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ACC issues new recommendations for HFrEF management
The American College of Cardiology has issued an expert consensus decision pathway to help streamline HF treatment and ensure optimized patient outcomes.
The document focuses mainly on issues that exist in the treatment of HF with reduced ejection fraction.
“The prevalence of HF is escalating rapidly. Compounding this, HF is an illness that consumes significant health care resources, inflicts significant morbidity and mortality and greatly impacts quality of life,” Clyde W. Yancy, MD, MSc, MACC, vice dean of diversity and inclusion, Magerstadt Professor of Medicine, professor of medical social sciences and chief of the division of cardiology at Northwestern University Feinberg School of Medicine, associate director of Bluhm Cardiovascular Institute and past president of the American Heart Association, and colleagues wrote in the document. “Although the evidence base for the treatment of HFrEF has expanded substantially, much work remains for the other forms of HF.”
According to the authors, the document is a complement to the 2017 ACC/AHA/Heart Failure Society of America focused update of the 2013 ACC/AHA Guideline for the Management of HF, which addressed new pharmacological therapies and other issues.
The authors developed questions to conduct a practical, consensus approach to identifying evidence gaps.
According to the writing committee, the 10 pivotal issues that remain in HFrEF are:
- how to initiate, add or switch therapy to new evidence-based guideline-directed treatments for HFrEF;
- how to achieve optimal therapy given multiple drugs for HF including augmented clinical assessment that may trigger additional changes in guideline-directed therapy (eg, imaging data, biomarkers and filling pressures);
- when to refer to a HF specialist;
- how to address challenges of care coordination;
- how to improve adherence;
- what is needed in specific patient cohorts: African-Americans, the frail and older adults;
- how to manage patients’ cost of care for HF;
- how to manage the increasing complexity of HF;
- how to manage common comorbidities; and
- how to integrate palliative care and transition to hospice care.
“There has been a challenge with implementation of guidelines across the board,” Yancy said in a press release. “This document is a major step toward deploying aspects of implementation science as a means to improve adherence to evidence-based guideline-directed therapy.” – by Dave Quaile
Disclosures: Yancy reports no relevant financial disclosures. Please see the full document for the other authors’ relevant financial disclosures.