A 47-year-old Black woman presents for a general cardiology follow-up appointment following hospitalization for an acute inferior myocardial infarction and percutaneous coronary intervention of the right coronary artery 6 weeks ago. Her left ventricular ejection fraction (LVEF) during hospitalization was 42%. Her medical history includes hyperlipidemia, type 2 diabetes mellitus, and tobacco use (0.5 pack per day).Her medications are aspirin 81 mg daily, ticagrelor 90 mg twice daily, rosuvastatin 20 mg daily, metoprolol succinate 25 mg daily, lisinopril 10 mg daily, and metformin 500 mg twice daily.
Her initial vital signs include blood pressure 110/72 mm Hg, heart rate 88 bpm, and respiratory rate 16 breaths/min. Her body mass index is 26.0.
Her most recent laboratory study values included hemoglobin A1c concentration 7.2%, low-density lipoprotein level 65 mg/dL, triglyceride level 116 mg/dL, cholesterol level 150 mg/dL, serum creatinine level 0.7 mg/dL, and potassium level 4.2 mEq/L. An echocardiogram obtained during her visit today reveals LVEF 45%.
The correct answer is: B. Stage B
This patient had structural heart disease (SHD), as demonstrated by her LVEF of <50%, but she did not yet demonstrate HF symptoms. She can be categorized as being at stage B (pre-HF).
Stage A HF describes patients who are at risk of HF but do not have symptoms, SHD, or cardiac biomarkers of stretch or injury. Because she had SHD, demonstrated by her LVEF, she did not meet the definition for stage A HF.
Stage C HF describes patients with SHD and current or previous symptoms of HF. Because she did not have HF symptoms, she did not meet the definition for stage C.
Stage D HF describes patients with marked HF symptoms that interfere with daily life and with recurrent hospitalizations despite attempts to optimize guideline-directed medical therapy. She did not have HF symptoms and did not meet the definition for stage D HF.
This patient case quiz is part of the larger Managing HF Across the Spectrum: From Recognizing Symptoms to Implementing Appropriate Treatment initiative, supported by Bayer. To visit the Managing HF Across the Spectrum page and access additional educational activities on this topic, click here.
References
- Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79(17):e263-e421. doi:10.1016/j.jacc.2021.12.012
- Kittleson MM, Panjrath GS, Amancherla K, et al. 2023 ACC expert consensus decision pathway on management of heart failure with preserved ejection fraction: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2023;81(18):1835-1878. doi:10.1016/j.jacc.2023.03.393
- Maddox TM, Januzzi JL Jr, Allen LA, et al. 2024 ACC expert consensus decision pathway for treatment of heart failure with reduced ejection fraction: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2024;83(15):1444-1488. doi:10.1016/j.jacc.2023.12.024
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