Heart failure guidelines updated


Clinical Question: What new evidence is available to guide heart failure (HF) management?

Background: New data has become available since the 2013 HF guidelines.

Study Design: A focused update.

Setting: Ongoing review of HF literature.

Dr. Joseph Sweigart is an assistant professor in the University of Kentucky division of hospital medicine and Lexington VA Medical Center.

Dr. Joseph Sweigart

Synopsis: Beta-natriuretic peptide (BNP) is recommended to screen at risk patients (IIaB), on admission (IA), and prior to discharge (IIaB). The combination of ARB and neprilysin inhibitor (ARB-NI) is recommended in symptomatic patients with HF with reduced ejection fraction (HFrEF) who are tolerant of ACE inhibition (IB). For these patients, transitioning from ACE-inhibitor to the ARB-NI combination, valsartan-sacubitril significantly reduced hospitalization and mortality. Optimal dose and titration strategies remain unclear. ARB-NIs should not be used in patients with a history of angioedema (IIIC) or within 36 hours of receiving ACE-inhibitors (IIIB). Ivabradine, a selective inhibitor of the If current in the sinoatrial node, is recommended to reduce hospitalizations for patients with HFrEF with stable symptoms with resting sinus heart rate greater than or equal to 70 despite maximally-tolerated beta-blockade (IIaB). Intravenous iron replacement is recommended to improve function and quality of life for patients with symptomatic HF and iron deficiency (IIbB).

Bottom Line: Updates support use of BNP, ARB-NIs, ivabradine, and IV iron for HFrEF.

Citation: Yancy CW, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: A report of the American college of cardiology/American heart association task force on clinical practice guidelines and the heart failure society of America. Published online, 2017 Apr 28. Circulation. doi: 10.1161/CIR.0000000000000509.

Dr. Sweigart is an assistant professor in the University of Kentucky division of hospital medicine and Lexington VA Medical Center.

Recommended Reading

FDA approves first spironolactone oral suspension
The Hospitalist
New findings from first all-female TAVR registry
The Hospitalist
Despite global decline, rheumatic heart disease persists in poorest regions
The Hospitalist
Rapid AMI rule out
The Hospitalist
Undiagnosed AF common in higher-risk patients
The Hospitalist
Forgo supplemental oxygen in adequately perfused patients with acute MI, study suggests
The Hospitalist
VIDEO: Rivaroxaban plus aspirin cut cardiovascular events in stable patients
The Hospitalist
VIDEO: Clopidogrel bests ticagrelor in PCI for ACS in real-world study
The Hospitalist
HEART score can safely identify low risk chest pain
The Hospitalist
Triple therapy reduces exacerbations in patients with symptomatic COPD
The Hospitalist
   Comments ()