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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EGregg Fonarow, MD, Division of Cardiology, University of California, agreed. \u201cThere are many patients without evidence of structural heart disease who are at increased risk,\u201d he said. \u201cAnd the data shows that modification of risk factors can have enormous impact in mitigating disease.\u201d\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eheart failure\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EGregg Fonarow, MD, Division of Cardiology, University of California, agreed. \u201cThere are many patients without evidence of structural heart disease who are at increased risk,\u201d he said. \u201cAnd the data shows that modification of risk factors can have enormous impact in mitigating disease.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EDr. Fonarow described the 2005 revision of ACC\/AHA Heart Failure (HF) guidelines that shifted from the New York Heart Association staging system to the AHA system where class A is defined as patients with risk factors for HF, B \u2013 patients with structural heart disease but no overt symptoms, C \u2013 patients with mild symptoms of HF and D \u2013 patients with severe symptoms of end stage HF.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/1\/25\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1713912190\u0022 data-figure-caption=\u0022\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure1\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/1\/25\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/1\/25\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure1\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/1\/25\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16095\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EThe ACC\/AHA system \u201cis designed to be more clinically useful and descriptive,\u201d he said. Focusing on Stage A, Dr. Fonarow stressed the significance of recognizing and documenting early HF. Using what he called an \u201ciceberg metaphor,\u201d Stage A HF has \u201cvirtually no signs or symptoms visible \u2018above the waterline,\u2019 but factors like smoking, elevated BMI, lack of exercise, microalbuminuria, and dyslipidemia might all be lurking below the waterline.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003E\u201cHeart failure (HF) is an evolving entity,\u201d said Margaret M. Redfield, MD, Director, Heart Failure Clinic, Mayo Clinic. \u201cEpidemiological data now tells us that lowered ejection fractions (EFs) are fairly common in the asymptomatic population.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EHF, much like atherosclerosis, is a disease process that progresses over many years. Along the way, Dr Redfield said, \u201clowered EFs may serve as potent early indicators of disease.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003ESome 1\u20132% of the population have EFs \u0026lt;40% and roughly 5% have EFs \u0026lt;50%. Meanwhile, HF with normal EF is emerging as an important disease variant. Referring to work published by Dr. Redfield and colleagues in 2003 (Burden of Systolic and Diastolic Ventricular Dysfunction in the Community: Appreciating the Scope of the Heart Failure Epidemic. \u003Cem\u003EJAMA\u003C\/em\u003E 2003: 289(2)), more than 25% of adults \u0026gt;45 years of age have diastolic filling abnormalities. \u201cOur most important overall finding was increased all-cause mortality among people who have some ventricular dysfunction, be it diastolic or systolic.\u201d Dr. Redfield said.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003E\u201cHF is, technically, not an epidemic,\u201d Dr. Redfield observed, \u201cbut in clinical terms, it is.\u201d And early HF (Stage A-B) is \u201cincredibly common,\u201d she added.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003ELee Goldberg, MD, MPH, Director, Heart\/Lung Transplant Program, University of Pennsylvania, emphasized that early detection is paramount. \u201cIn Stage A and B alike, the onus is on us to recognize, detect, treat early, and motivate our patients to make changes in diet and lifestyle. This is the only way we will reduce costs and improve health.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EMark Drazner, MD, University of Texas Southwestern Medical Center, reviewed the current treatment recommendations for Stage C HF, reminding clinicians that inhospital initiation of therapy is the \u201cgolden moment.\u201d Data reveals that patients not on a medication regimen at time of discharge are far less likely to be on medication 90 days later. \u201cThe risk of recurrence and worsening of disease is obvious,\u201d said Dr. Drazner.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EManagement of Stage D HF takes on a different shade, according to Joseph G. Rogers, MD, Duke University. \u201cStage D requires a determination if your patient wishes to proceed with therapy. If the answer is no, then management moves to palliative care and possibly hospice.\u201d Dr. Rogers reviewed two clinical trials (ESCAPE published in \u003Cem\u003EJAMA\u003C\/em\u003E 2005 that showed benefit of filling pressure reduction but no benefit and increased adverse events of pulmonary artery catheter use; REMATCH published in \u003Cem\u003ENEJM\u003C\/em\u003E in 2001 that showed survival benefit of left ventricular assist devices in class IV HF) that evaluated techniques for extending life in Stage D HF, but he said \u201cthere\u0027s a great deal of work we have yet to do to improve Stage D patients\u0027 survival and quality of life.\u201d\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2006 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/6\/1\/25.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzl0v1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzl0v1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}