The prevention and treatment strategies for heart failure (HF) have evolved in the past two decades. The stages of HF have been redefined, with recognition of the pre-HF state, which encompasses asymptomatic patients who have developed either structural or functional cardiac abnormalities or have elevated plasma levels of natriuretic peptides or cardiac troponin. The first-line treatment of patients with HF with reduced ejection fraction includes foundational therapies with angiotensin receptor–neprilysin inhibitors, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, β-blockers, mineralocorticoid receptor antagonists, sodium–glucose cotransporter 2 (SGLT2) inhibitors and diuretics. The first-line treatment of patients with HF with mildly reduced ejection fraction or with HF with preserved ejection fraction includes SGLT2 inhibitors and diuretics. The timely initiation of these disease-modifying therapies and the optimization of treatment are crucial in all patients with HF. Reassessment after initiation of these therapies is recommended to evaluate patient symptoms, health status and left ventricular function, and timely referral to a HF specialist is necessary if a patient has persistent advanced HF symptoms or worsening HF. Lifestyle modification and treatment of comorbidities such as diabetes mellitus, ischaemic heart disease and atrial fibrillation are crucial through each stage of HF. This Review provides an overview of the management strategies for HF according to disease stages that are derived from the recommendations in the latest US and European HF guidelines.

心力衰竭（HF）的预防和治疗策略在过去二十年不断发展。心力衰竭的阶段已被重新定义，并认识到心力衰竭前状态，其中包括出现结构性或功能性心脏异常或血浆钠尿肽或心肌肌钙蛋白水平升高的无症状患者。射血分数降低的心力衰竭患者的一线治疗包括血管紧张素受体脑啡肽酶抑制剂、血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂、β-阻滞剂、盐皮质激素受体拮抗剂、钠-葡萄糖协同转运蛋白 2 (SGLT2) 抑制剂的基础治疗和利尿剂。射血分数轻度降低的心力衰竭或射血分数保留的心力衰竭患者的一线治疗包括 SGLT2 抑制剂和利尿剂。及时启动这些疾病缓解疗法和优化治疗对于所有心力衰竭患者至关重要。建议在开始这些治疗后进行重新评估，以评估患者的症状、健康状况和左心室功能，如果患者持续存在晚期心力衰竭症状或心力衰竭恶化，则有必要及时转诊至心力衰竭专家。生活方式的改变和糖尿病、缺血性心脏病和心房颤动等合并症的治疗在心力衰竭的每个阶段都至关重要。本综述根据疾病阶段概述了心力衰竭的管理策略，这些策略源自最新的美国和欧洲心力衰竭指南的建议。