2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary

Take-Home Message No. 1 Guideline-directed medical therapy (GDMT) for HF with reduced ejection fraction (HFrEF) now includes 4 medication classes 1) renin-angiotensin system inhibition with angiotensin receptor-neprilysin inhibitors (ARNi), angiotensin-converting enzyme inhibitors (ACEi), or angiotensin (II) receptor blockers (ARB) alone; 2) beta blockers; 3) mineralocorticoid receptor antagonists (MRAs); and 4) the new group, SGLT2i Take-Home Message No. 2 Mildly reduced LVEF has new medication recommendations, including use of SGLT2i. Weaker recommendations (COR 2b) are made for ARNi, ACEi, ARB, MRA and beta blockers in this population. Take-Home Message No. 3 Preserved LVEF has new medication recommendations, including use of SGLT2i. New recommendations for HF with preserved EF (HFpEF) are made for SGLT2i (COR 2a), while weaker recommendation for MRAs (COR 2b), and ARNi (COR 2b). Several previous recommendations have been renewed, including treatment of hypertension (COR 1), treatment of AF (COR 2a), use of ARB (COR 2b), and avoidance of routine use of nitrates or phosphodiesterase-5 inhibitors (COR 3: No Benefit). Take-Home Message No. 4 Improved LVEF is used to refer to those with previous HFrEF who now have an LVEF >40%. These patients should continue their HFrEF treatment. Take-Home Message No. 5 Value statements have been created for many treatments. In accordance with ACC/AHA methodology.High-value therapies include ARNi, ACEi, ARB, beta blocker, MRA, implantable cardioverter-defibrillator, and cardiac resynchronization therapy. Intermediate-value therapies include SGLT2i and cardiac transplantation. The only therapy identified as low value was tafamidis for cardiac amyloidosis. The value of mechanical circulatory support and pulmonary pressure monitoring was considered uncertain. Take-Home Message No. 6 Amyloid heart disease has new recommendations for treatment. In patients with a clinical suspicion for cardiac amyloidosis, screening for serum and urine monoclonal light chains with serum and urine immunofixation electrophoresis and serum free light chains are recommended. If there is no evidence of serum or urine monoclonal light chains, bone scintigraphy is recommended to confirm the presence of transthyretin cardiac amyloidosis Transthyretin tetramer stabilizer therapy (tafamidis) is recommended in select patients with wild-type or variant transthyretin cardiac amyloidosis. Anticoagulation is a reasonable treatment strategy to reduce the risk of stroke in patients with cardiac amyloidosis and AF. Take-Home Message No. 7 The signs and symptoms of HF are nonspecific and thus a diagnosis of HF requires supporting evidence. Increased cardiac filling pressure is a feature of HF, and this is assumed for patients with an LVEF ≤40%. However, if the LVEF is 41% to 49% (mildly reduced) or ≥50% (preserved), evidence of spontaneous or provokable increased LV filling pressures is needed to confirm a diagnosis of HF. In such cases evidence for increased filling pressures can be obtained from non-invasive (e.g., natriuretic peptide, diastolic function on imaging) or invasive testing (e.g., hemodynamic measurement). Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.