Congestive heart failure treatment of associated conditions: Difference between revisions

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{{Congestive heart failure}}
{{Congestive heart failure}}
{{CMG}}
{{CMG}}; {{AE}} {{AKK}} {{EdzelCo}}


==Overview==
==Overview==
[[Congestive heart failure]] can be associated with and exacerbated by rapid supraventricular  as well as [[atrial fibrillation]], [[ventricular arrhythmias]], [[venous thromboembolism]], [[renal insufficiency]], and [[anemia]].
[[Congestive heart failure]] can be associated with and exacerbated by rapid supraventricular  as well as [[atrial fibrillation]], [[ventricular arrhythmias]], [[venous thromboembolism]], [[renal insufficiency]], and [[anemia]].


==2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure <ref name="pmid28461007">{{cite journal |vauthors=Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM, Drazner MH, Filippatos GS, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN, Stevenson LW, Westlake C |title=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 |journal=[[J. Am. Coll. Cardiol.]] |volume=70 |issue=6 |pages=776–803 |year=2017 |pmid=28461007 |doi=10.1016/j.jacc.2017.04.025 |url=}}</ref>==
==2022 ACC/AHA/HFSA Heart Failure Guidelines (DO NOT EDIT) <ref name="pmid35363500">{{cite journal| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM | display-authors=etal| title=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. | journal=Circulation | year= 2022 | volume= 145 | issue= 18 | pages= e876-e894 | pmid=35363500 | doi=10.1161/CIR.0000000000001062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500  }} </ref> ==


===Anemia===
===[[Iron Deficiency]] or [[Anemia]]===


{|class="wikitable" style="width:80%"
{|class="wikitable" style="width:80%"
|-
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| colspan="1" style="text-align:center; background: LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III (No Benefit)]]
|colspan="1" style="text-align:center; background:LemonChiffon| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
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| bgcolor="LightCoral"|
'''1.'''
In patients with HF and anemia, erythropoietin- stimulating agents should not be used to improve morbidity and mortality.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class III, Level of Evidence: B-R]])
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| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' In patients with HFrEF and iron deficiency with or without anemia, intravenous iron replacement is reasonable to improve functional status and QOL. <ref name="pmid19920054">{{cite journal| author=Anker SD, Comin Colet J, Filippatos G, Willenheimer R, Dickstein K, Drexler H | display-authors=etal| title=Ferric carboxymaltose in patients with heart failure and iron deficiency. | journal=N Engl J Med | year= 2009 | volume= 361 | issue= 25 | pages= 2436-48 | pmid=19920054 | doi=10.1056/NEJMoa0908355 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19920054  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=20404374 Review in: Ann Intern Med. 2010 Apr 20;152(8):JC4-5] </ref><ref name="pmid25176939">{{cite journal| author=Ponikowski P, van Veldhuisen DJ, Comin-Colet J, Ertl G, Komajda M, Mareev V | display-authors=etal| title=Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency†. | journal=Eur Heart J | year= 2015 | volume= 36 | issue= 11 | pages= 657-68 | pmid=25176939 | doi=10.1093/eurheartj/ehu385 | pmc=4359359 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25176939  }} </ref><ref name="pmid23680589">{{cite journal| author=Beck-da-Silva L, Piardi D, Soder S, Rohde LE, Pereira-Barretto AC, de Albuquerque D | display-authors=etal| title=IRON-HF study: a randomized trial to assess the effects of iron in heart failure patients with anemia. | journal=Int J Cardiol | year= 2013 | volume= 168 | issue= 4 | pages= 3439-42 | pmid=23680589 | doi=10.1016/j.ijcard.2013.04.181 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23680589  }} </ref><ref name="pmid33197395">{{cite journal| author=Ponikowski P, Kirwan BA, Anker SD, McDonagh T, Dorobantu M, Drozdz J | display-authors=etal| title=Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, controlled trial. | journal=Lancet | year= 2020 | volume= 396 | issue= 10266 | pages= 1895-1904 | pmid=33197395 | doi=10.1016/S0140-6736(20)32339-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33197395  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=33819065 Review in: Ann Intern Med. 2021 Apr;174(4):JC45] </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>
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{|class="wikitable" style="width:80%"
{|class="wikitable" style="width:80%"
|-
|-
| colspan="1" style="text-align:center; background: LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|colspan="1" style="text-align:center; background:LightCoral| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
|-
| bgcolor="LemonChiffon"|
'''1.'''
In patients with NYHA class II and III HF and iron deficiency (ferritin <100 ng/mL or 100 to 300 ng/mL if transferrin saturation is <20%), intravenous iron replacement might be reasonable to improve functional status and QoL.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class IIb, Level of Evidence: B-R]])
|-
|-
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| bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' In patients with HF and anemia, erythropoeitin-stimulating agents should not be used to improve morbidity and mortality. <ref name="pmid23473338">{{cite journal| author=Swedberg K, Young JB, Anand IS, Cheng S, Desai AS, Diaz R | display-authors=etal| title=Treatment of anemia with darbepoetin alfa in systolic heart failure. | journal=N Engl J Med | year= 2013 | volume= 368 | issue= 13 | pages= 1210-9 | pmid=23473338 | doi=10.1056/NEJMoa1214865 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23473338  }} </ref><ref name="pmid27209352">{{cite journal| author=Kang J, Park J, Lee JM, Park JJ, Choi DJ| title=The effects of erythropoiesis stimulating therapy for anemia in chronic heart failure: A meta-analysis of randomized clinical trials. | journal=Int J Cardiol | year= 2016 | volume= 218 | issue=  | pages= 12-22 | pmid=27209352 | doi=10.1016/j.ijcard.2016.04.187 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27209352  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>
 
