Congestive heart failure treatment of patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
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Resident Survival Guide |
| Congestive Heart Failure Microchapters |
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Pathophysiology |
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Differentiating Congestive heart failure from other Diseases |
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Diagnosis |
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Treatment |
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Medical Therapy: |
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Surgical Therapy: |
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ACC/AHA Guideline Recommendations
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Specific Groups: |
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Congestive heart failure treatment of patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B) On the Web |
| Congestive Heart Failure Microchapters |
|
Pathophysiology |
|---|
|
Differentiating Congestive heart failure from other Diseases |
|
Diagnosis |
|
Treatment |
|
Medical Therapy: |
|
Surgical Therapy: |
|
ACC/AHA Guideline Recommendations
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|
Specific Groups: |
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Congestive heart failure treatment of patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B) On the Web |
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]
Overview
Patients who have had an myocardial infarction or evidence of left ventricular remodeling are at considerable risk of developing heart failure even if they do not present with any symptoms of heart failure.[1] Reducing the risk of additional injury and retarding the evolution and progression of LV remodeling is thus very important in considerably decreasing the incidence of heart failure. Initial appropriate measures include those listed as Class 1 recommendations for patients in Stage A.
The use of nutritional supplements in patients with a recent or remote MI with or without LV remodeling has not been proved to reduce the risk of heart failure.[2] The aldosterone antagonist eplerenone on the other hand has been shown to reduce morbidity and mortality in patients with low ejection fraction and heart failure after an MI that has already been treated with ACEIs and beta blockers.
Patients with an Acute MI
Various procedures such as the infusion of a fibrinolytic agent or the use of percutaneous coronary intervention can reduce the risk of death and development of heart failure in patients who are experiencing an acute MI[3].[4] [5] Administration of beta blockers combined with ACEIs or ARB in patients with acute MI can decrease the risk of reinfarction or death when initiated within days after the ischemic event, especially in patients whose course is complicated by HF; Those drugs can be administered separately,[6] but the neurohormonal blockade achieved by the combination previously mentioned (beta blockers and ACEIs or ARB) has been demonstrated to produce additive benefits.
Patients With History of MI but Normal Left Ventricular Ejection Fraction
A history of MI, even in patients with normal left ventricular ejection fraction should prompt a vigorous treatment of both hypertension and hyperlipidemia, because of their immense benefit in decreasing the risk of further left ventricular dysfunction especially in patients with a prior ischemic event[7].[8] Patient with a recent MI should also be treated with ACEIs and beta blockers,[9] which have been proven to reduce the risk of death when started days or weeks after an ischemic cardiac event. Evidence from 2 other large-scale studies has shown that long term therapy with an ACEI can also decrease the risk of a major cardiovascular event, even when treatment is initiated months or years after MI[6].[10][11].
Patients with Chronic Reduction of Left Ventricular Ejection Fraction but No Symptoms
As previously discussed, long term treatment with an ACEI have been shown to reduce the risk of HF in patients with ischemic cardiac events without left ventricular dysfunction[12]. This is also true in case of asymptomatic patients with reduced left ventricular function, whether due to a remote ischemic injury or to a nonischemic cardiomyopathy. The usage of ARBs in asymptomatic patients with reduced LVEF have not been fully studied yet and has not been implemented in the treatment of those patients. On the other hand, asymptomatic patients with a low EF have benefited from treatment with ARBs according new studies, particularly in patients who cannot tolerate ACEI. Another important agent recommended in the management of patients with a low EF and no symptoms (especially patients with history of CAD) is beta blockers,[13] although adequate controlled clinical trials are lacking to fully support this recommendation.
No data have been obtained to date to recommend Digoxin in asymptomatic patients with reduced LVEF, except in those with Atrial Fibrillation; the reason behind this, is that Digoxin has only a minimal effect on disease progression in symptomatic patients, [14]so it is unlikely that the drug would be beneficial in those with no symptoms. Calcium Channel Blockers are not recommended as well in patients with asymptomatic reduction of LVEF, but they have not been shown to have adverse effects and may be helpful for the management of concomitant conditions such as hypertension. However, the usage of calcium channel blockers with negative inotropic effects in patients with EF below 40% after MI is not recommended. [15]
Patients whose cardiomyopathy is associated with a rapid arrhythmia of supraventricular origin (e.g. atrial flutter or atrial fibrillation) should be closely monitored because such arrhyhmias may contribute to a further impairment of ventricular function and may either induce or exacerbate the development of cardiomyopathy.[16]
Asymptomatic Patients With Valvular Heart Disease
Patients with severe aortic or mitral valve stenosis or insufficiency should be considered for valvular replacement or surgical repair.[17][18] Poor surgical candidates should be considered for TAVI. Long term therapy with vasodilators as hydralazine and nifedipine has not yet been proven to reduce risk of HF or death in long term studies,[19] however patients with severe aortic insufficiency and preserved LV function may benefit from such treatment to minimize structural changes in the ventricle but these drugs are usually poorly tolerated in this setting.[20]There are no trial or long term studies which prove that these vasodilators are beneficial in severe mitral insufficiency.
