From the Guidelines
Stage B heart failure is characterized by structural heart disease without symptoms of heart failure, and management focuses on preventing progression to symptomatic heart failure through evidence-based treatments. The criteria for Stage B heart failure include evidence of left ventricular hypertrophy, previous myocardial infarction, left ventricular systolic dysfunction, or valvular heart disease, all without accompanying heart failure symptoms, typically with an ejection fraction less than 40% but remaining asymptomatic 1. Key management strategies for Stage B heart failure include:
- Using ACE inhibitors to prevent symptomatic heart failure and reduce mortality in patients with LVEF ≤40% 1
- Prescribing statins to prevent symptomatic heart failure and adverse cardiovascular events in patients with a recent or remote history of myocardial infarction or acute coronary syndrome 1
- Utilizing evidence-based beta blockers to reduce mortality in patients with a recent or remote history of myocardial infarction or acute coronary syndrome and LVEF ≤40% 1
- Considering an implantable cardioverter-defibrillator for primary prevention of sudden cardiac death in patients who are at least 40 days post–myocardial infarction with LVEF ≤30% and NYHA class I symptoms while receiving GDMT 1 Regular monitoring with echocardiograms every 1-2 years is also important to assess the progression of the disease and adjust treatment accordingly. It is essential to avoid using thiazolidinediones in patients with LVEF <50% due to the increased risk of heart failure, including hospitalizations, and to exercise caution with nondihydropyridine calcium channel blockers with negative inotropic effects in this population 1.
From the Research
Stage B Heart Failure Criteria
The provided studies do not directly address the criteria for Stage B Heart Failure.
Available Information on Heart Failure
- The studies focus on the treatment of heart failure with reduced ejection fraction (HFrEF) using sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI) 2, 3, 4, 5, 6.
- They discuss the benefits of sacubitril/valsartan in reducing morbidity and mortality in patients with HFrEF compared to traditional treatments such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) 2, 3, 5, 6.
- The studies also explore the use of sacubitril/valsartan in patients with advanced chronic kidney disease, hypotension, and dose escalation 4.
- However, they do not provide specific criteria for diagnosing or classifying Stage B Heart Failure.
Limitations
- The available evidence does not directly address the question of Stage B Heart Failure criteria.
- Further research or clinical guidelines may be necessary to provide a clear answer to this question.