Update on ACCF/AHA Heart Failure guidelines

This document concerns an update of the “2013 ACCF/AHA Guidelines for the Management of Heart Failure” [1] in areas in which new evidence has emerged since this publication. To achieve this, and for future publishes, the Heart Failure Society of America (HFSA) has partnered.

This update represents the second part of a 2-stage publication; the first part has been published as the “2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure” [2]. This first part included guidance on new therapies, including an angiotensin receptor-neprilysin inhibitor (ARNI) and a sinoatrial node modulator.

The current second part of the document includes revision of the 2013 sections on biomarkers, new therapies indicated for stage C heart failure (HF) with reduced ejection fraction (HFrEF), updates on HF with preserved ejection fraction (HFpEF), new data on important comorbidities and new insights into the prevention of HF.

• Biomarkers for prevention, diagnosis, prognosis and added risk stratification are being discussed and include:
• NT-proBNP and BNP biomarkers can both be used to establish the presence and severity of HF and can be used in various settings, as long as their respective absolute values and cut points are not used interchangeably. There are insufficient data to inform specific guideline recommendations related to natriuretic peptide–guided therapy or serial measurements of BNP or NT-proBNP levels to reduce hospitalization or deaths.
• Elevations in either troponin I or T levels in the setting of acute HF are of prognostic significance and must be interpreted in the clinical context.
• Multiple other biomarkers, including those of inflammation, oxidative stress, vascular dysfunction, and myocardial and matrix remodeling, have been implicated in HF.

• Recommendations for pharmacological treatment for stage C HFrEF are given, including those with ACE inhibitors, ARBs, ARNIs and Ivabradine, as well as for stage C HFpEF, which includes updates on using aldosterone receptor antagonists and nitrates or phosphodiesterase-5 inhibitors.

• Comorbidities in HF that are being discussed are anemia (recommendations), hypertension (recommendations for prevention, treatment in stage C HFrEF and HFpEF) and sleep disordered breathing (recommendations for treatment).

References

Find this article online at Circulation