2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Chronic Heart Failure in the Adult (DO NOT EDIT) [21]
Patients With Cardiac Structural Abnormalities or Remodeling who have not Developed Heart Failure Symptoms (Stage B) (DO NOT EDIT) [21]
| Class I |
| "1. All Class I recommendations for Stage A should apply to patients with cardiac structural abnormalities who have not developed HF. (Level of Evidence: A, B and C as appropriate) " |
| "2. In patients with structural cardiac abnormalities, including LV hypertrophy, in the absence of a history of MI or ACS, blood pressure should be controlled in accordance with clinical practice guidelines for hypertension to prevent symptomatic HF.[7][22][23][24](Level of Evidence: A) " |
| "3. ACEIs should be used in all patients with a recent or remote history of MI and a reduced EF, In patients intolerant of ACEIs, ARBs are appropriate unless contraindicated.[12][25][26] [27][28][29][30](Level of Evidence: A) " |
| "4. ACEIs should be used in patients with a reduced EF and no symptoms of HF, even if they have not experienced MI.[12] [30](Level of Evidence: A) " |
| "5. Beta-blockers are indicated in all patients without a history of MI who have a reduced LVEF with no HF symptoms. (Level of Evidence: C) " |
| "6. In all patients with a recent or remote history of MI or ACS and reduced EF, evidence-based beta blockers should be used to reduce mortality.[25][26](Level of Evidence: B) " |
| "7. In all patients with a recent or remote history of MI or ACS, statins should be used to prevent symptomatic HF and cardiovascular events.[31][32][33](Level of Evidence: A) " |
| "8. Patients who have not developed HF symptoms should be treated according to contemporary guidelines after an acute MI. (Level of Evidence: C)" |
| "9. Coronary revascularization should be recommended in appropriate patients without symptoms of HF in accordance with contemporary guidelines (see ACC/AHA Guidelines for the Management of Patients With Chronic Stable Angina). (Level of Evidence: A)" |
| "10. Valve replacement or repair should be recommended for patients with hemodynamically significant valvular stenosis or regurgitation and no symptoms of HF in accordance with contemporary guidelines. (Level of Evidence: B) " |
| "11. Patients with HF should receive specific education to facilitate HF self-care.[34][35](Level of Evidence: B) " |
| "12. Exercise training (or regular physical activity) is recommended as safe and effective for patients with HF who are able to participate to improve functional status.[36][37](Level of Evidence: A) " |
| Class III (No Benefit) |
| "1. Digoxin should not be used in patients with low EF, sinus rhythm, and no history of HF symptoms, because in this population, the risk of harm is not balanced by any known benefit. (Level of Evidence: C) " |
| "2. Use of nutritional supplements to treat structural heart disease or to prevent the development of symptoms of HF is not recommended. (Level of Evidence: C) " |
| Class III (harm) |
| "1. Nondihydropyridine calcium channel blockers with negative inotropic effects may be harmful in asymptomatic patients with low LVEF and no symptoms of HF after MI. (Level of Evidence: C) " |
| Class IIa |
| "1.Sodium restriction is reasonable for patients with symptomatic HF to reduce congestive symptoms. (Level of Evidence: C) " |
| "2.Continuous positive airway pressure (CPAP) can be beneficial to increase LVEF and improve functional status in patients with HF and sleep apnea.[38][39](Level of Evidence: B) " |
| "3. Placement of an ICD is reasonable in patients with ischemic cardiomyopathy who are at least 40 days post-MI, have an LVEF of 30% or less, are NYHA functional class I on chronic optimal medical therapy, and have reasonable expectation of survival with a good functional status for more than 1 year.[40] (Level of Evidence: B) "
|
| "4.Cardiac rehabilitation can be useful in clinically stable patients with HF to improve functional capacity, exercise duration, HRQOL, and mortality.[36][41][42](Level of Evidence: B) "
|
| "5.enter info(Level of Evidence: ) " |
| "6.enter info(Level of Evidence: ) " |
