Congestive heart failure treatment of patients at high risk for developing heart failure (Stage A)

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Acute Pharmacotherapy
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Chronic Pharmacotherapy in HFrEF
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Biventricular Pacing or Cardiac Resynchronization Therapy (CRT)
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ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
Patients with current or prior symptoms of heart failure (Stage C)
Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
Quality Metrics/Performance Measures

Implementation of Practice Guidelines

Congestive heart failure end-of-life considerations

Specific Groups:

Special Populations
Patients who have concomitant disorders
Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Saleh El Dassouki, M.D. [2]; Lakshmi Gopalakrishnan, M.B.B.S. [3]Mahmoud Sakr, M.D. [4],Seyedmahdi Pahlavani, M.D. [5], Edzel Lorraine Co, D.M.D., M.D. [6]


Overview

Early detection and mitigation of risk factors associated with the subsequent development of heart failure may have a tremendous impact on public and individual health.

Treatment of Hypertension

Controlling both systolic and diastolic hypertension has been associated with a significant reduction in the risk of subsequent HF.[1] Control of systolic blood pressure is consistently associated with a 50% reduction in new heart failure. Other complications of hypertension include left ventricular hypertrophy (LVH), MI, stroke and sudden death.[2]In the Framingham heart study, hypertension was present in 39% of men and in 59% of women with heart failure. These numbers emphasize the importance of managing hypertension at an early stage to avoid complications such as heart failure.

Lowering both systolic and diastolic blood pressure in accordance with the recommendations provided in published guidelines has proven its effectiveness in lowering systemic vascular resistance, improving ventricular remodeling and decreasing hemodynamic load on the failing ventricle in patients with established heart failure. The treatment of hypertension in patients with HF should take into consideration the type of heart failure that is present: In systolic dysfunction the biggest problem is the impaired contractility whereas in diastolic dysfunction, the main issue is the limitation of diastolic filling and therefore abnormal forward cardiac output due to increased ventricular stiffness.

When any anti-hypertensive regimen is prescribed, an important aspect to keep in mind is the presence of concomitant medical problems as CAD, diabetes, renal disease, pulmonary disease in many patients suffering from HF, which requires the health care providers to keep in mind the priority of lowering blood pressure while trying not to affect the treatment of those diseases.

Diuretic-based antihypertensive therapy has repeatedly been shown to prevent HF in a wide range of target populations.[3]Patients may also benefit from the usage of ACE inhibitors(ACEIs) and beta blockers, which are proven to be effective in preventing HF in hypertensive individuals. However, ACEIs and beta blockers, as single therapies, are not superior to other antihypertensive drug classes in the reduction of all cardiovascular outcomes.

Nevertheless, among patients with diabetes and other cardiovascular complications, ACEIs have shown to reduce the onset of HF and progression of nephropathy.[4]Another significant reduction of HF incidence in comparison to placebo in patients with type 2 diabetes mellitus and nephropathy has been achieved by the usage of ARB’s losartan and irbesartan.[5] As previously mentioned an ultimate and appropriate hypertensive treatment would take into consideration all the concomitant diseases in an HF patient, and would involve multiple drugs used in combination.

Treatment of Diabetes Mellitus

Diabetes increases the risk of HF in all patients groups whether coronary heart disease or hypertension is present and it may cause cardiomyopathy.[6] A gender difference in terms of HF risk in diabetic patients is present, since the increase of HF for diabetic men is 3 times less than that for a diabetic woman.[7] In a study of patients with type 2 diabetes mellitus over 50 years old, with urinary albumin greater than 20 mg/l, 4% of patients developed HF over the study period, of whom 36 % died.[8] Health care providers should closely monitor hyperglycemia and target a certain blood glucose level to avoid end-organ complications in such patients since each 1% increase in (Hb)A1c is associated with an 8% increase risk of heart failure, and an (Hb)A1c > 10 increases the risk of CHF by 1.56 compared to an (Hb)A1c less than 7 [9][10]ACEIs and ARBs have been proven to reduce the development of end-organ disease and the occurrence of clinical events in diabetic patients even when hypertension is not present. Long term treatment with ACEIs and ARBs has been shown to lower various dangerous complications in diabetic patients such as renal disease and prolonged treatment with ACEI ramipril has been shown to decrease the event of cardiovascular death, MI, and CHF. Long term therapy with ARBs has also been proven to lower cardiovascular complication, decreasing the incidence of first HF hospitalization and improving renal function in diabetic patients.[11]

Management of Metabolic Syndrome

The metabolic syndrome or syndrome X is mainly linked to obesity (mainly abdominal obesity), insulin resistance, hypertriglyceridemia, low HDL, hypertension and fasting hyperglycemia. Those combined metabolic risks promotes vascular endothelial dysfunction, vascular inflammation and thus, the development of atherosclerotic cardiovascular disease.[12] The major complication of metabolic syndrome is coronary artery disease which in turn increases the incidence of congestive heart failure in the general population;[13] For this reason, the appropriate management of hypertension, diabetes mellitus, and dyslipedemia can significantly reduce the risk of developing CHF.

