Treatment of heart failure according to the stage of the disease

The article was professionally consulted by Specialist Doctor II Nguyen Quoc Viet - Interventional Cardiologist - Department of Medical Examination & Internal Medicine - Vinmec Danang International General Hospital.

Treatment of heart failure is divided into 4 levels according to each stage A, B, C and D. There are 2 main treatment options: medication and non-drug treatment. The goals of heart failure treatment are to reduce symptoms, limit hospitalization, and prolong survival.

At initial stage A, the patient was only at high risk for heart failure, but without structural heart disease or typical heart failure symptoms. Therefore, it is necessary to first correct an unhealthy lifestyle or treat diseases with high risk of heart failure, such as:
Hypertension, dyslipidemia and diabetes: Treatment according to the right plan and need to achieve the goals. Tachyarrhythmias: Control ventricular rhythm or restore sinus rhythm. Hypothyroidism or Hyperthyroidism: Treat thyroid disease as recommended. Smokers, drinkers, or drug addicts: Advise patients to avoid substances that increase heart failure. In addition, the doctor can also prescribe appropriate treatment depending on the specific case, for example:
Measure the EF ejection fraction by echocardiography for patients with a family or personal history of the disease. about heart. ACE inhibitors in patients with a history of atherosclerosis, diabetes, hypertension or other cardiovascular factors. Angiotensin II receptor blocker (effectively similar to ACE Inhibitor). Beta-blockers if not contraindicated.

When a patient already has structural heart disease but has not yet shown any symptoms of heart failure, he or she is classified as stage B. Treatment measures include:
Similar to all indications applied in stage A β-Inhibitors or ACE-Inhibitors: Patients after myocardial infarction. β-blockers and ACE-inhibitors: Patients with reduced EF ejection fraction. ACE inhibitors: Patients with hypertension with left ventricular hypertrophy. Angiotensin II receptor blockers: In patients after myocardial infarction, EF decreases and is not tolerated by ACE inhibitors. Coronary artery reperfusion. Valve repair or valve replacement surgery. Implant a defibrillator pacemaker (ICD). On the other hand, it is reasonable to use ivabradine alone when β-blocker-treated patients have a heart rate > 70 beats/min. A number of randomized clinical studies have shown that the use of digoxin and calcium channel blockers has no therapeutic effect, sometimes even causing harm in certain patients.

Stage C, also known as grade 3, is defined when a patient has structural heart disease, with a history of or current symptoms of heart failure. Treatment of heart failure grade 3 should be applied strictly according to indications and carefully coordinated, otherwise it may aggravate the condition of heart failure or the patient will drop out of treatment because of side effects.
Treatment of heart failure grade 3 (Stage C) specifically:
All indications of stage A and B. Medication: Diuretic (with salt restriction), β-Inhibitor / ACE / direct sinus node, Ivabradine, Angiotensin II receptor blocker, Digitalis, a combination of Hydralazine with Nitrates, Omega 3 and Aldosterone antagonists (Spironolactone, Eplerenone). Device therapy includes: implantation of a defibrillator pacemaker (ICD), myocardial resynchronization or biventricular pacing (CRT), and the use of a ventricular assist device. Exercise according to a program designed specifically for patients with heart failure. In the treatment of grade 3 heart failure, the following should not be done:
An ACE inhibitor and/or Angiotensin II receptor blocker should not be routinely combined with aldosterone antagonists. Antiarrhythmics, non-steroidal anti-inflammatory drugs, or COX-2 inhibitors should be avoided. Calcium channel blockers should not be routinely used. Long-term vasopressor therapy or hormone therapy can be harmful, except in certain cases where it is mandatory.

When heart failure has reached the end stage, there is a risk of treatment resistance, so special intervention is needed. Quantification and careful management of fluid retention are fundamental and important in the management of end-stage heart failure. Specific measures:
Continuous intravenous infusion of peripheral vasodilators; Intravenous infusion of vasopressors; Use diuretics, but pay attention to the dose, if too strong the patient may be dehydrated, making the condition worse; Indications for heart transplantation (in some countries). Doctors will consider the appointment of a heart transplant for patients with end-stage heart failure who have severe symptoms, poor prognosis, and no other alternative therapy. In addition, the heart transplant recipient must be active, communicate well and have stable emotions. After a heart transplant requires aggressive treatment, it is important to consider the patient's and family's ability to comply.
Heart transplantation is contraindicated in the following cases:
Advanced infection; Addiction to alcohol or taking drugs; Have had cancer treatment within 5 years; Patients with other serious comorbidities have a poor prognosis; Mood swings, untreated mental illness; Unstable heart and blood vessel condition; See also: Find out the breakthrough method of treating end-stage heart failure: Implantation of left ventricular assist device HVAD

In general, even in any stage of heart failure, the basic treatment is still not taking drugs and focusing on changing the lifestyle so that it is scientific and healthy. More importantly, not only those who already have symptoms of heart failure, but especially the middle-aged group (45-50 years old and older) also need periodic heart failure screening.
When choosing the package of heart failure examination at Vinmec International General Hospital, the patient will be determined the heart failure status, the degree of heart failure, the cause of the heart failure as well as the accompanying diseases. In particular, the group of subjects who have no symptoms of heart failure but are in middle age (from 45 to 50 years old) should be screened for cardiovascular disease every year, especially smokers, who regularly drink alcohol. drink a lot or are obese.

Details of a heart failure examination package at Vinmec include: Cardiology specialist examination, 24-hour total analysis of blood and urine cells by automatic counter, quantification and measurement of activity of some substances in the body, electricity electrocardiogram and electrocardiogram, echocardiography (conventional and stress), transthoracic pericardoscopy and straight chest x-ray, ...