic dysfunction in outpatients with stable coronary heart disease (CHD) is unknown. We evaluated the prevalence and prognosis of asymptomatic LV diastolic dysfunction in ambulatory patients with CHD with preserved systolic function and no history of HF. We hypothesized that asymptomatic LV diastolic dysfunction would be an independent predictor of adverse cardiovascular outcomes in these patients. Methods PatientsPatients were enrolled in the Heart and Soul Study, a prospective cohort study investigating the influence of psychosocial factors on cardiovascular events. Methods were described previously. 5 Ad...

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Section: Discussionmentioning

confidence: 99%

Prevalence and Prognosis of Asymptomatic Left Ventricular Diastolic Dysfunction in Ambulatory Patients With Coronary Heart Disease

Ren

Ristow

et al. 2007

The American Journal of Cardiology

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“…After the acute event, optimizing chronic HF medications should be a priority because ACE inhibitors, beta-blockers and spironolactone have all been shown to reduce mortality and hospitalizations, and digoxin has been shown to reduce hospitalizations (13). Interestingly, while 70% of patients were receiving ACE inhibitors or angiotensin receptor blockers on admission, only 45% were documented to be receiving these agents within 72 h after ED admission.…”

Section: Discussionmentioning

confidence: 99%

Practice patterns and outcomes in patients presenting to the emergency department with acute heart failure

Richter

Kalenga

Rowe

et al. 2009

Canadian Journal of Cardiology

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“…In Alberta HEART, patients were prospectively enrolled into one of five groups that loosely followed the American Heart Association / American College of Cardiology (AHA/ACC) stages of HF and included clinically relevant comparators and adjudication 8. We further studied standard and advanced biomarkers and imaging as to their added discriminatory and diagnostic value.…”

Section: Introductionmentioning

confidence: 99%

A prospective evaluation of the established criteria for heart failure with preserved ejection fraction using the Alberta HEART cohort

et al. 2017

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AimsHeart failure with a preserved ejection fraction (HF‐PEF) remains a difficult clinical diagnosis. The aim of this study was to test the utility of established criteria to classify patients with HF‐PEF. We prospectively enrolled patients into one of five groups across a spectrum of cardiac disease and applied three different criteria for HF‐PEF and calculated diagnostic metrics.Methods and resultsA total of 565 patients were included in the analysis, including 170 patients with an adjudicated diagnosis of HF‐PEF, 152 patients with heart failure with reduced ejection fraction, 152 patients at risk for heart failure, and 91 age‐matched healthy controls. For the diagnosis of HF‐PEF, the positive likelihood ratios were 6.1, 6.9, and 4.8 for the Zile, European Society of Cardiology (ESC) 2007, and ESC 2016 criteria, respectively. The negative likelihood ratios were 0.58, 0.60, and 0.42 for the Zile, ESC 2007, and ESC 2016 criteria, respectively. All three criteria lacked sensitivity to detect HF‐PEF (46.5%, 44.1%, and 51.8%, respectively) but were highly specific (92.4%, 93.9%, and 89%, respectively). We further evaluated the criteria to distinguish HF‐PEF from other diagnoses after excluding heart failure with reduced ejection fraction; the results were similar.ConclusionsIn this community based cohort, the likelihood ratios of the existing criteria for HF‐PEF were not at the level necessary to be considered diagnostic. Improved criteria for the diagnosis of patients with HF‐PEF are needed.

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Cited by 1,630 publications

References 49 publications

Prevalence and Prognosis of Asymptomatic Left Ventricular Diastolic Dysfunction in Ambulatory Patients With Coronary Heart Disease

Prevalence and Prognosis of Asymptomatic Left Ventricular Diastolic Dysfunction in Ambulatory Patients With Coronary Heart Disease

Practice patterns and outcomes in patients presenting to the emergency department with acute heart failure

A prospective evaluation of the established criteria for heart failure with preserved ejection fraction using the Alberta HEART cohort

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