Patients at High Risk for Developing
Left Ventricular Dysfunction (Stage A)

Many conditions or behaviors that are associated with an increased risk of Heart Failure (HF) can be identified before patients show any evidence of structural heart disease. Because early modification of these factors can often reduce the risk of HF, working with patients with these risk factors provides the earliest opportunity to reduce the impact of HF on public and individual health. ¹

Control of Risk

• Treatment of hypertension— Elevated levels of either systolic or diastolic blood pressure are a major risk factor for the development of HF, and long-term treatment of both systolic and diastolic hypertension has been shown to reduce the risk of HF. Physicians should lower both systolic and diastolic blood pressure in accordance with the recommendations provided in published guidelines using diuretics, ACE inhibitors and / or beta blockers.¹
  
• Treatment of diabetes— Diabetes markedly increases the likelihood of HF in patients without structural heart disease, and adversely affects the outcomes of patients with established HF. Although control of hyperglycemia has not been shown to reduce the subsequent risk of HF; every effort should be made to control it.¹
  
• Management of Atherosclerotic Disease— Patients with known atherosclerotic disease are likely to develop HF, therefore, physicians should seek to control vascular risk factors. Treatment of hyperlipidemia in accordance with published guidelines has been shown to reduce the likelihood of death and of HF in patients with a history of MI.¹
  
• Control of Conditions that May Cause Cardiac Injury— Many therapeutic and recreational agents can exert important cardiotoxic effects and patients should be strongly counseled about the hazards of smoking, as well as the use of alcohol, cocaine and other illicit drugs. In addition, several interventions used in the treatment of cancer can injure the heart and lead to the development of HF, even in patients with no other cardiovascular risk factors.¹
  
• Other Measures— There is no evidence that control of dietary sodium or participation in regular exercise can prevent the development of HF in normal individuals or in patients at risk, although these efforts may have other health benefits and may enhance a general sense of well being.¹

Early Detection of Ventricular Dysfunction

While routine periodic assessment of left ventricular function in the general population is not recommended, it appears reasonable to perform echocardiographic evaluation in selected patients without apparent structural heart disease who are at high risk of cardiomyopathy (e.g., those with a strong family history of cardiomyopathy or those receiving cardiotoxic interventions).¹

For more information on treating specific stages of heart failure, click on the following topics:

Patients at High Risk for Developing Left Ventricular Dysfunction (Stage A)
Patients with Left Ventricular Dysfunction Who Have Not Developed Symptoms (Stage B)
Patients With Left Ventricular Dysfunction With Current or Prior Symptoms (Stage C)
Patients with Refractory End-Stage HF (Stage D)

References