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...

Hypertrophic Cardiomyopathy: A Welcome Guideline Update

Hypertrophic cardiomyopathy (HCM) is one of the most common genetic heart diseases in the United States, affecting approximately 600,000 to 700,000 people. In many cases, patients remain unidentified. This, in part, may explain why few cardiology practices have the opportunity to evaluate HCM patients nationwide. In 2003, the American College of Cardiology (ACC) and European Society of Cardiology created an expert consensus panel on HCM. The ACC and the American Heart Association (AHA) revisited the topic with the publication of guidelines in the December 13, 2011 issues of Circulation and the Journal of the American College of Cardiology. “HCM has become a highly treatable disease thanks to new management strategies, but many physicians are still challenged with managing it,” says Barry J. Maron, MD, who co-chaired the ACC/AHA guideline update writing committee. “We took this opportunity to clarify the most important diagnostic and management strategies. Many of the recommendations in the 2011 guidelines are similar to those in the 2003 consensus document, but newer data have provided a better understanding of these recommendations, particularly in the areas of prevention of sudden death and genetic testing.” Hypertrophic Cardiomyopathy Recommendations According to the ACC/AHA guidelines, treatment of patients with HCM must be individualized and requires an understanding of the complex pathophysiology and natural history of the disease. According to Dr. Maron, the three areas of greatest importance are use of prophylactic defibrillators, management of outflow tract obstruction, and application of genetic testing. Implantable cardioverter defibrillators (ICDs) for the prevention of sudden cardiac death are the only treatment known to prolong life in this disease, says Dr. Maron. The generally agreed upon...