Updated ACC/AHA Guideline for Management of Heart Failure
The ACC Foundation (ACCF) and American Heart Association (AHA) jointly released an expanded clinical practice guideline for the management of patients with Heart Failure (HF).
10 points to remember about this guideline:
- The definition of HF has now expanded to:
a. HF with reduced ejection fraction (HFrEF, EF ≤40%)
b. HF failure with preserved ejection fraction (HFpEF, EF ≥50%)
c. HFpEF, borderline (EF 41-49%)
d. HFpEF, improved (EF >40%)
- The number of patients with HF, as well as the cost to treat patients with HF, is expected to increase in the future.
- All causes of HF must be evaluated, with consideration of multigenerational family histories and genetic testing.
- Risk factors need to be continually addressed when managing a patient with HF: hypertension, lipid disorders, obesity, diabetes mellitus, tobacco use, and known cardiotoxic agents.
- There is a clear mortality benefit from using guideline-directed medical therapy.
- Anticoagulation should not be used in patients with chronic HFrEF with no risk factors (atrial fibrillation, thromboembolic event, or cardioembolic source).
- Aim for control of systolic and diastolic blood pressures, as well as volume status, to treat HFpEF.
- Re-evaluate patients with left ventricular EF ≤35%, New York Heart Association class II-IV, left bundle branch block, and a QRS ≥150 ms for cardiac resynchronization therapy.
- HF education, dietary restrictions, and exercise training should be provided for all patients to enhance self-care.
- A HF multidisciplinary team, including a palliative care team, should be involved when treating patients with advanced HF.
The document was developed in collaboration with the American Academy of Family Physicians, American College of Chest Physicians, Heart Rhythm Society, and the International Society for Heart and Lung Transplantation. A full text of the report and an executive summary have been published in the Journal of the American College of Cardiology;