As previously stated, this classification recognizes that there are established risk factors and structural prerequisites for the development of HF and that therapeutic interventions performed even before the appearance of left ventricular dysfunction or symptoms can reduce the morbidity and mortality of HF.
This classification system is intended to complement but not to replace the New York Heart Association (NYHA) functional classification, which primarily gauges the severity of symptoms in patients who are in stage C or D.
PATIENTS AT HIGH RISK OF DEVELOPING LEFT VENTRICULAR DYSFUNCTION (STAGE A)
Many conditions or behaviors that are associated with an increased risk of HF can be identified before patients show any evidence of structural heart disease. Early modification and treatment of these factors can often reduce the risk of HF, providing the most precocious opportunity to reduce the impact of HF on public and individual health.
The recommendations for patients at high risk of developing HF (Stage A) can be summarized as follows:
Class I recommendations
Control of systolic and diastolic hypertension in accordance with recommended guidelines. (Level of Evidence: A)
Treatment of lipid disorders in accordance with recommended guidelines. (Level of Evidence: B)
Avoidance of patient behaviors that may increase the risk of HF (e.g., smoking, alcohol consumption, and illicit drug use). (Level of Evidence: C)
Control of ventricular rate in patients with supraventricular tachyarrhythmias. (Level of Evidence: B)
Treatment of thyroid disorders. (Level of Evidence: C)
Periodic evaluation for signs and symptoms of HF. (Level of Evidence: C)
Non-invasive evaluation of left ventricular function in patients with a strong family history of cardiomyopathy or in those receiving cardiotoxic interventions. (Level of Evidence: C)