Recommendations Updated for Management of Heart Failure

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by Healthday

Sodium-glucose cotransporter-2 inhibitors recommended for HF with reduced, mildly reduced ejection fraction

FRIDAY, April 8, 2022 (HealthDay News) — In a clinical practice guideline issued by the American College of Cardiology, the American Heart Association, and the Heart Failure Society of America and published online April 1 in the Journal of the American College of Cardiology, updated recommendations are presented for the management of heart failure.

Paul A. Heidenreich, M.D., from the Stanford University School of Medicine in California, and colleagues conducted a literature review to inform patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure.

The authors note that for heart failure with reduced ejection fraction (HFrEF), guideline-directed medical therapy is composed of four medication classes, including sodium-glucose cotransporter-2 inhibitors (SGLT2is). For heart failure with mildly reduced ejection fraction, SGLT2is have a Class of Recommendation of 2a; weaker recommendations are made for angiotensin receptor-neprilysin inhibitors (ARNis), angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, mineralocorticoid receptor antagonists (MRAs), and beta-blockers (Class of Recommendation, 2b). For heart failure with preserved ejection fraction, new recommendations are made for SGLT2is (Class of Recommendation, 2a) and for MRAs and ARNis (Class of Recommendation, 2b). Patients with previous HFrEF who now have a left ventricular ejection fraction >40 percent should continue their HFrEF treatment. New recommendations for treatment have been made for amyloid heart disease. Patients with advanced heart failure should be referred to a team specializing in heart failure, which reviews management, assesses suitability for advanced therapies, and uses palliative care where consistent with the patient’s goals of care.

“There has been an increase in rigorous science assessing how best to treat symptomatic heart failure,” Heidenreich said in a statement. “With this new guideline, the writing committee hopes to inform better treatment options for a broader number of our patients with heart failure.”

Several authors disclosed financial ties to the pharmaceutical and medical device industries.

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