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Clinical Guidelines for Heart Failure

To receive the best care for heart failure, talking frankly with your health care team is a good place to start. It’s also helpful to know about a resource published by health experts that outlines treatment plans recommended for patients with chronic heart failure.

Since 1980, the American College of Cardiology and the American Heart Association have jointly published clinical guidelines to help health care providers create good care plans for their patients. The guidelines are based on scientific research and medical evidence. One set of guidelines, published in 2005 and updated in 2009, is called Evaluation and Management of Chronic Heart Failure in the Adult.

An overview

The guidelines are written for medical people, so the language is technical and focuses on clinical information. As a patient, 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 tips for health care providers on performing a thorough checkup to detect heart failure and to evaluate how serious it is. They guide the 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 heart failure falls into one of the following stages of the disease:

Stage A: A person who is at high risk for heart failure, but has no problem with his or her heart structure and does not have symptoms of heart failure

Stage B: A person who has a problem with his or her heart structure, but does not have symptoms of heart failure

Stage C: 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: A person who has end-stage heart disease; this is the most serious stage

Only people in stages C and D are already in heart failure. There is a separate set of guidelines for the management of these people, called the New York Heart Association functional classification, which should not be confused with this staging method. 

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, suggested actions focus on treating risk factors, such as high blood pressure, smoking and drinking. For all stages, the guidelines suggest specific medicines and certain medical tests or procedures.

The guidelines also advise health care providers to take a “multidisciplinary approach” to your care. This means that, rather than working alone to treat you, your provider teams up with other health care specialists, such as nurses, exercise physiologists and smoking-cessation experts. Your health care 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 patients in most cases. They give health care providers a range of treatment options. The ultimate decisions rest with the provider and with you. Remember that you are the most important member of your health care team. Asking questions about your treatment is smart and responsible. It’s your right to know your health care team’s goals for you--and how clinical guidelines compare with your care plan.