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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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Source: self

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