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Treatment for Stage B
Treatments for patients with Stage B risk for heart failure include all of the treatments recommended in Stage A. In addition, the following types of drugs and devices may be recommended for some patients. These include:
- Angiotensin-converting enzyme (ACE) inhibitors for patients with a recent or past history of heart attack. Also for patients who have not had a heart attack if they have a low left ventricular ejection fraction (LVEF) and no heart failure symptoms. A reduced LVEF indicates that the heart’s left ventricle is not pumping blood efficiently.
- Beta blockers for patients with a recent or past history of heart attack. Also for patients who have not had a heart attack but who do have reduced LVEF without heart failure symptoms.
- Angiotensin-receptor blockers (ARBs) for patients who have had a heart attack or have low LVEF, but who cannot take ACE inhibitors.
- Implantable defibrillators for patients who have weakened heart pumps (ischemic cardiomyopathy), who had a heart attack more than 40 days prior, and who have low LVEF.
Treatment for Stage C
Treat conditions as recommended in Stage A plus:
- Restrict dietary salt. Lowering salt in the diet can help diuretics work better.
- ACE inhibitors, beta blockers, and diuretics are recommended for most patients.
- ARBs are recommended for patients who cannot tolerate ACE inhibitors.
- Aldosterone inhibitors or digitalis may be used for some patients.
- A hydralazine and nitrate combination (BiDil) may be used for African American patients who are taking an ACE inhibitor and beta blocker and who still have heart failure symptoms.
- Avoid drugs that can worsen heart failure symptoms. These include nonsteroidal anti-inflammatory drugs (NSAIDs), most calcium channel blockers, and most drugs used to treat irregular heart rhythms (arrhythmia).
- Exercise training for appropriate patients.
- Biventricular pacemakers and implantable defibrillators for some patients.
Treatment for Stage D
Treatment includes appropriate measures used for Stages A, B, and C plus:
- Heart transplantation referral for appropriate patients.
- Left-ventricular assist devices (LVADs) as permanent therapy for patients who are not candidates for heart transplants. LVADs are surgically implanted to help pump blood through the body.
- Hospice and end-of-life care information for patients and families.
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