2013年美国心力衰竭管理指南(心衰指南)-英文

hypertension. Obesity, CAD, diabetes mellitus, atrial fibrillation (AF), and hyperlipidemia are also highly

prevalent in HFpEF in population-based studies and registries (40, 43). Despite these associated cardiovascular risk factors, hypertension remains the most important cause of HFpEF, with a prevalence of 60% to 89% from large controlled trials, epidemiological studies, and HF registries (44). It has been recognized that a subset of patients with HFpEF previously had HFrEF (45). These patients with improvement or recovery in EF may be clinically distinct from those with persistently preserved or reduced EF. Further research is needed to better characterize these patients.

Table 3. Definitions of HFrEF and HFpEF

Description

Also referred to as systolic HF. Randomized clinical trials have mainly enrolled patients with HFrEF, and it is only in these patients that

efficacious therapies have been demonstrated to date.

≥50 Also referred to as diastolic HF. Several different criteria have been used to further define HFpEF. The diagnosis of HFpEF is challenging

because it is largely one of excluding other potential noncardiac causes

of symptoms suggestive of HF. To date, efficacious therapies have not

been identified.

a. HFpEF, borderline 41 to 49 These patients fall into a borderline or intermediate group. Their

characteristics, treatment patterns, and outcomes appear similar to

those of patients with HFpEF.

b. HFpEF, improved >40 It has been recognized that a subset of patients with HFpEF previously

had HFrEF. These patients with improvement or recovery in EF may

be clinically distinct from those with persistently preserved or reduced

EF. Further research is needed to better characterize these patients.

EF indicates ejection fraction; HF, heart failure; HFpEF, heart failure with preserved ejection fraction; and HFrEF, heart failure with reduced ejection fraction. Classification I. Heart failure with reduced ejection fraction (HFrEF) II. Heart failure with preserved ejection fraction (HFpEF) EF (%) ≤40

See Online Data Supplement 1 for additional data on HFpEF.

3. HF Classifications

Both the ACCF/AHA stages of HF (38) and the New York Heart Association (NYHA) functional classification (38, 46) provide useful and complementary information about the presence and severity of HF. The ACCF/AHA stages of HF emphasize the development and progression of disease and can be used to describe individuals and populations, whereas the NYHA classes focus on exercise capacity and the symptomatic status of the disease (Table 4).

The ACCF/AHA stages of HF recognize that both risk factors and abnormalities of cardiac structure are associated with HF. The stages are progressive and inviolate; once a patient moves to a higher stage, regression to an earlier stage of HF is not observed. Progression in HF stages is associated with reduced 5-year survival and increased plasma natriuretic peptide concentrations (47). Therapeutic interventions in each stage aimed at modifying risk factors (stage A), treating structural heart disease (stage B), and reducing morbidity and

mortality (stages C and D) (covered in detail in Section 7) are reviewed in this document. The NYHA functional