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Update of ACCF/AHA Guideline for Management of Heart Failure


Update of ACCF/AHA Guideline for Management of Heart Failure

2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure have been published in Circulation.

Major Recommendations:

Biomarkers:

  • For prevention: The 2017 Focused Update gives a Class IIa recommendation (Level of Evidence: B-R) 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 (GDMT), to prevent the development of left ventricular dysfunction (systolic or diastolic) or new-onset HF.
  • For diagnosis: The 2017 Focused Update gives a Class I recommendation (Level of Evidence: A) for measurement of natriuretic peptide biomarkers in patients presenting with dyspnea, to support a diagnosis or exclusion of HF.
  • For prognosis or added risk stratification: The 2017 Focused Update gives a:
    • Class I recommendation (Level of Evidence: A) for measurement of B-type natriuretic peptide (BNP) or N-terminal (NT)-proBNP for establishing prognosis or disease severity in chronic HF.
    • Class I recommendation (Level of Evidence: A) for measurement of baseline natriuretic peptide biomarkers and/or cardiac troponin on admission to the hospital to establish a prognosis in acutely decompensated HF.
    • Class IIa recommendation (Level of Evidence: B-NR) for measurement of a predischarge natriuretic peptide level during a HF hospitalization, to establish a post-discharge prognosis.
    • Class IIa 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 HF for additive risk stratification.

Stage C HF With Preserved EF (HFpEF): The 2017 Focused Update gives the following:

  • Class IIa recommendation (Level of Evidence: B-R) for use of aldosterone antagonists in appropriately selected patients with HFpEF (with EF ≥45%, elevated BNP or HF admission within 1 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 activity or quality of life (QoL) in patients with HFpEF, as there is no benefit.
  • Class III recommendation (Level of Evidence: B-C) for routine use of nutritional supplements in patients with HFpEF, as there is no benefit.

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Anjali Nimesh

Anjali Nimesh

Anjali Nimesh Joined Medical Dialogue as Reporter in 2016. she covers all the medical specialty news in different medical categories. She also covers the Medical guidelines, Medical Journals, rare medical surgeries as well as all the updates in medical filed. She is a graduate from Dr. Bhimrao Ambedkar University. She can be contacted at editorial@medicaldialogues.in Contact no. 011-43720751
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