What are the Medicare stage B heart failure criteria?

Medicare Stage B Heart Failure Criteria

Stage B heart failure (pre-heart failure) is defined as structural heart disease without current or previous symptoms or signs of heart failure. 1

Definition and Diagnostic Criteria for Stage B Heart Failure

Stage B heart failure includes patients who meet the following criteria:

• No current or previous symptoms or signs of heart failure 1
• Evidence of at least one of the following: 1
  • Structural heart disease
    • Reduced left or right ventricular systolic function
    • Reduced ejection fraction or reduced strain
    • Ventricular hypertrophy
    • Chamber enlargement
    • Wall motion abnormalities
    • Valvular heart disease
  • Evidence of increased filling pressures
    • By invasive hemodynamic measurements
    • By noninvasive imaging suggesting elevated filling pressures
  • Risk factors with increased natriuretic peptide levels or persistently elevated cardiac troponin in the absence of competing diagnoses 1

Common Examples of Stage B Heart Failure

Patients with Stage B heart failure commonly include those with: 1

• Previous myocardial infarction 1
• Known structural heart disease 1
• Asymptomatic valvular disease 1
• LV hypertrophy or LV dysfunction without symptoms 1

Clinical Significance and Management

Stage B heart failure represents a critical opportunity for prevention of symptomatic heart failure. Management recommendations include:

• ACE inhibitors or ARBs in appropriate patients with a history of MI and reduced EF to prevent progression to symptomatic heart failure 1
• Evidence-based beta blockers in patients with MI and reduced EF 1
• Statins in patients with a history of MI to prevent heart failure 1
• Blood pressure control according to published guidelines 1
• Implantable cardioverter-defibrillators may be reasonable in selected patients (e.g., those with asymptomatic ischemic cardiomyopathy who are at least 40 days post-MI, have LVEF ≤30%, and are on guideline-directed medical therapy) 1

Evolution of Stage B Criteria

It's important to note that the definition of Stage B heart failure has evolved over time:

• The 2005 ACC/AHA guidelines defined Stage B simply as "structural heart disease but without signs or symptoms of HF" 1
• The 2022 ACC/AHA/HFSA guidelines expanded the definition to include objective evidence of increased filling pressures and biomarker criteria 1

Clinical Pearls and Pitfalls

• Avoid nondihydropyridine calcium channel blockers with negative inotropic effects in patients with low LVEF, as they may be harmful 1
• Stage B represents a critical intervention point where appropriate medical therapy can prevent progression to symptomatic heart failure (Stage C) 1
• Regular monitoring of patients with Stage B heart failure is essential, as they remain at high risk for developing symptomatic heart failure 1
• The trajectory of LVEF over time is important to evaluate, as patients with mildly reduced EF may be in a dynamic trajectory toward improvement or deterioration 1

Relationship to Other Classification Systems

Stage B heart failure typically includes patients who would be classified as NYHA Class I (no limitations on physical activity) if they have structural heart disease 1