Patients at High Risk for Developing Heart Failure (Stage A)

CLASS I
(1) In patients at high risk for developing HF, systolic and diastolic hypertension should be controlled in accordance with contemporary guidelines.

(2) In patients at high risk for developing HF, lipid disorders should be treated in accordance with contemporary guidelines.

(3) For patients with diabetes mellitus (who are all at high risk for developing HF), blood sugar should be controlled in accordance with contemporary guidelines.

(4) Patients at high risk for developing HF should be counseled to avoid behaviors that may increase the risk of HF (e.g., smoking, excessive alcohol consumption, and illicit drug use).

(5) Ventricular rate should be controlled or sinus rhythm restored in patients with supraventricular tachyarrhythmias who are at high risk for developing HF.

(6) Thyroid disorders should be treated in accordance with contem- porary guidelines in patients at high risk for developing HF.

(7) Healthcare providers should perform periodic evaluation for signs and symptoms of HF in patients at high risk for developing HF.

(8) In patients at high risk for developing HF who have known atherosclerotic vascular disease, healthcare providers should follow current guidelines for secondary prevention.

(9) Healthcare providers should perform a noninvasive evaluation of LV function (i.e., LVEF) in patients with a strong family history of cardiomyopathy or in those receiving cardiotoxic interventions.


CLASS IIa
(1) Angiotensin converting enzyme inhibitors can be useful to prevent HF in patients at high risk for developing HF who have a history of atherosclerotic vascular disease, diabetes mellitus, or hypertension with associated cardiovascular risk factors.

(2) Angiotensin II receptor blockers can be useful to prevent HF in patients at high risk for developing HF who have a history of atherosclerotic vascular disease, diabetes mellitus, or hypertension with associated cardiovascular risk factors.

CLASS III
(1) Routine use of nutritional supplements solely to prevent the development of structural heart disease should not be recommended for patients at high risk for developing HF.


JACC. 2009; 53; e1-e90