| Class IIb |
| "2. Placement of an ICD might be considered in patients without HF who have nonischemic cardiomyopathy and an LVEF less than or equal to 30% who are in NYHA functional class I with chronic optimal medical therapy and have a reasonable expectation of survival with good functional status for more than 1 year. (Level of Evidence: C) " |
Vote on and Suggest Revisions to the Current Guidelines
External Links
- The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult [21]
- 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 [44]
References
- ↑ Flather MD, Yusuf S, Køber L, Pfeffer M, Hall A, Murray G, Torp-Pedersen C, Ball S, Pogue J, Moyé L, Braunwald E (2000). "Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients. ACE-Inhibitor Myocardial Infarction Collaborative Group". Lancet. 355 (9215): 1575–81. PMID 10821360. Retrieved 2011-04-04. Unknown parameter
|month=ignored (help) - ↑ Pitt B, Williams G, Remme W, Martinez F, Lopez-Sendon J, Zannad F, Neaton J, Roniker B, Hurley S, Burns D, Bittman R, Kleiman J (2001). "The EPHESUS trial: eplerenone in patients with heart failure due to systolic dysfunction complicating acute myocardial infarction. Eplerenone Post-AMI Heart Failure Efficacy and Survival Study" (PDF). Cardiovascular Drugs and Therapy / Sponsored by the International Society of Cardiovascular Pharmacotherapy. 15 (1): 79–87. PMID 11504167. Retrieved 2011-04-04. Unknown parameter
|month=ignored (help) - ↑ Guerci AD, Gerstenblith G, Brinker JA, Chandra NC, Gottlieb SO, Bahr RD, Weiss JL, Shapiro EP, Flaherty JT, Bush DE (1987). "A randomized trial of intravenous tissue plasminogen activator for acute myocardial infarction with subsequent randomization to elective coronary angioplasty". The New England Journal of Medicine. 317 (26): 1613–8. doi:10.1056/NEJM198712243172601. PMID 2960897. Retrieved 2011-04-04. Unknown parameter
|month=ignored (help) - ↑ "GISSI-3: effects of lisinopril and transdermal glyceryl trinitrate singly and together on 6-week mortality and ventricular function after acute myocardial infarction. Gruppo Italiano per lo Studio della Sopravvivenza nell'infarto Miocardico". Lancet. 343 (8906): 1115–22. 1994. PMID 7910229. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ "Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators". Lancet. 342 (8875): 821–8. 1993. PMID 8104270. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ 6.0 6.1 Vantrimpont P, Rouleau JL, Wun CC, Ciampi A, Klein M, Sussex B, Arnold JM, Moyé L, Pfeffer M (1997). "Additive beneficial effects of beta-blockers to angiotensin-converting enzyme inhibitors in the Survival and Ventricular Enlargement (SAVE) Study. SAVE Investigators". Journal of the American College of Cardiology. 29 (2): 229–36. PMID 9014971. Retrieved 2011-04-04. Unknown parameter
|month=ignored (help) - ↑ 7.0 7.1 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) - ↑ "Effects of treatment on morbidity in hypertension. II. Results in patients with diastolic blood pressure averaging 90 through 114 mm Hg". JAMA : the Journal of the American Medical Association. 213 (7): 1143–52. 1970. PMID 4914579. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ "A randomized trial of propranolol in patients with acute myocardial infarction. I. Mortality results". JAMA : the Journal of the American Medical Association. 247 (12): 1707–14. 1982. PMID 7038157. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ 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 2011-04-05. Unknown parameter
|month=ignored (help) - ↑ 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 2011-04-05. Unknown parameter
|month=ignored (help) - ↑ 12.0 12.1 12.2 "Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. The SOLVD Investigattors". The New England Journal of Medicine. 327 (10): 685–91. 1992. doi:10.1056/NEJM199209033271003. PMID 1463530. Retrieved 2011-04-05. Unknown parameter
|month=ignored (help) - ↑ Chadda K, Goldstein S, Byington R, Curb JD (1986). "Effect of propranolol after acute myocardial infarction in patients with congestive heart failure". Circulation. 73 (3): 503–10. PMID 3948357. Retrieved 2011-04-05. Unknown parameter