Management of Anemia

Routine baseline assessment of all patients with HF includes an evaluation for anemia in addition to other baseline laboratory measurements. Anemia is independently associated with HF disease severity, and iron deficiency appears to be uniquely associated with reduced exercise capacity. When iron deficiency is diagnosed and after full evaluation for cause, intravenous repletion of iron, especially in the setting of concomitant hepcidin deficiency in HF, may improve exercise capacity and quality of life.

Management of Atherosclerotic Disease

Atherosclerotic diseases (eg., of the coronary, cerebral, peripheral blood vessels) are an important risk factor in the development of CHF.[14] A series of different large scale studies involving the long term usage of ACEIs, produced mixed data and recommendations.[15] In one study, the treatment with ACEIs proved to decrease the risk of the primary endpoint of cardiovascular death, MI and stroke in patients with previous vascular disease who were without evidence of HF or reduced LVEF at the time of randomization, but the incidence of HF was not a primary or secondary endpoint, although it was improved.[4] A more recent trial of ACEIs versus placebo didn’t prove to be effective in reducing the primary composite endpoint, although a post hoc analysis did show a decrease in HF hospitalization.

Those various findings led the AHA to change the level of recommendation for the use of ACEIs for stage A patients from Class 1 to Class 2a[16]. Treatment of hyperlipidemia has also been shown to reduce the risk of death and of HF in patients with a history of MI.

Sleep Disordered Breathing

Sleep disorders are common in patients with HF. A study of adults with chronic HF treated with evidence-based therapies found that 61% had either central or obstructive sleep apnea. It is clinically important to distinguish obstructive sleep apnea from central sleep apnea, given the different responses to treatment. Adaptive servo-ventilation for central sleep apnea is associated with harm. Continuous positive airway pressure (CPAP) for obstructive sleep apnea improves sleep quality, reduces the apnea-hypopnea index, and improves nocturnal oxygenation.[17][18]

Control of Conditions That May Cause Heart Failure

Cardiotoxic effect of various agents and substances should be closely controlled, especially in patients at higher risk of developing HF. Smoking, alcohol, amphetamines, cocaine and other illicit drugs are some of the most common substances that patients should be advised about. Several HF programs limit alcoholic beverage consumption to no more than one alcoholic beverage a day for all the patients with LV dysfunction, regardless of cause[19]. Cardiac injuries could be sustained from other causes and interventions, such as ionizing radiation involving the mediastinum, chemotherapeutic agents such as anthracyclines, immunotherapy such as trastuzumab, or high dose-cyclophosphamide.[20] Trastuzumab in particular when combined with anthracyclines increase the risk of HF and may occur years after the initial exposure.

2022 AHA/ACC/HFSA Heart Failure Guideline/ 2013 ACC/AHA Guideline/ 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure/2013 ACC/AHA Guideline, 2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Heart Failure in the Adult (DO NOT EDIT)[21] [22][23]

Patients at High Risk of HF (Stage A: Primary Prevention) (DO NOT EDIT)[21] [22][23]

Class I
"1. In patients with hypertension, blood pressure should be controlled in accordance with GDMT for hypertension to prevent symptomatic HF. [24][25][1][26][27][28][29][7][30] (Level of Evidence: A) "
"2. In patients with type 2 diabetes and either established CVD or at high cardiovascular risk, SGLT2i should be used to prevent hospitalization for HF. [31][32][33] (Level of Evidence: A) "
"3. In the general population, healthy lifestyle habits such as regular physical activity, maintaining normal weight, healthy dietary patterns, and avoiding smoking are helpful to reduce future risk of HF.[34][35][36][36][37][38][39][40][41][42] (Level of Evidence: B-NR) "
Class IIa
"4. For patients at risk of developing HF, natriuretic peptide biomarker-based screening followed by team-based care, including a cardiovascular specialist optimizing GDMT, can be useful to prevent the development of LV dysfunction (systolic or diastolic) or new-onset HF.[43][44] (Level of Evidence: B-R) "
"5. In the general population, validated multivariable risk scores can be useful to estimate subsequent risk of incident HF.[45][46](Level of Evidence: A) "
Stage A and Stage B recommendations for HF. Adapted from 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure
Stage A and Stage B recommendations for HF. Adapted from 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure


