From the Guidelines
The major and minor criteria for heart failure (congestive heart failure) are primarily categorized into four stages: Stage A (At Risk for HF), Stage B (Pre-HF), Stage C (Symptomatic HF), and Stage D (Advanced HF), as defined by the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1.
Stages of Heart Failure
The stages of heart failure are defined as follows:
- Stage A: At risk for HF but without current or previous symptoms/signs of HF and without structural/functional heart disease or abnormal biomarkers, including patients with hypertension, CVD, diabetes, obesity, exposure to cardiotoxic agents, genetic variant for cardiomyopathy, or family history of cardiomyopathy 1.
- Stage B: Pre-HF, characterized by patients without current or previous symptoms/signs of HF but evidence of structural heart disease, reduced left or right ventricular systolic function, or increased filling pressures, as well as patients with risk factors and increased levels of natriuretic peptides or persistently elevated cardiac troponin in the absence of competing diagnoses 1.
- Stage C: Symptomatic HF, defined by structural heart disease with current or previous symptoms of HF 1.
- Stage D: Advanced HF, marked by HF symptoms that interfere with daily life and with recurrent hospitalizations despite attempts to optimize guideline-directed medical therapy (GDMT) 1.
Diagnostic Criteria
The diagnostic criteria for each stage include:
- Structural heart disease, such as ventricular hypertrophy, chamber enlargement, or valvular heart disease 1.
- Reduced left or right ventricular systolic function, including reduced ejection fraction or reduced strain 1.
- Evidence of increased filling pressures, as determined by invasive hemodynamic measurements or noninvasive imaging suggesting elevated filling pressures, such as Doppler echocardiography 1.
- Elevated levels of biomarkers, including B-type natriuretic peptide (BNP) or cardiac troponin, in the absence of competing diagnoses 1.
Management and Treatment
Management and treatment of heart failure should be guided by the stage of the disease, with a focus on optimizing GDMT, lifestyle modifications, and device therapies as appropriate 1. The 2022 AHA/ACC/HFSA guideline provides a comprehensive framework for the diagnosis, classification, and management of heart failure, emphasizing the importance of early identification and treatment to improve outcomes and quality of life for patients with heart failure 1.
From the Research
Major Criteria for Heart Failure
- There is no direct evidence in the provided studies to list the major criteria for heart failure. However, the studies discuss various aspects of heart failure management, diagnosis, and treatment 2, 3, 4, 5, 6.
Minor Criteria for Heart Failure
- Similarly, there is no direct evidence in the provided studies to list the minor criteria for heart failure. The studies focus on the epidemiology, pathophysiology, diagnosis, and management of heart failure, but do not explicitly mention the minor criteria 2, 3, 4, 5, 6.
Diagnosis and Management of Heart Failure
- The diagnosis and management of heart failure involve a complex cluster of aetiologies and risks that are not easy to correctly identify, even in specialist settings 2.
- Recent evidence supports the use of sacubitril-valsartan combination in frail, deteriorating or de novo patients with LVEF≤40% 4.
- New strategies such as SGLT2 inhibitors and vericiguat provide further benefit for patients with decompensating HF 4.
- The first-line treatment of patients with HF with reduced ejection fraction includes foundational therapies with angiotensin receptor-neprilysin inhibitors, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, β-blockers, mineralocorticoid receptor antagonists, sodium-glucose cotransporter 2 (SGLT2) inhibitors and diuretics 5.