As a result of our deviation from the ACVIM Consensus definition of Stage D heart failure, we felt that avoiding the term “Stage D heart failure” and using a more general term of “advanced heart failure” would be more accurate. We purposely avoided the term, “Stage D heart failure” because our criteria for these dogs with severe, advanced heart failure deviates from the ACVIM Consensus Statement because it is our general practice to add in other cardiac medications before the furosemide dose reaches ≥6 mg/kg q12h. Dogs in Stage A or B and dogs that had Stage C heart failure but died or were euthanized before meeting the criteria for advanced heart failure also were not enrolled. Prescription of other cardiac medications such as spironolactone, amlodipine, torsemide, or sildenafil before the date of the first recurrent episode of heart failure was permitted although dogs were classified in advanced heart failure only once they had recurrent congestive heart failure despite having been on these medications in addition to the previously described combination of furosemide (>4 mg/kg/day), pimobendan, and ACEI (ie, dogs that were receiving these other medications but were not receiving >4 mg/kg/day of furosemide were not enrolled). Dogs receiving a total daily dose of furosemide ≤4 mg/kg/day while receiving pimobendan and an ACEI with recurrent signs of congestive heart failure were included only if the total daily dose of furosemide was increased to >4 mg/kg/day, and if either at least 1 additional cardiac medication was introduced or if the dose of pimobendan was increased to an off‐label dose. Dogs classified with Stage C heart failure secondary to DMVD but that, after review of their medical history and records, met the study's definition of advanced heart failure were also included.įor the purposes of the study, advanced heart failure was defined as the recurrence of congestive heart failure signs despite a daily dose of furosemide >4 mg/kg/day, a recommended dose of pimobendan (0.5‐0.6 mg/kg/day), and a maximally tolerated dose of ACEI. The cardiology database and hospital electronic medical records were searched for dogs diagnosed with Stage D disease secondary to DMVD. Therefore, the objective of our study was to describe the clinical findings and outcome of dogs with advanced heart failure secondary to DMVD.ĭogs were eligible for inclusion in this retrospective study if they had been evaluated by the Cardiology Service at the Cummings Veterinary Medical Center at Tufts University between January 2010 and February 2016, were diagnosed with DMVD, and had advanced heart failure. 2 In humans, Stage D heart failure has been described by some as “advanced progression and/or persistent severe signs and clinical signs of heart failure despite optimal medical, surgical, and device therapy.” 3 Frequent hospitalization, severe exercise intolerance, and poor quality of life are key features of the syndrome.Īdvanced heart failure in dogs represents a clinical challenge for veterinarians, not only with the precise definition, but optimal treatment since there are no studies or clinical trials that report clinical features and outcome for this population or are designed to evaluate treatment of dogs in this stage of disease. 1 In this 4‐stage system, dogs with DMVD with end‐stage disease and clinical signs of congestive heart failure that are refractory to standard therapy (ie, furosemide, an angiotensin converting enzyme inhibitor, and Pimobendan, ) were classified as Stage D heart failure.Įven in human medicine, a clear and precise definition of Stage D or advanced heart failure, has proven difficult. 1 Although other classification systems have been used to stratify the severity of disease, the 2009 ACVIM Consensus Statement on the diagnosis and treatment of DMVD provided a new system which has been incorporated into practice. Degenerative mitral valve disease (DMVD) or chronic valvular disease is the most common canine acquired heart disease in dogs, and often leads to congestive heart failure.
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