ACC Expert consensus decision pathway for management of patients admitted for HF
2019 ACC Expert Consensus Decision Pathway on Risk Assessment, Management, and Clinical Trajectory of Patients Hospitalized With Heart Failure
A Report of the American College of Cardiology Solution Set Oversight Committee
A committee of the American College of Cardiology (ACC) has composed and published an Expert Consensus Decision Pathway (ECDPs) on risk assessment, management and clinical trajectory of patients hospitalized with heart failure (HF).
The ACC develops integrated “solution sets”, which are groups of closely related activities, policy, mobile applications, decision support and other tools necessary to transform care and/or improve heart health. With these resources, they aim to make “actionable knowledge” available and easy to implement. Solution sets address key questions facing care teams and attempt to provide practical guidance to be applied at the point of care.
ECDPs represent a key component of solution sets. Rather than providing a single correct answer, they encourage clinicians to ask questions and consider important factors as they define a treatment plan for their patients.
This ECDP focuses on patients hospitalized with HF and complements existing tools for outpatient management. Recommendations span the management starting from the original emergency department visit through the first post-discharge visit. The primary aim of the document is to optimize patient care and improve outcomes, more so than reducing length of stay and readmission. The document hopes to help clinicians consider the short- and long-term outlook for their patients with HF, to provide therapies to reduce symptoms and optimize outcomes. Moreover, it encourages for those plans to be conveyed well to caregivers after discharge and to engage patients in shared decision-making and to become an active participant in their care.
Except for specific instances, the committee did not distinguish HF on the basis of ejection fraction (EF), because the goals of decongestion and the importance of consideration of comorbidities and factors that influence adherence are common to patients with HFrEF and HFpEF.
The document is structured around 5 “nodes”: Admission, trajectory check, transition to oral therapies, discharge and first follow-up visit. These are not well-separated stages, but rather flow into each other, and their timing varies per patient. Overall, the algorithms assume that a broad multidisciplinary approach is ideal, including input from pharmacy, social work, psychiatry, physical therapy and nutrition.