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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...
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