Societies Update Heart Failure Management Guidelines
WASHINGTON, April 28, 2017 — The American College of Cardiology, along with the American Heart Association and the Heart Failure Society of America, today released an updated guideline for the management of heart failure.
The guideline update extends the prior guideline update released May 20, 2016 addressing new pharmacological therapy for heart failure. This guideline update includes revision to the sections on biomarkers, including recommendations for the prevention, diagnosis, and prevention or added risk stratification of heart failure; updates on heart failure with preserved ejection fraction; new data on important comorbidities including sleep apnea, anemia and hypertension; and new insights regarding the prevention of heart failure.
“For clinical practice guidelines to be truly useful, new evidence that changes clinical practice should be rapidly incorporated in the guidelines and disseminated to the practice community. These updates were deemed necessary as new evidence in all of the areas addressed, derived from clinical trials, has emerged since the 2013 Heart Failure Guidelines and now merits inclusion,” said Clyde W. Yancy, MD, MSc, MACC, FAHA, FHFSA, chair of the writing group for the document.
Revisions to the biomarkers section include:
For Prevention: C(Level of Evidence: B-R) for utilizing -based screening for those at risk of developing heart failure, followed by team-based care including a cardiovascular specialist optimizing guideline-directed medical therapy, to prevent the development of left ventricular dysfunction or new-onset heart failure.
For Diagnosis: Class(Level of Evidence: A) measurement of in patients presenting with dyspnea, to support a diagnosis or exclusion of heart failure.
For Prognosis or Added Risk Stratification:
- Class I recommendation (Level of Evidence: A) for measurement of B-type natriuretic peptide or N-terminal pro-B-type natriuretic peptide for establishing prognosis or disease severity in chronic heart failure.
- C(Level of Evidence: A)measurement of baseline
- Class IIa recommendation (Level of Evidence: B-NR) for measurement of a predischarge natriuretic peptide level during a heart failure hospitalization, to establish a post-discharge prognosis
- Class IIb recommendation (Level of Evidence: B-NR) for measurement of other clinically available tests, such as biomarkers of myocardial injury or fibrosis, in patients with chronic heart failure for additive risk stratification.
Revisions to the section on Stage C heart failure with preserved ejection fraction include:
- Class IIb recommendation (Level of Evidence: B-R) for use of aldosterone antagonists in appropriately selected patients with heart failure with preserved ejection fraction (with ejection fraction ≥45 percent, elevated B-type natriuretic peptide or heart failure admission within one year, estimated glomerular filtration rate >30 and creatinine <2.5 mg/dL, potassium <5.0 mEq /L), to decrease hospitalizations.
- Class III recommendation: (Level of Evidence: B-R) for routine use of nitrates or phosphodiesterase-5 inhibitors to increase quality of life or outcomes in patients with heart failure with preserved ejection fraction, as there is no benefit.
Revisions to the section on comorbidities include:
- Class(Level of Evidence: B-R) for
- Class(Level of Evidence: B-R)
- Class I recommendation (Level of Evidence: B-R) for targeting an optimal blood pressure of less than 130/80 mm Hg in those with hypertension and at increased risk (stage A heart failure).
- Class(Level of Evidence: C-EO) for guideline-directed medical therapyheart failure with reduced ejection fraction
- Class(Level of Evidence: C-LD) for guideline-directed medical therapyheart failure with preserved ejection fraction
Sleep Disordered Breathing:
- Class IIa recommendation (Level of Evidence: C-LD) for a formal sleep assessment in patients with NYHA class II–IV heart failure and suspicion of sleep disordered breathing or excessive daytime sleepiness.
- C(Level of Evidence: B-R) for utilization of continuous positive airway pressure in patients with cardiovascular disease and obstructive sleep apnea, to improve sleep quality and daytime sleepiness.
- Class(Level of Evidence: B-R) for use of adaptive servo-ventilation in patients with NYHA class II–IV heart failure with reduced ejection fraction and central sleep apnea as it causes harm.
This updated guideline is the second of a two-stage publication. Part one was published as the 2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure, which introduced guidance on new therapies, specifically for the use of an angiotensin receptor–neprilysin inhibitor (ARNI) (valsartan/sacubitril) and a sinoatrial node modulator (ivabradine). The 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure will publish online today in the Journal of the American College of Cardiology, Circulation and the Journal of Cardiac Failure. Both updates represent a new model in the generation of heart failure clinical practice guidelines that now includes the American College of Cardiology, American Heart Association and the Heart Failure Society of America.
About the American College of Cardiology
The American College of Cardiology is a 52,000-member medical society that is the professional home for the entire cardiovascular care team. The mission of the College is to transform cardiovascular care and to improve heart health. The ACC leads in the formation of health policy, standards and guidelines. The College operates national registries to measure and improve care, provides professional medical education, disseminates cardiovascular research and bestows credentials upon cardiovascular specialists who meet stringent qualifications. For more information, visit acc.org.
About the American Heart Association
The American Heart Association is devoted to saving people from heart disease and stroke - America's No. 1 and No. 5 killers. We team with millions of volunteers to fund innovative research, fight for stronger public health policies, and provide lifesaving tools and information to prevent and treat these diseases. The Dallas-based association is the nation’s oldest and largest voluntary organization dedicated to fighting heart disease and stroke. To learn more or to get involved, call 1-800-AHA-USA1, visit heart.org or call any of our offices around the country. Follow us on Facebook and Twitter.
About the Heart Failure Society of America
The Heart Failure Society of America (HFSA) represents the first organized effort by heart failure experts from the Americas to provide a forum for all those interested in heart function, heart failure, and congestive heart failure (CHF) research and patient care. HFSA supports a multi-disciplinary clinical team approach for the preventions of and care for heart failure patients and is seeking to raise awareness about this devastating disease.