“2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary”: Links And Excerpts

In this post, I link to and excerpt from 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines [PubMed Abstract] [Full-Text HTML] [Full-Text PDF].  Circulation. 2022 May 3;145(18):e876-e894. doi: 10.1161/CIR.0000000000001062. Epub 2022 Apr 1.+

All that follows is from the above resource.

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Top 10 Take-Home Messages

  1. Guideline-directed medical therapy (GDMT) for heart failure (HF) with reduced ejection fraction (HFrEF) now includes 4 medication classes that include sodium-glucose cotransporter-2 inhibitors (SGLT2i).

  2. SGLT2i have a Class of Recommendation 2a in heart failure with mildly reduced ejection fraction (HFmrEF). Weaker recommendations (Class of Recommendation 2b) are made for ARNi, ACEi, ARB, MRA, and beta blockers in this population.

  3. New recommendations for HFpEF are made for SGLT2i (Class of Recommendation 2a), MRAs (Class of Recommendation 2b), and ARNi (Class of Recommendation 2b). Several prior recommendations have been renewed including treatment of hypertension (Class of Recommendation 1), treatment of atrial fibrillation (Class of Recommendation 2a), use of ARBs (Class of Recommendation 2b), and avoidance of routine use of nitrates or phosphodiesterase-5 inhibitors (Class of Recommendation 3: No Benefit).

  4. Improved LVEF is used to refer to those patients with a previous HFrEF who now have an LVEF >40%. These patients should continue their HFrEF treatment.

  5. Value statements were created for select recommendations where high-quality, cost-effectiveness studies of the intervention have been published.

  6. Amyloid heart disease has new recommendations for treatment including screening for serum and urine monoclonal light chains, bone scintigraphy, genetic sequencing, tetramer stabilizer therapy, and anticoagulation.

  7. Evidence supporting increased filling pressures is important for the diagnosis of HF if the LVEF is >40%. Evidence for increased filling pressures can be obtained from noninvasive (eg, natriuretic peptide, diastolic function on imaging) or invasive testing (eg, hemodynamic measurement).

  8. Patients with advanced HF who wish to prolong survival should be referred to a team specializing in HF. A HF specialty team reviews HF management, assesses suitability for advanced HF therapies and uses palliative care including palliative inotropes where consistent with the patient’s goals of care.

  9. Primary prevention is important for those at risk for HF (stage A) or pre-HF (stage B). Stages of HF were revised to emphasize the new terminologies of “at risk” for HF for stage A and pre-HF for stage B.

  10. Recommendations are provided for select patients with HF and iron deficiency, anemia, hypertension, sleep disorders, type 2 diabetes, atrial fibrillation, coronary artery disease, and malignancy.

Purpose of the Executive Summary

The purpose of the “2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure” (2022 HF guideline) is to provide an update and to consolidate the “2013 ACCF/AHA Guideline for the Management of Heart Failure”1 for adults and the “2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure”2 into a new document. Related ACC/AHA guidelines include recommendations relevant to HF and, in such cases, the HF guideline refers to these documents. For example, the 2019 primary prevention of cardiovascular disease guideline3 includes recommendations that will be useful in preventing HF, and the 2021 valvular heart disease guideline4 provides recommendations for mitral valve (MV) clipping in mitral regurgitation (MR).

Areas of focus include:

  • Prevention of HF.

    • ◦ New treatment strategies in HF, including sodium-glucose cotransporter-2 inhibitors (SGLT2i) and angiotensin receptor-neprilysin inhibitors (ARNi).

    • ◦ Management of HF and atrial fibrillation (AF), including ablation of AF.

    • ◦ Management of HF and secondary MR, including MV transcatheter edge-to-edge repair.

      Management strategies in stage C HF, including:

    • ◦ Cardiac amyloidosis.

    • ◦ Cardio-oncology.

      Specific management strategies, including:

  • Implantable devices.

  • Left ventricular assist device (LVAD) use in stage D HF.

The intended primary target audience consists of clinicians who are involved in the care of patients with HF. The focus of the full clinical practice guideline5 is to provide the most up-to-date evidence to direct the clinician in patient decision-making. This executive summary provides readers with the Top 10 items that they should know about the 2022 HF guideline5 and incorporates material from the full guideline along with each statement.



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