Overview

Patients undergoing evaluation for ventricular dysfunction and heart failure (HF) fall into 3 general groups: (1) patients at risk of developing HF, (2) patients suspected of having HF based on signs and symptoms or incidental evidence of abnormal cardiac structure or function, and (3) patients with established symptomatic HF.

Patients at Risk for HF. Patients identified to be at risk for HF require aggressive management of modifiable risk factors as outlined in Section 3 of this guideline. Patients with risk factors may have undetected abnormalities of cardiac structure or function. In addition to risk factor reduction, these patients require careful assessment for the presence of symptoms of HF and, depending on their underlying risk, may warrant noninvasive evaluation of cardiac structure and function.

Patients Suspected of Having HF. The evaluation of patients suspected of having HF focuses on interpretation of signs and symptoms that have led to the consideration of this diagnosis. Careful history and physical examination, combined with evaluation of cardiac structure and function, should be undertaken to determine the cause of symptoms and to evaluate the degree of underlying cardiac pathology.

Patients With Established HF. The evaluation of patients with an established diagnosis of HF is undertaken to identify the etiology, assess symptom nature and severity, determine functional impairment, and establish a prognosis. Follow-up of patients with HF or cardiac dysfunction involves continuing reassessment of symptoms, functional capacity, prognosis, and therapeutic effectiveness.