Societies Release HF Guideline Focused Update

The ACC, along with the American Heart Association (AHA) and the Heart Failure Society of America (HFSA), have released a focused update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. The focused update was published April 28 in the Journal of the American College of Cardiology.

The document is the second of a two-part focused update to the 2013 heart failure (HF) guideline. Part one, published in May 2016, introduced guidance on new pharmacological therapies for patients in Stage C HF with reduced ejection fraction. This second part of the focused update incorporates the guidance from part one, and includes a new figure that puts the new HF pharmacotherapies in context with previous therapies, as well as a revision to the sections on biomarkers, including recommendations for the prevention, diagnosis and prevention or added risk stratification of HF; updates on HF with preserved ejection fraction; new data on important comorbidities including sleep apnea, anemia and hypertension; and new insights regarding the prevention of HF.

Specifically, revisions to the biomarkers section include a Class IIa recommendation for utilizing natriuretic peptide biomarker-based screening for those at risk of developing HF, 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 HF.

New anemia recommendations include a Class IIb recommendation for intravenous iron replacement in patients with NYHA class II and III HF and iron deficiency, to improve functional status and quality of life. In addition, there is a Class III recommendation that erythropoietin stimulating agents should not be used in patients with HF and anemia to improve morbidity and mortality, as there is no benefit.

Also of note is a new section on hypertension that incorporates evidence from the SPRINT trial. Recommendations include a Class I recommendation for targeting an optimal blood pressure of less than 130/80 mm Hg in those with hypertension and at increased risk (stage A HF); a Class I recommendation for titration of guideline-directed medical therapy to attain systolic blood pressure <130 mm Hg in patients with HF with reduced ejection fraction and hypertension; and a Class I recommendation for titration of guideline-directed medical therapy to attain systolic blood pressure <130 mm Hg in patients with HF with preserved ejection fraction and persistent hypertension after management of volume overload.

"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," said Clyde W. Yancy, MD, MSc, MACC, chair of the writing group. "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."

Both HF focused updates represent a new model in the generation of HF clinical practice guidelines that now includes the ACC, AHA and HFSA.

The ACC recently launched a Heart Failure Discussion Guide to help guide conversations between clinicians and patients about HF treatments in order to optimize outcomes. For additional clinical tools and resources, check out the College’s Heart Failure Practice Solutions clinical toolkit and ACC's Succeed in Managing Heart Failure Initiative. On the education front, the College also recently launched the RightSTEPS: Optimizing Medical Therapy for Chronic Heart Failure curriculum to give clinicians evidence-based strategies to treat and manage HF. The curriculum consists of online, self-paced learning activities; a live on-site meeting; and online quality improvement coaching to reinforce the education, and is available for up to 16 CME/CNE credits. ACC's CardioSmart also has several patient resources available to help teach patients the symptoms and causes of HF including a Heart Failure infographic and a Heart Failure resource center.

Keywords: Anemia, Biomarkers, Cardiac Resynchronization Therapy, Cardiomyopathies, Heart Failure, Guideline, Therapeutics, Heart Failure, Heart Transplantation, Hypertension, Defibrillators, Implantable, Palliative Care, Peripheral Vascular Diseases, Therapeutics, Risk Assessment, Risk Factors, Sleep Apnea Syndromes, Heart-Assist Devices

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