Vote on and Suggest Revisions to the Current Guidelines

External Links

References

  1. ↑ 1.0 1.1 Kostis JB, Davis BR, Cutler J, Grimm RH, Berge KG, Cohen JD, Lacy CR, Perry HM, Blaufox MD, Wassertheil-Smoller S, Black HR, Schron E, Berkson DM, Curb JD, Smith WM, McDonald R, Applegate WB (1997). "Prevention of heart failure by antihypertensive drug treatment in older persons with isolated systolic hypertension. SHEP Cooperative Research Group". JAMA : the Journal of the American Medical Association. 278 (3): 212–6. PMID 9218667. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  2. ↑ Swamy RS, Lang RM (2010). "Echocardiographic quantification of left ventricular mass: prognostic implications". Current Cardiology Reports. 12 (3): 277–82. doi:10.1007/s11886-010-0104-y. PMID 20424973. Retrieved 2011-03-28. Unknown parameter |month= ignored (help)
  3. ↑ Staessen JA, Wang JG, Thijs L (2003). "Cardiovascular prevention and blood pressure reduction: a quantitative overview updated until 1 March 2003". Journal of Hypertension. 21 (6): 1055–76. doi:10.1097/01.hjh.0000059044.65882.db. PMID 12777939. Retrieved 2011-03-28. Unknown parameter |month= ignored (help)
  4. ↑ 4.0 4.1 Fox KM (2003). "Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study)". Lancet. 362 (9386): 782–8. PMID 13678872. Retrieved 2011-03-28. Unknown parameter |month= ignored (help)
  5. ↑ Berl T, Hunsicker LG, Lewis JB, Pfeffer MA, Porush JG, Rouleau JL, Drury PL, Esmatjes E, Hricik D, Parikh CR, Raz I, Vanhille P, Wiegmann TB, Wolfe BM, Locatelli F, Goldhaber SZ, Lewis EJ (2003). "Cardiovascular outcomes in the Irbesartan Diabetic Nephropathy Trial of patients with type 2 diabetes and overt nephropathy". Annals of Internal Medicine. 138 (7): 542–9. PMID 12667024. Retrieved 2011-03-28. Unknown parameter |month= ignored (help)
  6. ↑ Taegtmeyer H, McNulty P, Young ME (2002). "Adaptation and maladaptation of the heart in diabetes: Part I: general concepts". Circulation. 105 (14): 1727–33. PMID 11940554. Retrieved 2011-03-29. Unknown parameter |month= ignored (help)
  7. ↑ 7.0 7.1 Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK (1996). "The progression from hypertension to congestive heart failure". JAMA : the Journal of the American Medical Association. 275 (20): 1557–62. PMID 8622246. |access-date= requires |url= (help)
  8. ↑ Vaur L, Gueret P, Lievre M, Chabaud S, Passa P (2003). "Development of congestive heart failure in type 2 diabetic patients with microalbuminuria or proteinuria: observations from the DIABHYCAR (type 2 DIABetes, Hypertension, CArdiovascular Events and Ramipril) study". Diabetes Care. 26 (3): 855–60. PMID 12610049. Retrieved 2011-03-29. Unknown parameter |month= ignored (help)
  9. ↑ Kasiske BL, Kalil RS, Ma JZ, Liao M, Keane WF (1993). "Effect of antihypertensive therapy on the kidney in patients with [[diabetes]]: a meta-regression analysis". Annals of Internal Medicine. 118 (2): 129–38. PMID 8416309. Retrieved 2011-03-29. Unknown parameter |month= ignored (help); URL–wikilink conflict (help)
  10. ↑ Lewis EJ, Hunsicker LG, Bain RP, Rohde RD (1993). "The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. The Collaborative Study Group". The New England Journal of Medicine. 329 (20): 1456–62. doi:10.1056/NEJM199311113292004. PMID 8413456. Retrieved 2011-03-29. Unknown parameter |month= ignored (help)
  11. ↑ Fox KM (2003). "Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study)". Lancet. 362 (9386): 782–8. Retrieved 2011-03-29. Unknown parameter |month= ignored (help)
  12. ↑ Wilson PW, Grundy SM (2003). "The metabolic syndrome: practical guide to origins and treatment: Part I". Circulation. 108 (12): 1422–4. doi:10.1161/01.CIR.0000089505.34741.E5. PMID 14504251. Retrieved 2011-03-30. Unknown parameter |month= ignored (help)
