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Stages Stage A Patients at high risk for CHF but without structural heart disease or symptoms of CHF e.g.

, Patients with systolic hypertension, coronary artery disease (CAD), or diabetes mellitus (DM) OR Hx of cardiotoxic drugs, alcohol abuse, rheumatic fever, or FHx of cardiomyopathy Stage B Patients with a structural disorder of the heart but without symptoms of CHF e.g., Patients with LVSD (left ventricular hypertrophy, fibrosis, dilatation); previous MI; asymptomatic vascular disease Stage C Patients with past or current symptoms of CHF associated with structural heart disease e.g., Patients with known structural heart disease, shortness of breath and fatigue due to LVSD, reduced exercise tolerance. Asymptomatic patients who are undergoing treatment for prior symptoms of HF Stage D End-stage disease; Refractory CHF requiring specialized interventions e.g., Patients who have marked symptoms at rest despite maximal medical therapy (recurrent hospitalization or cannot be safely discharged from hospital without specialized interventions)

Therapy Treat hypertension Encourage smoking cessation Treat lipid disorders Encourage regular exercise Discourage alcohol intake, illicit drug use ACEI in patients with a Hx of atherosclerotic vascular disease, DM, or hypertension and associated cardiovascular risk factors All measures under Stage A ACEI in patients with either a Hx of recent or remote MI or with low ejection fraction Beta-blockers in patients either with recent Hx of MI or with low ejection fraction All measures under Stage A Drugs for routine use: Diuretics ACEI Beta-blockers Digoxin Dietary salt restriction

All measures under Stages A, B, and C Mechanical assist devices Heart transplantation. Continuous intravenous inotropic infusions for palliation Hospice care