Heart Failure – Guidelines, Staging and Treatment

Heart failure
  • New York Heart Association Functional Classes
    • Class I – No symptoms
    • Class II – Symptoms with ordinary activity
    • Class III – Symptoms with less than ordinary activity
    • Class IV – Symptoms at rest or with any minimal activity
  • Stage (objective)
    • Stage A: at high risk for developing HF, no structural disorder of the heart
    • Stage B: structural disorders of heart, never had symptoms of HF 
    • Stage C: past or current symptoms of HF associated with underlying structural heart disease 
    • Stage D: end-stage disease who require specialized treatment strategies (mechanical circulatory support, continuous IV inotrope infusions, cardiac transplantation, or hospice care)
  • BNP
    • <100 – unlikely to have acute HF
    • >500 – high likelihood of heart failure
  • Contra—Thiazoladinediones  (__gliptan), calcium channel blockers (nifedipine)
  • HFrEF – reduced EF, systolic
  • HFpEF=HFNEF=DHF – preserved EF, diastolic
ACEI – reduce mortality
ARB – reduce mortality
BB – reduce mortality
Statin – prevent cardiovascular events
Diuretic – symptom control
Hydralazine + isosorbide dinitrate – reduce mortality in certain populations
Digoxin – decrease hospitalizations
Cardiac rehab – ↑functional capacity, exercise duration, QOL, mortality
  • Diuretics
    • Furosemide (Lasix) IV to PO 1:2  — Ex: 20mg IV = 40mg PO
    • Torsemide (Demadex) IV to PO 1:1  — Ex: 20mg IV = 20 mg PO 
    • Bumetanide (Bumex) IV to PO 1:1  — Ex: 20mg IV = 20 mg PO 
    • Furosemide to Torsemide 2:1 — Ex: Furosemide 40mg=Torsemide 20mg
    • Furosemide to Bumetanide 40:1 — Ex: Furosemide 40mg=Bumetanide 1mg
    • PO conversion: 1 mg Bumetanide = 20 mg Torsemide = 40 mg Furosemide

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