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The Prevention of Heart Failure Almost five million people in the United States have heart failure. It is estimated that approximately four times that many may have abnormalities in their heart function but do not have symptoms of heart failure. Since it is expected that these patients will progress to symptomatic heart failure and the death rate in the presence of symptoms is 50% in five years, prevention of heart failure should be a primary goal. Many studies have shown that treatment will prevent or limit the progression of heart failure. Certain risk factors may indicate that the patient has undiagnosed abnormal heart function or is at higher risk for heart muscle dysfunction. These factors are: High blood pressure (more than 135/85). Diabetes mellitus (blood sugar greater than 120 or HgbA1c greater than 7%) Over 70 years of age History of coronary artery disease (hardening of the arteries) Atrial fibrillation (rhythm disturbance) EKG abnormalities If one or more of these risk factors are present, the patient should be evaluated for heart failure. We would suggest a lab test call BNP. If this is normal, for the age group, there is a very low likelihood that there are any abnormalities in heart function. If the test is not normal, the patient may require an echocardiogram (ultrasound) test of the heart. There are other factors that may be associated with heart failure but are not felt to be in this risk factor equation including: abnormal cholesterol levels, lack of activity, obesity, family history, excessive alcohol intake and/or certain medications (cancer drugs). If the echocardiogram is abnormal, each patient should be placed on medications called beta blockers and ACE inhibitors. Both of these drugs have been shown to reduce or prevent the progression of heart failure. In addition, or if the echocardiogram is normal, all of the other risk factors that contribute to heart failure should be treated. CLASSIFICATIONS OF HEART FAILURE A. Patients with conditions at high risk for future development of heart failure, but without structural heart abnormalities (50-60 million in the U.S) B. Patients with structural heart disorder strongly associated with the development of heart failure, who have never presented symptoms or signs of heart failure (8-10 million). C. Patients with current or prior symptoms of heart failure associated with structural heart disease (5 million). D. Patients with end stage heart failure, i.e. severe symptoms despite maximal medical therapy, who require specialized treatment (50-200 thousand).