När används graderingen?
- För att gradera patienter med hjärtsvikt, som komplement till NYHA-klass.
- För att gradera risk för hjärtsvikt.
Graderingen är utarbetad av American College of Cardiology (ACC) och American Heart Association (AHA) med syfte att komplementera New York Heart Association (NYHA) klassificering av hjärtsvikt. Skillnaden mellan ACC/AHA-graderingen och NYHA är att förstnämnda klargör vilka behandlingar som är aktuella i varje steg under sjukdomsförloppet.
Graderingen
- Grad A: Hög risk för att utveckla hjärtsvikt, men ingen aktuell strukturell hjärtsjukdom.
- Grad B: Strukturell hjärtsjukdom men utan symptom på hjärtsvikt.
- Grad C: Strukturell hjärtsjukdom med nuvarande eller tidigare symptom på hjärtsvikt.
- Grad D: Grav hjärtsvikt som fordrar särskilda behandlingar, exempelvis mekanisk cirkulatorisk support, inotropa läkemedel, hjärttransplantation eller vård i livets slutskede.
Fakta om graderingen
För att bevara den exakta rekommendationen återges den i originalspråk här nedan.
| Stage | Class I recommendations* |
| A | Control of systolic and diastolic hypertension in accordance with recommended guidelines. (Level of Evidence: A)Treatment of lipid disorders in accordance with recommended guidelines. (Level of Evidence: B)Avoidance of patient behaviors that may increase the risk of HF (e.g., smoking, alcohol consumption, and illicit drug use). (Level of Evidence: C)Angiotensin converting enzyme (ACE) inhibition in patients with a history of atherosclerotic vascular disease, diabetes mellitus, or hypertension and associated cardiovascular risk factors. (Level of Evidence: B)Control of ventricular rate in patients with supraventricular tachyarrhythmias. (Level of Evidence: B)Treatment of thyroid disorders. (Level of Evidence: C)Periodic evaluation for signs and symptoms of HF. (Level of Evidence: C) |
| B | ACE inhibition in patients with a recent or remote history of myocardial infarction regardless of ejection fraction. (Level of Evidence: A)ACE inhibition in patients with a reduced ejection fraction, whether or not they have experienced a myocardial infarction. (Level of Evidence: B)Beta-blockade in patients with a recent myocardial infarction regardless of ejection fraction. (Level of Evidence: A)Beta-blockade in patients with a reduced ejection fraction, whether or not they have experienced a myocardial infarction. (Level of Evidence: B)Valve replacement or repair for patients with hemodynamically significant valvular stenosis or regurgitation. (Level of Evidence: B)Regular evaluation for signs and symptoms of HF. (Level of Evidence: C)Measures listed as class I recommendations for patients in stage A. (Levels of Evidence: A, B, and C as appropriate). |
| C | Diuretics in patients who have evidence of fluid retention. (Level of Evidence: A)ACE inhibition in all patients unless contraindicated. (Level of Evidence: A)Beta-adrenergic blockade in all stable patients unless contraindicated. Patients should have no or minimal evidence of fluid retention and should not have required treatment recently with an intravenous positive inotropic agent. (Level of Evidence: A)Digitalis for the treatment of symptoms of HF, unless contraindicated. (Level of Evidence: A)Withdrawal of drugs known to adversely affect the clinical status of patients (e.g., nonsteroidal anti-inflammatory drugs, most antiarrhythmic drugs, and most calcium channel blocking drugs). (Level of Evidence: B)Measures listed as class I recommendations for patients in stages A and B (Levels of Evidence: A, B, and C as appropriate). |
| D | Meticulous identification and control of fluid retention. (Level of Evidence: B)Referral for cardiac transplantation in eligible patients. (Level of Evidence: B)Referral to an HF program with expertise in the management of refractory HF. (Level of Evidence: A)Measures listed as class I recommendations for patients in stages A, B, and C. (Levels of Evidence: A, B, and C as appropriate). |
Fråm Hunt et al, 2001.
*Conditions for which there is evidence and/or general agreement that a given procedure/therapy is useful and effective. For full recommendations, see Hunt et al, 2001.
