Advertisement
Updated Guidelines for Heart Failure

Updated Guidelines for Heart Failure

Recently, the American College of Cardiology Foundation (ACCF) and American Heart Association (AHA) jointly released an expanded clinical practice guideline for the management of patients with heart failure (HF). The update, published in the Journal of the American College of Cardiology was designed to assist clinicians in selecting the best management strategies for patients. “The guideline updates definitions and classifications for HF, increases the emphasis on patient-centric outcomes, and introduces ‘guideline- directed medical therapy’ (GDMT),” explains Clyde W. Yancy, MD, MSc, FACC, who chaired the ACCF/AHA writing committee. Descriptions & Classifications of Heart Failure The ACCF/AHA guideline update provides a more focused approach on dilated cardiomyopathies and the appropriate evaluation of patients. This includes family and genetic screening and counseling. “The guidelines once again endorse four stages of disease progression: Stages A thru D,” explains Dr. Yancy. “Stage A patients are those with positive risk factors, whereas Stage B patients have existing but still asymptomatic left ventricular function.” “The expectations are highest for hospitalized patients with HF because of their vast resource consumption from initial admissions to subsequent readmissions.” Stage C is the classic patient with congestive HF, but importantly, Dr. Yancy says this patient group is now well dichotomized as having HF with reduced ejection fraction (EF) or HF with preserved EF. “Best therapies are aligned with each stage, specifically risk factor modification, pre-emptive medical and device therapies for asymptomatic left ventricular dysfunction, and classic evidence-based therapies for symptomatic HF patients with reduced EF,” he says. “The guidelines also provide a treatment algorithm for Stage C HF patients with reduced EF [Figure]. The algorithm, known as GDMT, can...
Devices for Cardiac Rhythm Abnormalities: A Guideline Update

Devices for Cardiac Rhythm Abnormalities: A Guideline Update

According to recent estimates, about 400,000 pacemakers and implantable cardioverter defibrillators (ICDs) are surgically implanted each year in the United States. In 2008, the American College of Cardiology Foundation (ACCF), American Heart Association (AHA), and the Heart Rhythm Society (HRS) released guidelines for using device therapy to manage cardiac rhythm abnormalities. Since the release of the 2008 guidelines, many clinical research advances relating to device-based therapies have emerged, says Andrew E. Epstein, MD, FAHA, FACC, FHRS. “In an effort to help clinicians keep pace with these advances, the ACCF, AHA, and HRS jointly released updated guidelines in 2012 for the use of device-based therapy in treating heart rhythm disorders. The guidelines can help in clinical decision making in most circumstances.” The 2012 update writing group included experts in device therapy, cardiovascular care, internal medicine, cardiovascular surgery, and pediatric and adult electrophysiology. The guidelines were also developed in collaboration with the American Association for Thoracic Surgery, Heart Failure Society of America, and Society of Thoracic Surgeons. Building on Earlier Cardiac Device Guidelines For the 2012 update, the writing group began by reviewing the 2008 recommendations. The latter are largely unchanged for standard pacing and ICD indications. However, given new data on cardiac resynchronization therapy (CRT), the 2008 guidelines were updated with CRT as its focus, especially with regard to expanding indications for this treatment (Figure 1). “CRT can significantly improve quality and quantity of life by delaying or avoiding worsening heart failure.” —Andrew E. Epstein, MD, FAHA, FACC, FHRS “Despite our improvements in managing patients with device-based therapies, it can still be challenging for physicians to select patients in whom...

Conference Highlights: American Heart Association’s 2010 Scientific Sessions

The American Heart Association held its 2010 Scientific Sessions from November 13 to 17 in Chicago. The features below highlight some of the news emerging from the meeting. » Benefits Observed With Experimental Cholesterol Drug » A New Approach for Difficult Hypertension Cases » PTSD Linked to Death, Atherosclerosis » Smoking Rates Decline, But Cessation Efforts Still Warranted » Scanning Matters When Managing Diabetics With Heart Disease » Combination Therapy Effective in Heart Failure Benefits Observed With Experimental Cholesterol Drug The Particulars:  Elevated LDL and low HDL cholesterol levels are risk factors for cardiovascular disease (CVD). Statins have been shown to reduce LDL and lessen CVD risk. Despite statin therapy, many patients still have a high risk of CVD. Anacetrapib is an experimental cholesteryl ester transfer protein (CETP) inhibitor. It is intended to block the ability of the CETP enzyme to transfer cholesterol particles from HDL to LDL cholesterol. Data Breakdown: The DEFINE study (Determining the Efficacy and Tolerability of CETP Inhibition with Anacetrapib) was a randomized, double-blind trial of 1,623 patients who took either 100 mg anacetrapib or a placebo for 18 months. Patients were already being treated with a statin and/or other lipid-lowering medicine. Anacetrapib reduced LDL by 40%—from 81 mg/dL to 49 mg/dL. It also more than doubled the level of HDL cholesterol—from 40 mg/dL to 101 mg/dL—without raising blood pressure. Take Home Pearls: Anacetrapib appears to more than double the level of HDL cholesterol and reduce LDL cholesterol without the blood pressure increase that has been linked to other CETP inhibitors. The full efficacy and safety of anacetrapib must be evaluated in a larger, phase...
[ HIDE/SHOW ]