Desired Therapeutic Outcomes

There is no cure for HF. The general management goals for chronic HF include preventing the onset of clinical symptoms or reducing symptoms, preventing or reducing hospitalizations, slowing progression of the disease, improving quality of life, and prolonging survival. The ACC/AHA staging system described earlier provides a guide for application of these goals based on the clinical progression of HF for a given patient. The goals are additive as one moves from stage A to stage D.1'11 For stage A, risk factor management is the primary goal. Stage B includes the addition of pharmacologic therapies known to slow the progression of the disease in an attempt to prevent the onset of clinical symptoms. Stage C involves the use of additional therapies aimed at controlling symptoms and decreasing morbidity. Finally, in stage D, the goals shift toward quality of life related issues. Only with aggressive management throughout all the stages of the disease will the ultimate goal of improving survival be realized. The attainment of these goals is based on designing a therapeutic approach that encompasses strategies aimed at control and treatment of contributing disorders, nonpharma-cologic interventions, and optimal use of pharmacologic therapies.12,13

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