Clinical Guidelines for Heart Failure

To get the best care for heart failure (HF), talking frankly with your healthcare team is a good place to start. It’s also helpful to know about a resource published by health experts that outlines treatment plans advised for people with chronic heart failure.

Since 1980, the American College of Cardiology (ACC) and the American Heart Association (AHA) have published clinical guidelines to help healthcare providers create care plans for their patients. The guidelines are based on scientific research and medical evidence.

An overview

The guidelines are written for medical people so the language is technical and focuses on clinical information. Understanding the basics of the guidelines can help you take a more active role in your treatment. You’ll also be able to ask questions that can help you receive the best care.

The guidelines offer information for healthcare providers on doing a thorough checkup to detect heart failure and evaluate how serious it is. They guide the healthcare provider in what symptoms to look for and what screenings may be needed (such as lab or exercise tests) to gather more information.

According to the guidelines, a person who is at risk for or who has HF falls into 1 of the following stages of the disease:

• Stage A: At Risk for HF A person who is at high risk for heart failure but has no problem with their heart structure and does not have symptoms of heart failure

• Stage B: Pre- HF A person who has evidence of a problem with their heart structure. This can be increased filling pressures or risk factors from stage A and increased levels of levels of B-type natriuretic peptide (BNP). It can also be persistently elevated cardiac troponin, which indicates your heart muscle is injured. They do not have symptoms of heart failure

• Stage C: Symptomatic HF A person who already has, or who has had in the past, heart failure symptoms which have to do with structural heart disease

• Stage D: Advanced HF A person who has marked HF symptoms that interfere with daily life. They also have recurrent hospitalizations despite medical therapy. This is the most serious stage

Only people in stages C and D are already in heart failure. There is an additional set of categories for the management of these people. This is called the New York Heart Association functional classification. Don't confuse this with the ACC/AHA staging method above. 

The guidelines suggest specific treatments and actions for each stage. Once you know the stage you are in you can learn which treatments the guidelines suggest. For example, for people in Stage A focus on treating risk factors. These include high blood pressure, smoking, and drinking. The guidelines suggest specific medicines and certain medical tests or procedures for all stages.

The guidelines also advise healthcare providers to take a multidisciplinary approach to your care. This means your healthcare provider teams up with other healthcare specialists to treat you. These are specialists such as nurses, exercise physiologists, and smoking-cessation experts. Your healthcare team may suggest that you participate in support groups or visit certain specialists to help you make lifestyle changes to manage heart disease.

Take a proactive role

The guidelines are designed to apply to most people in most cases. They give healthcare providers a range of treatment choices. The main decisions rest with the healthcare provider and with you. Remember that you are the most important member of your healthcare team. Asking questions about your treatment is smart and responsible. It’s your right to know your healthcare team’s goals for you and how clinical guidelines compare with your care plan. It's important that you understand the approach to your care plan and that you arrive at it together with your healthcare provider.