10 Take-home messages of the 2022 AHA/ACC/HFSA guideline for HF

ACC 2022 In the 2022 AHA/ACC/HFSA guideline for the management of heart failure (HF) that was presented at ACC.22, a top 10 of take-home messages on patient-centric recommendations is provided.

Presented at ACC.22 by Paul Heidenreich, MD (Palo Alto, CA, USA), and Biykem Bozkurt, MD, PhD (Bellaire, TX, USA)

The previous guidelines for the management of heart failure (HF) from 2013 and 2017 were consolidated and updated to provide a new document: “The 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure” (2022 HF guideline).

This full clinical practice guideline provides the most up-to-date evidence (relevant studies and clinical trials published through Sep 2021 were considered) to support and direct clinicians who are involved in the care of patients with HF to prevent, diagnose and manage patients with HF.

Areas of focus in the HF guideline are:

• Prevention of HF
• Management strategies in stage C HF (symptomatic HF) including new treatment strategies such as SGLT2i and ARNI, management of HF and atrial fibrillation (AF), management of HF and secondary mitral regurgitation (MR)
• Specific management strategies, including cardiac amyloidosis, cardio-oncology
• Implantable-devices
• Left ventricular assist device (LVAD) use in stage D HF (advanced HF)

The top 10 take-home messages

1. 4 Medication classes are now recommended as guideline-directed medical therapy for HFrEF: ARNI, ACEi or ARB, beta blockers, MRAs and the new group SGLT2i.

2. There are new medication recommendations for HFmrEF, including use of SGLT2i (class of recommendations 2a).

3. There are new medication recommendations for HFpEF, including use of SGLT2i (class of recommendations 2a), MRAs (class of recommendations 2b) and ARNI (2b).

4. Patients with previous HFrEF who now have an LVEF >40% are referred to as having improved LVEF. They should continue their HFrEF treatment.

5. For many treatments, value statements have been created. High-value therapies include ARNI, ACEi, ARB, beta blocker, MRA, implantable cardioverter-defibrillator, and cardiac resynchronization therapy. Intermediate-value therapies include SLGT2i and cardiac transplantation.

6. There are new recommendations for treatment of amyloid heart disease.

7. If LVEF >40% evidence of spontaneous or provokable increased LV filling pressures is needed to confirm diagnosis of HF.

8. Patients with advanced HF and a wish for prolonged survival should be referred to a HF specialty team.

9. For those at risk for HF (stage A) or pre-HF (stage B), primary prevention is important. There was a revision of stages of HF to highlight the new terminology of “at risk for HF” (stage A) and “pre-HF” (stage B).

10. Specific-treatment recommendations are provided for select patients with HF and iron deficiency, anemia, hypertension, sleep disorders, type 2 diabetes, AF, coronary artery disease and malignancy.

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– Our coverage of ACC.22 is based on the information provided during the congress –

Find the HF guideline online at J Am Coll Cardiol