Stages of heart failure in infants and children and recommended therapy

Stage	Definition	Examples	Therapy
A	Patients with increased risk of developing HF, but with normal cardiac function and chamber size	Exposure to cardiotoxic agents Family history of heritable cardiomyopathy Univentricular heart Congenitally corrected transposition of the great arteries	None
B	Patients with abnormal cardiac morphology or function, with no symptoms of HF, past or present	Aortic insufficiency with LV enlargement History of anthracycline exposure with decreased LV systolic function	ACE inhibitor for patients with systemic ventricular dysfunction
C	Patients with structural or functional heart disease, and past or current symptoms of HF	Symptomatic cardiomyopathy Congenital heart defect with ventricular pump dysfunction	ACE inhibitor and an aldosterone antagonist; oral diuretic therapy as needed for fluid overload; low-dose digoxin if needed for additional symptom relief After a few weeks of stability, a beta blocker is added in patients with persistent LV dilation and dysfunction
D	Patients with end-stage HF requiring specialized interventions	Marked symptoms at rest despite maximal medical therapy	Pharmacologic therapy consists of intravenous diuretics and/or inotropes Other interventions may include positive pressure ventilation, cardiac resynchronization therapy, mechanical circulatory support, and heart transplantation

HF: heart failure; LV: left ventricular; ACE: angiotensin-converting enzyme.

Original table modified for this publication. Rosenthal D, Chrisant MR, Edens E, et al. International Society for Heart and Lung Transplantation: Practice guidelines for management of heart failure in children. J Heart Lung Transplant 2004; 23:1313. Table used with the permission of Elsevier Inc. All rights reserved.

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Stages of heart failure in infants and children and recommended therapy