The benefits of the ABCD classification system for heart disease – DVM 360

The importance of diagnosing pets in the pre-clinical phase of heart disease, plus the advantages of the classification system.

Although veterinarians are often skilled at diagnosing pets with clinical heart failure, it is critical they are skilled at diagnosing those with pre-clinical heart disease as well, according to Amara Estrada, DVM, DACVIM(Cardiology), professor of cardiology at the University of Florida. This proactive approach positively impacts patients by enhancing their quality of life and ultimately helping to delay the disease's development.

At the 2021 New York Vet Show in New York, New York, Estrada shared the various benefits of the ABCD classification system, plus she outlined each stage.

Classifying each stage of heart disease in pets helps with the following:

Although the first several stages (A-B2) consist of preclinical heart disease and are when it is key to step in and take initiative, the final 2 stages (C-D) include the clinical phases of heart failure.

During this first stage, the pet appears healthy and there is no structural disease, but they are at high risk for developing heart disease because of their breedsome at-risk dog and cat breeds Estrada noted include Doberman pinschers, cavalier King Charles spaniels, and Maine coons.

Stage A, this is pets that have nothing wrong with them, you dont find anything on the physical exam, but theyre kind of the poster child for heart disease in the veterinary world, she explained.

There are genetic tests available for heart disease that allow pets to be tested as early as in puppyhood which Estrada said is a great time to begin. Although this will likely not change the course of the disease, you can confirm if mutations are present and establish with the owner that earlier screenings are advised for their predisposed pet.

Stage B1 is classified by asymptomatic disease with none to minimal remodeling present yet something abnormal appears on the physical exam, which then should prompt you to stage the disease, according to Estrada.

The reason I have to stage it is because Im trying to decide: is [the dog] very, very early in the course of his disease where [its] a B1 and [it] doesnt have any structural remodeling, or is [the dog] at the phase where hes a B2 and I now have clinical trial evidence that tells me if I start to treat X at this stage B2, I will make an extreme difference in that dogs long term survival and quality of life, she emphasized.

Meanwhile in the B2 stage, the disease is asymptomatic as well, however it is established that significant remodeling is apparent, so the pet is ready for therapy.

B2s, these are the dogs or cats, where you heard something on your physical exam, you now looked at some kind of imaging modality and found that there is structural remodeling, so you are going to classify that patient and he is ready for therapy, Estrada said.

Stage C is when the clinical signs of heart disease the pet has been screening for begin to appear, therefore specific therapy and follow up are now required.

Some shared clinical signs of heart disease in dogs and cats include1,2,3:

According to Estrada, the main priority of this last stage is to best retain the pets quality of life and discuss end-of-life care considerations with the pet parent. Symptom-specific therapy and follow up are required as well.

Stage D is where I kind of shift my brain and Im no longer just thinking about heart failure, Im thinking about quality of lifethose are those pets that are refractory to standard treatment, theyre requiring frequent visits to the hospitalbut my brain starts to switch to quality of life and hospice care, she explained.

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The benefits of the ABCD classification system for heart disease - DVM 360