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Updated ACCF/AHA guideline for the management of heart failure

News - Oct. 24, 2013

A report of the American College of Cardiology foundation/American Heart Association task force on practice guidelines
Yancy CW, Jessup M, Bozkurt B, et al.
Circulation. 2013;128:1810-1852.

This guideline covers multiple management issues for the adult patient with HF. Adherence to the clinical practice guidelines should lead to improved patient outcomes.
This guideline does address HF with preserved ejection fraction (EF) in more detail and similarly revisits hospitalized HF. Additional areas of renewed interest are stage D HF, palliative care, transition of care, and quality of care for HF.

Recommendations contained in numerous other relevant clinical practice guidelines and scientific statements were not reiterated; recommendations were harmonized when appropriate and discrepancies eliminated. This is especially the case for device-based therapeutics, where complete alignment between the HF guideline and the device-based therapy guideline was deemed imperative.

Some recommendations from earlier guidelines have been updated as warranted by new evidence or a better understanding of earlier evidence, whereas others that were no longer accurate or relevant or that were overlapping were modified; recommendations from previous guidelines that were similar or redundant were eliminated or consolidated when possible.

In view of the advances in medical therapy across the spectrum of cardiovascular diseases, the Task Force has designated the term guideline-directed medical therapy (GDMT) to represent optimal medical therapy as defined by ACCF/AHA guideline−recommended therapies (primarily Class I).

The present document recommends a combination of lifestyle modifications and medications that constitute GDMT.

Both for GDMT and other recommended drug treatment regimens, it is advised to confirm dosages with product insert material and to evaluate carefully for contraindications and drug-drug interactions.

Despite the objective evidence compiled by the writing committee on the basis of hundreds of clinical trials, there are huge gaps in the knowledge base about many fundamental aspects of HF care. Some key examples include an effective management strategy for patients with HFpEF beyond blood pressure control; a convincing method to use biomarkers in the optimization of medical therapy; the recognition
and treatment of cardiorenal syndrome; and the critical need for improving patient adherence to therapeutic regimens.
Even the widely embraced dictum of sodium restriction in HF is not well supported by current evidence.

Future research will need to focus on novel pharmacological therapies, especially for patients hospitalized with HF; regenerative cell-based therapies to restore myocardium; and new device platforms that will either improve existing technologies (eg, CRT, ICD, left ventricular assist device) or introduce simpler, less morbid devices that are capable of changing the natural history of HF. What is critically needed is an evidence base that clearly identifies best processes of care, especially in the transition from hospital to home. Finally, preventing the burden of this disease through more successful
risk modification, sophisticated screening, perhaps using specific omics technologies (ie, systems biology), or effective treatment interventions that reduce the progression from stage A to stage B is an urgent need.

Find the ACCF/AHA guidelines online

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