|month=ignored (help) - ↑ "The effect of digoxin on mortality and morbidity in patients with heart failure. The Digitalis Investigation Group". The New England Journal of Medicine. 336 (8): 525–33. 1997. doi:10.1056/NEJM199702203360801. PMID 9036306. Retrieved 2011-04-05. Unknown parameter
|month=ignored (help) - ↑ "The effect of diltiazem on mortality and reinfarction after myocardial infarction. The Multicenter Diltiazem Postinfarction Trial Research Group". The New England Journal of Medicine. 319 (7): 385–92. 1988. doi:10.1056/NEJM198808183190701. PMID 2899840. Retrieved 2011-04-05. Unknown parameter
|month=ignored (help) - ↑ Grogan M, Smith HC, Gersh BJ, Wood DL (1992). "Left ventricular dysfunction due to atrial fibrillation in patients initially believed to have idiopathic dilated cardiomyopathy". The American Journal of Cardiology. 69 (19): 1570–3. PMID 1598871. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ Connolly HM, Oh JK, Orszulak TA, Osborn SL, Roger VL, Hodge DO, Bailey KR, Seward JB, Tajik AJ (1997). "Aortic valve replacement for aortic stenosis with severe left ventricular dysfunction. Prognostic indicators". Circulation. 95 (10): 2395–400. PMID 9170402. Retrieved 2011-04-06. Unknown parameter
|month=ignored (help) - ↑ Bolling SF, Pagani FD, Deeb GM, Bach DS (1998). "Intermediate-term outcome of mitral reconstruction in cardiomyopathy". The Journal of Thoracic and Cardiovascular Surgery. 115 (2): 381–6, discussion 387–8. PMID 9475533. Retrieved 2011-04-06. Unknown parameter
|month=ignored (help) - ↑ Scognamiglio R, Rahimtoola SH, Fasoli G, Nistri S, Dalla Volta S (1994). "Nifedipine in asymptomatic patients with severe aortic regurgitation and normal left ventricular function". The New England Journal of Medicine. 331 (11): 689–94. doi:10.1056/NEJM199409153311101. PMID 8058074. Retrieved 2011-04-06. Unknown parameter
|month=ignored (help) - ↑ Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS, Nishimura RA, Carabello BA, Faxon DP, Freed MD, Lytle BW, O'Gara PT, O'Rourke RA, Shah PM (2008). "2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Journal of the American College of Cardiology. 52 (13): e1–142. doi:10.1016/j.jacc.2008.05.007. PMID 18848134. Retrieved 2011-04-06. Unknown parameter
|month=ignored (help) - ↑ 21.0 21.1 21.2 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
- ↑ Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL; et al. (2003). "Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure". Hypertension. 42 (6): 1206–52. doi:10.1161/01.HYP.0000107251.49515.c2. PMID 14656957.
- ↑ Beckett N, Peters R, Tuomilehto J, Swift C, Sever P, Potter J; et al. (2012). "Immediate and late benefits of treating very elderly people with hypertension: results from active treatment extension to Hypertension in the Very Elderly randomised controlled trial". BMJ. 344: d7541. doi:10.1136/bmj.d7541. PMID 22218098.
- ↑ Staessen JA, Wang JG, Thijs L (2003). "Cardiovascular prevention and blood pressure reduction: a quantitative overview updated until 1 March 2003". J Hypertens. 21 (6): 1055–76. doi:10.1097/01.hjh.0000059044.65882.db. PMID 12777939.
- ↑ 25.0 25.1 Dargie HJ (2001). "Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial". Lancet. 357 (9266): 1385–90. PMID 11356434. Review in: ACP J Club. 2002 Jan-Feb;136(1):7
- ↑ 26.0 26.1 Exner DV, Dries DL, Waclawiw MA, Shelton B, Domanski MJ (1999). "Beta-adrenergic blocking agent use and mortality in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a post hoc analysis of the Studies of Left Ventricular Dysfunction". J Am Coll Cardiol. 33 (4): 916–23. PMID 10091816.
- ↑ Verdecchia P, Sleight P, Mancia G, Fagard R, Trimarco B, Schmieder RE; et al. (2009). "Effects of telmisartan, ramipril, and their combination on left ventricular hypertrophy in individuals at high vascular risk in the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial and the Telmisartan Randomized Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease". Circulation. 120 (14): 1380–9. doi:10.1161/CIRCULATIONAHA.109.865774. PMID 19770395.
