Stage A - Individuals at high risk for Heart failure (HF)

Individuals in Stage A at high risk for HF have predisposing factors that put them at high risk for developing the cardiomyocyte loss or dysfunction characteristic of HF. However, in many instances, steps can be taken to prevent or reduce the conditions that may progress to heart failure (Tello, et al. 2017). The goal for these patients is to prevent cardiac structural changes including hypertensive heart disease, cardiac remodeling, coronary heart disease (CHD) from developing (Yancy, et al., 2017).

Patient assessment of predisposing factors

Does the family history include any of the following?

Does the patient’s medical history indicate any of these conditions?

Does the patient’s medical history indicate exposure to any of the following cardiotoxic substances which can increase the incidence of HF?

Physical assessment of the cardiovascular system

Other signs

Metabolic syndrome

Metabolic syndrome includes a cluster of risk factors that raises a person's risk for coronary heart disease, diabetes and stroke. Medications may be required. Lifestyle changes include heart-healthy diet, weight control, managing stress, physical activity, and quitting smoking (Yanping, et al., 2018).

The National Institutes of Health have identified five risk factors common to metabolic syndrome. The presence of three or more of these factors may indicate metabolic syndrome. The more risk factors a person has, the greater the chance of heart disease, diabetes and stroke.

Five risk factors:

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A blood pressure of 140/90 or lower is considered normal.


American Heart Association. (2015). The American Heart Association’s diet and lifestyle recommendations. Retrieved from

Drazner, M. (2011). The Progression of Hypertensive Heart Disease. Circulation. 123 (3), 327-34.

Klatsky, A.L. (2015). Alcohol and cardiovascular diseases: where do we stand today? J Intern Med., 278(3), 238-50.

Mesas, A. E., Leon-Munoz, L.M., Rodriguez-Artalejo & Lopez-Garcia, E. (2011). The effect of coffee on blood pressure and cardiovascular disease in hypertensive individuals: a systematic review and meta-analysis. Am J Clin Nutr, 94 (4), 1113-1126.

National Heart, Lung, and Blood Institute (NHLBI). (2019). Metabolic Syndrome?

National Heart, Lung, and Blood Institute (NHLBI). (2016). Assessing your weight and health risks. Retrieved from

Sheps, S. (2016) How does caffeine affect blood pressure? Retrieved from

Szmitko, P. E. & Verma, S. (2005). Red Wine and Your Heart. Circulation. 111, e10-e11.

Tello, M. (2018). Healthy lifestyles: 5 keys to a longer life. Harvard Health Publishing.

Thibodeau, J. T. & Drazner, M.H. (2018). The Role of the Clinical Examination in Patients with Heart Failure. JACC Heart Fail. 6(7), 543-551.

Yanping, et al. (2018). Impact of healthy lifestyle factors on life expectancies in the US population. Circulation. 138(4), 345-355.

Yancy, C. W. et al. (2017). ACCF/AHA/HFSA Focused update of the 2013 Guideline for the management of heart failure. A report of the American College of Cardiology/American Heart Association task force on practice guidelines and the Heart Failure Society of America. Circulation. 136(6), 137-161.