Dr Amresh Raina Illuminates Top Concerns in Asymptomatic Heart Failure

Risk factors not properly addressed in patients with asymptomatic heart failure, such as high blood pressure and having diabetes or mild heart valve problems, can lead to structural heart problems or heart failure itself, noted Amresh Raina, MD, of the Allegheny Health Network in Pittsburgh, Pennsylvania.

New heart failure guidelines from the American College of Cardiology, American Heart Association, and Heart Failure Society of America emphasize treatment as prevention, with 2 stages being asymptomatic disease.

Amresh Raina, MD, director of the Advanced Heart Failure and Pulmonary Hypertension Program at Allegheny General Hospital and the Allegheny Health Network in Pittsburgh, Pennsylvania, recently discussed with The American Journal of Managed Care® how to manage asymptomatic heart failure and what the disease stages in the guidelines cover.


What are some of the signs of potential asymptomatic heart failure, and what do clinicians and patients need to know about this condition?

The heart failure guidelines have 2 stages when patients are asymptomatic, called stage A and stage B. Stage A in the paradigm is really patients who are at risk for developing heart failure. These patients actually don't have any structural heart disease and also don't, by definition, have any symptoms. But they have other risk factors that put them at potential risk for developing heart failure. Those risk factors are things like having high blood pressure, having diabetes, being overweight, or having heart valve problems that are mild. If those risk factors are not appropriately addressed, those patients could go on to develop structural heart problems and/or eventually heart failure if they were not addressed.

The stage B of heart failure is patients who actually do have structural abnormalities of the heart but are yet clinically asymptomatic. So for example, in patients who have high blood pressure, if the high blood pressure is not optimally controlled, the walls of the heart can become thick, and that's an entity called left ventricular hypertrophy. If that's unchecked, that can progress to the point where people develop stiffness or ultimately weakness of the heart muscle and develop heart failure.

Similarly, if a patient has a narrowing of a heart valve or leakiness of a heart valve that's more than mild, that may be asymptomatic for a long period of time, but eventually if it's not addressed, that could become symptomatic with shortness of breath and heart failure symptomatology.

Things to look out for, obviously, in people and patients who have these risk factors [are] to make sure that they're appropriately being addressed. So making sure that the blood pressure is controlled; that people watch their diet and exercise; that they control their diabetes if they have it; if they are overweight, to try to lose weight; if they have sleep apnea, to try to treat the sleep apnea. All these things can control these risk factors to help prevent the development of symptomatic heart failure. But patients who are asymptomatic, they should also get some sort of screening tests to evaluate their cardiac function over time.

For example, an echocardiogram is a typical screening test to evaluate for structural abnormalities of the heart. We also use lab tests such as metabolic panels and natriuretic peptide levels. Things like proBNP [B-type natriuretic peptide] or BNP are hormones that are released in the body in response to stress on the walls of the heart or overt congestive heart failure, fluid retention.

These are things that clinicians can recommend for patients who have stage A or stage B heart failure risk factors.

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