Journal Scan Summary
2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
June 5, 2013
Yancy CW, Jessup M, Bozkurt B, et al.
J Am Coll Cardiol 2013;Jun 5:[Epub ahead of print].
The following are 10 points to remember about this guideline for the management of heart failure (HF):
- The definition of HF has now expanded to:
a. HF with reduced ejection fraction (HFrEF, EF ≤40%)
b. HF failure with preserved ejection fraction (HFpEF, EF ≥50%)
c. HFpEF, borderline (EF 41-49%)
d. HFpEF, improved (EF >40%)
- The number of patients with HF, as well as the cost to treat patients with HF, is expected to increase in the future.
- All causes of HF must be evaluated, with consideration of multigenerational family histories and genetic testing.
- Risk factors need to be continually addressed when managing a patient with HF: hypertension, lipid disorders, obesity, diabetes mellitus, tobacco use, and known cardiotoxic agents.
- There is a clear mortality benefit from using guideline-directed medical therapy.
- Anticoagulation should not be used in patients with chronic HFrEF with no risk factors (atrial fibrillation, thromboembolic event, or cardioembolic source).
- Aim for control of systolic and diastolic blood pressures, as well as volume status, to treat HFpEF.
- Re-evaluate patients with left ventricular EF ≤35%, New York Heart Association class II-IV, left bundle branch block, and a QRS ≥150 ms for cardiac resynchronization therapy.
- HF education, dietary restrictions, and exercise training should be provided for all patients to enhance self-care.
- A HF multidisciplinary team, including a palliative care team, should be involved when treating patients with advanced HF.
Reema Hasan, MD, F.A.C.C. (Disclosure)