- ↑ Pfeffer MA, McMurray JJ, Velazquez EJ, Rouleau JL, Køber L, Maggioni AP; et al. (2003). "Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both". N Engl J Med. 349 (20): 1893–906. doi:10.1056/NEJMoa032292. PMID 14610160. Review in: ACP J Club. 2004 Jul-Aug;141(1):3
- ↑ Pfeffer MA, Braunwald E, Moyé LA, Basta L, Brown EJ, Cuddy TE; et al. (1992). "Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators". N Engl J Med. 327 (10): 669–77. doi:10.1056/NEJM199209033271001. PMID 1386652.
- ↑ 30.0 30.1 Jong P, Yusuf S, Rousseau MF, Ahn SA, Bangdiwala SI (2003). "Effect of enalapril on 12-year survival and life expectancy in patients with left ventricular systolic dysfunction: a follow-up study". Lancet. 361 (9372): 1843–8. doi:10.1016/S0140-6736(03)13501-5. PMID 12788569.
- ↑ Grundy SM, Cleeman JI, Merz CN, Brewer HB, Clark LT, Hunninghake DB; et al. (2004). "Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines". J Am Coll Cardiol. 44 (3): 720–32. doi:10.1016/j.jacc.2004.07.001. PMID 15358046.
- ↑ Scirica BM, Morrow DA, Cannon CP, Ray KK, Sabatine MS, Jarolim P; et al. (2006). "Intensive statin therapy and the risk of hospitalization for heart failure after an acute coronary syndrome in the PROVE IT-TIMI 22 study". J Am Coll Cardiol. 47 (11): 2326–31. doi:10.1016/j.jacc.2006.03.034. PMID 16750703.
- ↑ Sacks FM, Pfeffer MA, Moye LA, Rouleau JL, Rutherford JD, Cole TG; et al. (1996). "The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators". N Engl J Med. 335 (14): 1001–9. doi:10.1056/NEJM199610033351401. PMID 8801446.
- ↑ Boren SA, Wakefield BJ, Gunlock TL, Wakefield DS (2009). "Heart failure self-management education: a systematic review of the evidence". Int J Evid Based Healthc. 7 (3): 159–68. doi:10.1111/j.1744-1609.2009.00134.x. PMID 21631856.
- ↑ Riegel B, Moser DK, Anker SD, Appel LJ, Dunbar SB, Grady KL; et al. (2009). "State of the science: promoting self-care in persons with heart failure: a scientific statement from the American Heart Association". Circulation. 120 (12): 1141–63. doi:10.1161/CIRCULATIONAHA.109.192628. PMID 19720935.
- ↑ 36.0 36.1 Davies EJ, Moxham T, Rees K, Singh S, Coats AJ, Ebrahim S; et al. (2010). "Exercise training for systolic heart failure: Cochrane systematic review and meta-analysis". Eur J Heart Fail. 12 (7): 706–15. doi:10.1093/eurjhf/hfq056. PMC 2891490. PMID 20494922.
- ↑ Piña IL, Apstein CS, Balady GJ, Belardinelli R, Chaitman BR, Duscha BD; et al. (2003). "Exercise and heart failure: A statement from the American Heart Association Committee on exercise, rehabilitation, and prevention". Circulation. 107 (8): 1210–25. PMID 12615804.
- ↑ Arzt M, Floras JS, Logan AG, Kimoff RJ, Series F, Morrison D; et al. (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.
- ↑ Mansfield DR, Gollogly NC, Kaye DM, Richardson M, Bergin P, Naughton MT (2004). "Controlled trial of continuous positive airway pressure in obstructive sleep apnea and heart failure". Am J Respir Crit Care Med. 169 (3): 361–6. doi:10.1164/rccm.200306-752OC. PMID 14597482.
- ↑ Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS; et al. (2002). "Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction". N Engl J Med. 346 (12): 877–83. doi:10.1056/NEJMoa013474. PMID 11907286. Review in: ACP J Club. 2002 Nov-Dec;137(3):81
- ↑ O'Connor CM, Whellan DJ, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ; et al. (2009). "Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial". JAMA. 301 (14): 1439–50. doi:10.1001/jama.2009.454. PMC 2916661. PMID 19351941.
- ↑ Austin J, Williams WR, Ross L, Hutchison S (2008). "Five-year follow-up findings from a randomized controlled trial of cardiac rehabilitation for heart failure". Eur J Cardiovasc Prev Rehabil. 15 (2): 162–7. doi:10.1097/HJR.0b013e3282f10e87. PMID 18391642.
- ↑ 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.
- ↑ 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