New heart failure guidelines from the American College of Cardiology, American Heart Association, and Heart Failure Society of America emphasize treatment as prevention, with both stages being asymptomatic disease.
Amresh Raina, MD, director of the advanced heart failure and pulmonary hypertension program at Allegheny General Hospital and Allegheny Health Network in Pittsburgh, Pennsylvania, recently spoke with The American Journal of Managed Care® how to manage asymptomatic heart failure and what stages of the disease are covered by the guidelines.
What are some of the signs of possible asymptomatic heart failure and what should clinicians and patients know about this condition?
Heart failure guidelines have 2 stages when patients are asymptomatic, called stage A and stage B. Stage A of the paradigm actually corresponds to patients who are at risk of developing heart failure. These patients actually have no structural heart disease and, by definition, have no symptoms. But they have other risk factors that put them at potential risk of developing heart failure. These risk factors are things like high blood pressure, diabetes, being overweight, or mild heart valve problems. If these risk factors are not treated appropriately, these patients could develop structural heart problems and/or possibly heart failure if left untreated.
Stage B of heart failure concerns patients who do present with structural abnormalities of the heart but who are nevertheless clinically asymptomatic. So, for example, in patients with high blood pressure, if high blood pressure is not optimally controlled, the walls of the heart can thicken, and this is a condition called left ventricular hypertrophy. If left unchecked, it can progress to the point where people develop stiffness or eventually weakness in the heart muscle and develop heart failure.
Similarly, if a patient has heart valve narrowing or more than mild heart valve leakage, it may be asymptomatic for a long time, but eventually, if left untreated, it could become symptomatic with shortness of breath and symptoms of heart failure.
Things to look out for, of course, in people and patients with these risk factors [are] to ensure they are handled appropriately. So make sure blood pressure is controlled; that people watch their diet and exercise; that they control their diabetes if they have it; if they are overweight, try to lose weight; if they have sleep apnea, try to treat the sleep apnea. All of these things can control these risk factors to help prevent the development of symptomatic heart failure. But asymptomatic patients should also undergo some kind of screening tests to assess their heart function over time.
For example, an echocardiogram is a typical screening test to assess structural abnormalities of the heart. We also use laboratory tests such as metabolic panels and natriuretic peptide levels. Things like proBNP [B-type natriuretic peptide] or BNP are hormones that are released in the body in response to stress on the walls of the heart or overt congestive heart failure, fluid retention.
These are things that clinicians may recommend for patients who have risk factors for stage A or B heart failure.