  13. ↑ Grundy SM, Cleeman JI, Merz CN, Brewer HB, Clark LT, Hunninghake DB, Pasternak RC, Smith SC, Stone NJ (2004). "Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines". Journal of the American College of Cardiology. 44 (3): 720–32. doi:10.1016/j.jacc.2004.07.001. PMID 15358046. Retrieved 2011-03-30. Unknown parameter |month= ignored (help)
  14. ↑ Smith SC, Blair SN, Bonow RO, Brass LM, Cerqueira MD, Dracup K, Fuster V, Gotto A, Grundy SM, Miller NH, Jacobs A, Jones D, Krauss RM, Mosca L, Ockene I, Pasternak RC, Pearson T, Pfeffer MA, Starke RD, Taubert KA (2001). "AHA/ACC Scientific Statement: AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 update: A statement for healthcare professionals from the American Heart Association and the American College of Cardiology". Circulation. 104 (13): 1577–9. PMID 11571256. Retrieved 2011-03-30. Unknown parameter |month= ignored (help)
  15. ↑ Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G (2000). "Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators". The New England Journal of Medicine. 342 (3): 145–53. doi:10.1056/NEJM200001203420301. PMID 10639539. Retrieved 2011-03-30. Unknown parameter |month= ignored (help)
  16. ↑ Braunwald E, Domanski MJ, Fowler SE, Geller NL, Gersh BJ, Hsia J, Pfeffer MA, Rice MM, Rosenberg YD, Rouleau JL (2004). "Angiotensin-converting-enzyme inhibition in stable coronary artery disease". The New England Journal of Medicine. 351 (20): 2058–68. doi:10.1056/NEJMoa042739. PMC 2556374. PMID 15531767. Retrieved 2011-03-30. Unknown parameter |month= ignored (help)
  17. ↑ Arzt M, Floras JS, Logan AG, Kimoff RJ, Series F, Morrison D, Ferguson K, Belenkie I, Pfeifer M, Fleetham J, Hanly P, Smilovitch M, Ryan C, Tomlinson G, Bradley TD (2007). "Suppression of central sleep apnea by continuous positive airway pressure and transplant-free survival in heart failure: a post hoc analysis of the Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure Trial (CANPAP)". Circulation. 115 (25): 3173–80. doi:10.1161/CIRCULATIONAHA.106.683482. PMID 17562959.
  18. ↑ Somers VK (2005). "Sleep--a new cardiovascular frontier". N. Engl. J. Med. 353 (19): 2070–3. doi:10.1056/NEJMe058229. PMID 16282183.
  19. ↑ Abramson JL, Williams SA, Krumholz HM, Vaccarino V (2001). "Moderate alcohol consumption and risk of heart failure among older persons". JAMA : the Journal of the American Medical Association. 285 (15): 1971–7. PMID 11308433. Retrieved 2011-04-01. Unknown parameter |month= ignored (help)
  20. ↑ Sparano JA (2001). "Cardiac toxicity of trastuzumab (Herceptin): implications for the design of adjuvant trials". Seminars in Oncology. 28 (1 Suppl 3): 20–7. PMID 11301371. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  21. ↑ 21.0 21.1 Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM; et al. (2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (18): e876–e894. doi:10.1161/CIR.0000000000001062. PMID 35363500 Check |pmid= value (help).
  22. ↑ 22.0 22.1 22.2 Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE; et al. (2013). "2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. doi:10.1016/j.jacc.2013.05.019. PMID 23747642.
  23. ↑ 23.0 23.1 23.2 Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 119 (14):1977-2016.DOI:10.1161/CIRCULATIONAHA.109.192064 PMID: 19324967
  24. ↑ Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D; et al. (2008). "Treatment of hypertension in patients 80 years of age or older". N Engl J Med. 358 (18): 1887–98. doi:10.1056/NEJMoa0801369. PMID 18378519. Review in: J Fam Pract. 2008 Aug;57(8):506-7 Review in: ACP J Club. 2008 Aug 19;149(2):10 Review in: Evid Based Med. 2008 Oct;13(5):136
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  33. ↑ Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S; et al. (2015). "Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes". N Engl J Med. 373 (22): 2117–28. doi:10.1056/NEJMoa1504720. PMID 26378978. Review in: Ann Intern Med. 2016 Jan 19;164(2):JC2
