Congestive heart failure risk factors: Difference between revisions
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==Risk Factors== | ==Risk Factors== | ||
* Common Triggers for referral to [[heart failure]] specialist are: | |||
* New-onset [[HF]] (regardless of [[EF]]): Refer for evaluation of [[etiology]], therapies base on the guideline, evaluation by [[advanced imaging]], [[endomyocardial biopsy]], or [[genetic]] testing | |||
* Chronic [[HF]] with high-risk features, such as development or persistence of one or more of the following risk factors: | |||
*: Need for chronic intravenous [[inotropes]] | |||
*: Persistent [[NYHA]] [[functional class]] III–IV [[symptoms]] of [[congestion]] or profound [[fatigue]] | |||
*: [[Systolic blood pressure]] ≤90 mm Hg or symptomatic [[hypotension]] | |||
*: [[Creatinine]] ≥1.8 mg/dL or BUN ≥43 mg/dL | |||
*:Initiation of [[atrial fibrillation]], [[ventricular arrhythmias]], or repetitive [[ICD shocks]] | |||
*: Two or more emergency department visits or [[hospitalizations]] for worsening [[HF]] in the prior 12 months | |||
*: Inability to tolerate optimally dosed [[beta-blockers]] and/or [[ACEI]]/[[ARB]]/[[ARNI]] and/or [[aldosterone antagonists]] | |||
*: [[Clinical deterioration]], by worsening [[edema]], increase [[biomarkers]] ([[BNP]], [[NT-proBNP]], others), worsened [[exercise]] testing, decompensated [[hemodynamics]], or evidence of progressive [[remodeling]] on [[imaging]] | |||
*: High [[mortality]] risk using a validated risk model such as the [[Seattle Heart Failure Model]] | |||
* Persistently reduced [[LVEF]] ≤ 35% despite [[GDMT]] for ≥3 months: refer for [[device therapy]] in those [[patients]] without prior placement of [[ICD ]] or [[CRT]], unless [[device therapy]] is contraindicated or inconsistent with overall goals of care | |||
*Second [[opinion]] needed regarding [[etiology]] of [[HF]], for example: | |||
*:[[ Coronary ischemia]] and possibility of the need for [[revascularization]] | |||
*: [[Valvular heart disease]] and possibility of the need for [[valve repair]] | |||
*: Suspected [[myocarditis]] | |||
*: Suspected specific [[cardiomyopathies]] ( [[hypertrophic cardiomyopathy]], [[arrhythmogenic right ventricular dysplasia]], [[Chagas disease]], [[restrictive cardiomyopathy]], [[cardiac sarcoidosis]], [[amyloid]], [[aortic stenosis]]) | |||
* Annual review needed for [[patients]] with established advanced [[HF]] | |||
* Assessment of [[patient]] for participation in a [[clinical trial]] | |||
#Demographic factors | #Demographic factors | ||
#*Age (increased) | #*Age (increased) | ||
Revision as of 03:38, 15 December 2021
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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 risk factors On the Web |
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Directions to Hospitals Treating Congestive heart failure risk factors |
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Risk calculators and risk factors for Congestive heart failure risk factors |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Saleh El Dassouki, M.D. [3]; Atif Mohammad, M.D.
Overview
Several risk factors may predispose to heart failure. These risk factors can be demographic, genetic, associated with lifestyle or medications.
