Ambulatory Stage C2D Heart Failure Definitions and Current Therapeutic Approaches: JACC: Heart Failure Position...

Area of Science:

• Cardiology
• Heart Failure Research
• Clinical Practice Guidelines

Background:

• Traditional heart failure (HF) staging categorizes patients into Stage C (manageable symptoms with guideline-directed medical therapy - GDMT) and Stage D (transplant, circulatory support, or palliation).
• Advanced HF encompasses not only end-stage patients but also a significant ambulatory population experiencing progression despite GDMT.

Purpose of the Study:

• To enhance recognition of a new HF stage, termed C2D, for ambulatory patients progressing beyond GDMT.
• To survey existing knowledge gaps regarding the extension of Stage C HF GDMT into the C2D stage.
• To propose future research directions for managing advanced HF.

Main Methods:

• This is a position statement commissioned to address advanced HF.
• Proposed next steps include identification and curation of C2D cohorts.
• Future research will involve dissecting physiological phenotypes, considering social determinants and patient preferences.

Main Results:

• Current HF staging may not fully capture the needs of ambulatory patients progressing on GDMT.
• There is a need to define therapeutic strategies for patients in the C2D stage.
• Understanding C2D patient phenotypes and preferences is crucial for developing new management approaches.

Conclusions:

• Recognizing and defining Stage C2D is essential for improving care in advanced heart failure.
• Further research into C2D cohorts, phenotypes, and patient-centered factors is needed.
• Developing novel strategies for the C2D stage can potentially alter HF trajectories and improve patient outcomes.