  34. ↑ Del Gobbo LC, Kalantarian S, Imamura F, Lemaitre R, Siscovick DS, Psaty BM; et al. (2015). "Contribution of Major Lifestyle Risk Factors for Incident Heart Failure in Older Adults: The Cardiovascular Health Study". JACC Heart Fail. 3 (7): 520–528. doi:10.1016/j.jchf.2015.02.009. PMC 4508377. PMID 26160366.
  35. ↑ Wang Y, Tuomilehto J, Jousilahti P, Antikainen R, Mähönen M, Katzmarzyk PT; et al. (2011). "Lifestyle factors in relation to heart failure among Finnish men and women". Circ Heart Fail. 4 (5): 607–12. doi:10.1161/CIRCHEARTFAILURE.111.962589. PMID 21914814.
  36. ↑ 36.0 36.1 Young DR, Reynolds K, Sidell M, Brar S, Ghai NR, Sternfeld B; et al. (2014). "Effects of physical activity and sedentary time on the risk of heart failure". Circ Heart Fail. 7 (1): 21–7. doi:10.1161/CIRCHEARTFAILURE.113.000529. PMID 24449810.
  37. ↑ Hu G, Jousilahti P, Antikainen R, Katzmarzyk PT, Tuomilehto J (2010). "Joint effects of physical activity, body mass index, waist circumference, and waist-to-hip ratio on the risk of heart failure". Circulation. 121 (2): 237–44. doi:10.1161/CIRCULATIONAHA.109.887893. PMID 20048205.
  38. ↑ Folsom AR, Shah AM, Lutsey PL, Roetker NS, Alonso A, Avery CL; et al. (2015). "American Heart Association's Life's Simple 7: Avoiding Heart Failure and Preserving Cardiac Structure and Function". Am J Med. 128 (9): 970–6.e2. doi:10.1016/j.amjmed.2015.03.027. PMC 4554769. PMID 25908393.
  39. ↑ Tektonidis TG, Åkesson A, Gigante B, Wolk A, Larsson SC (2016). "Adherence to a Mediterranean diet is associated with reduced risk of heart failure in men". Eur J Heart Fail. 18 (3): 253–9. doi:10.1002/ejhf.481. PMID 26781788.
  40. ↑ Levitan EB, Wolk A, Mittleman MA (2009). "Consistency with the DASH diet and incidence of heart failure". Arch Intern Med. 169 (9): 851–7. doi:10.1001/archinternmed.2009.56. PMC 2682222. PMID 19433696.
  41. ↑ Levitan EB, Wolk A, Mittleman MA (2009). "Relation of consistency with the dietary approaches to stop hypertension diet and incidence of heart failure in men aged 45 to 79 years". Am J Cardiol. 104 (10): 1416–20. doi:10.1016/j.amjcard.2009.06.061. PMC 2774905. PMID 19892061.
  42. ↑ Lara KM, Levitan EB, Gutierrez OM, Shikany JM, Safford MM, Judd SE; et al. (2019). "Dietary Patterns and Incident Heart Failure in U.S. Adults Without Known Coronary Disease". J Am Coll Cardiol. 73 (16): 2036–2045. doi:10.1016/j.jacc.2019.01.067. PMC 6501554 Check |pmc= value (help). PMID 31023426.
  43. ↑ Ledwidge M, Gallagher J, Conlon C, Tallon E, O'Connell E, Dawkins I; et al. (2013). "Natriuretic peptide-based screening and collaborative care for heart failure: the STOP-HF randomized trial". JAMA. 310 (1): 66–74. doi:10.1001/jama.2013.7588. PMID 23821090. Review in: Evid Based Med. 2014 Jun;19(3):107
  44. ↑ Huelsmann M, Neuhold S, Resl M, Strunk G, Brath H, Francesconi C; et al. (2013). "PONTIAC (NT-proBNP selected prevention of cardiac events in a population of diabetic patients without a history of cardiac disease): a prospective randomized controlled trial". J Am Coll Cardiol. 62 (15): 1365–72. doi:10.1016/j.jacc.2013.05.069. PMID 23810874.
  45. ↑ Kannel WB, D'Agostino RB, Silbershatz H, Belanger AJ, Wilson PW, Levy D (1999). "Profile for estimating risk of heart failure". Arch Intern Med. 159 (11): 1197–204. doi:10.1001/archinte.159.11.1197. PMID 10371227.
  46. ↑ Butler J, Kalogeropoulos A, Georgiopoulou V, Belue R, Rodondi N, Garcia M; et al. (2008). "Incident heart failure prediction in the elderly: the health ABC heart failure score". Circ Heart Fail. 1 (2): 125–33. doi:10.1161/CIRCHEARTFAILURE.108.768457. PMC 2748334. PMID 19777072.
  47. ↑ Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW (May 2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (18): e895–e1032. doi:10.1161/CIR.0000000000001063. PMID 35363499 Check |pmid= value (help).
  48. ↑ Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202

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