Risk Factors
- Common Triggers for referral to heart failure specialist are:
- New-onset HF (regardless of EF): Refer for evaluation of etiology, therapies base on the guideline, evaluation by advanced imaging, endomyocardial biopsy, or genetic testing
- Chronic HF with high-risk features, such as development or persistence of one or more of the following risk factors:
- Need for chronic intravenous inotropes
- Persistent NYHA functional class III–IV symptoms of congestion or profound fatigue
- Systolic blood pressure ≤90 mm Hg or symptomatic hypotension
- Creatinine ≥1.8 mg/dL or BUN ≥43 mg/dL
- Initiation of atrial fibrillation, ventricular arrhythmias, or repetitive ICD shocks
- Two or more emergency department visits or hospitalizations for worsening HF in the prior 12 months
- Inability to tolerate optimally dosed beta-blockers and/or ACEI/ARB/ARNI and/or aldosterone antagonists
- Clinical deterioration, by worsening edema, increase biomarkers (BNP, NT-proBNP, others), worsened exercise testing, decompensated hemodynamics, or evidence of progressive remodeling on imaging
- High mortality risk using a validated risk model such as the Seattle Heart Failure Model
- Persistently reduced LVEF ≤ 35% despite GDMT for ≥3 months: refer for device therapy in those patients without prior placement of ICD or CRT, unless device therapy is contraindicated or inconsistent with overall goals of care
- Second opinion needed regarding etiology of HF, for example:
- Coronary ischemia and possibility of the need for revascularization
- Valvular heart disease and possibility of the need for valve repair
- Suspected myocarditis
- Suspected specific cardiomyopathies ( hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, Chagas disease, restrictive cardiomyopathy, cardiac sarcoidosis, amyloid, aortic stenosis)
- Annual review needed for patients with established advanced HF
- Assessment of patient for participation in a clinical trial
- Demographic factors
- Age (increased)
- Low socioeconomic status
- Lifestyle-related factors
- Tobacco and coffee consumption
- Alcohol consumption
- Dietary sodium intake
- Recreational drug use: Cocaine, methamphetamines.
- Comorbidities
- Echocardiographic factors
- Ventricular dimension
- Ventricular mass
- Diastolic filling impairment
- Pharmacological factors
- Chemotherapeutic agents
- Non-steroidal anti-inflammatory drugs
- Thiazolidinediones
- Doxazosin
- Biochemical
- Albuminuria
- Homocysteine: Elevated plasma homocysteine levels are associated with almost a 75% increase in risk for heart failure development.
- Tumor necrosis factor-alpha (TNF-alpha): After adjustment for other risk factors, every tertile increment in tumor necrosis factor-alpha (TNF-alpha) levels was associated with a 60% increase in risk of heart failure. TNF-alpha has several negative pleiotropic effects and also negative inotropic properties that may be responsible for excessive heart failure risk. TNF-alpha is also associated with progression of heart failure.
- Interleukin-6: IL-6 is a pro-inflammatory cytokine which associated with an excessive risk of development of heart failure.
- C-reactive protein
- Insulin-like growth factor-I (IGF-I)
- Natriuretic peptides
- Genetic risk factors
Risk Factors Associated with Heart Failure Progression and Outcomes
- Clinical
- Etiology
- Age
- Gender
- Symptom duration
- NYHA class
- Weight
- Heart rate
- Mean arterial pressure
- S3 gallop
- Jugular venous pressure
- Cardiothoracic ratio
- Renal function
- Serum sodium
- Troponin T
- History of diabetes
- Anemia
- Echocardiographic
- Ejection fraction
- Exercise ejection fraction
- Ventricular dimensions
- Sphericity index
- Prolonged isovolumic relaxation
- Restrictive mitral filling
- Changes in E/A ratio
- Mitral regurgitation
- Contractile reserve
- Left ventricular mass
- Exercise Tolerance
- Exercise duration
- Peak O2 consumption
- VE/VCO2
- Anaerobic threshold 6-minute walk test
- Hemodynamics
- Cardiac index
- Pulmonary artery pressure
- Pulmonary artery wedge pressure
- Pulmonary vascular resistance
- Stroke work index
- Right atrial pressure
- A-V oxygen difference
- Coronary sinus O2 content
- Electrophysiological
- Conduction delay
- Atrial arrhythmia
- Family history of sudden death
- Presence of late potentials
- QT dispersion
- T wave alternans
- Neurohormonal
- Renin-angiotensin system
- Angiotensin II
- Aldosterone
- Plasma renin activity
- Sympathetic nervous system
- Norepinephrine
- Epinephrine
- Heart rate variability
- Norepinephrine spillover
- Natriuretic factors
- Atrial natriuretic peptide (ANP)
- B-type natriuretic peptide
- N-terminal-pro-ANP
- Cytokines and others