===Atrial Fibrillation===


{|class="wikitable" style="width:80%"
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| colspan="1" style="text-align:center; background: LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
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'''1.'''
Management of AF according to published clinical practice guidelines in patients with HFpEF is reasonable to improve symptomatic HF.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class IIa, Level of Evidence: C]])
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===Diabetes Mellitus===
===[[Diabetes Mellitus]]===


{|class="wikitable" style="width:80%"
{|class="wikitable" style="width:80%"
|-
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| colspan="1" style="text-align:center; background: LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|colspan="1" style="text-align:center; background:LightGreen| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]  
|-
| bgcolor="LightGreen"|
'''1.'''
For patients with diabetes mellitus (who are all at high risk for developing HF), blood sugar should be controlled in accordance with contemporary guidelines.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class I, Level of Evidence: C]])
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''7.''' In patients with HF and type 2 diabetes, the use of SGLT2i is recommended for the management of hyperglycemia and to reduce HF-related morbidity and mortality. <ref name="pmid32877652">{{cite journal| author=Zannad F, Ferreira JP, Pocock SJ, Anker SD, Butler J, Filippatos G | display-authors=etal| title=SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials. | journal=Lancet | year= 2020 | volume= 396 | issue= 10254 | pages= 819-829 | pmid=32877652 | doi=10.1016/S0140-6736(20)31824-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32877652  }} </ref><ref name="pmid30882238">{{cite journal| author=Kato ET, Silverman MG, Mosenzon O, Zelniker TA, Cahn A, Furtado RHM | display-authors=etal| title=Effect of Dapagliflozin on Heart Failure and Mortality in Type 2 Diabetes Mellitus. | journal=Circulation | year= 2019 | volume= 139 | issue= 22 | pages= 2528-2536 | pmid=30882238 | doi=10.1161/CIRCULATIONAHA.119.040130 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30882238  }} </ref><ref name="pmid31535829">{{cite journal| author=McMurray JJV, Solomon SD, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA | display-authors=etal| title=Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. | journal=N Engl J Med | year= 2019 | volume= 381 | issue= 21 | pages= 1995-2008 | pmid=31535829 | doi=10.1056/NEJMoa1911303 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31535829  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=32066149 Review in: Ann Intern Med. 2020 Feb 18;172(4):JC16] </ref><ref name="pmid32865377">{{cite journal| author=Packer M, Anker SD, Butler J, Filippatos G, Pocock SJ, Carson P | display-authors=etal| title=Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. | journal=N Engl J Med | year= 2020 | volume= 383 | issue= 15 | pages= 1413-1424 | pmid=32865377 | doi=10.1056/NEJMoa2022190 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32865377  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=33197352 Review in: Ann Intern Med. 2020 Nov 17;173(10):JC51] </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>


{|class="wikitable" style="width:80%"
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| colspan="1" style="text-align:center; background: LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
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| bgcolor="LemonChiffon"|
'''1.'''
ACE inhibitors can be useful to prevent HF in patients at high risk for developing HF who have a history of atherosclerotic vascular disease, diabetes mellitus, or hypertension with associated cardiovascular risk factors.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class IIa, Level of Evidence: A]])
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| bgcolor="LemonChiffon"|
'''2.'''
ARBs can be useful to prevent HF in patients at high risk for developing HF who have a history of atherosclerotic vascular disease, diabetes mellitus, or hypertension with associated cardiovascular risk factors.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class IIa, Level of Evidence: B]])
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===Hyperlipidemia===
===[[Sleep Disorders]]===


{|class="wikitable" style="width:80%"
{|class="wikitable" style="width:80%"
|-
|-
| colspan="1" style="text-align:center; background: LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|colspan="1" style="text-align:center; background:LemonChiffon| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LightGreen"|
'''1.'''
In patients with a recent or remote history of MI or acute coronary syndrome, statins should be used to prevent cardiovascular events.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class I, Level of Evidence: A]])
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| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' In patients with HF and suspicion of sleep-disordered breathing, a formal sleep assessment is reasonable to confirm the diagnosis and differentiate between obstructive and central sleep apnea. <ref name="pmid23222879">{{cite journal| author=Arzt M, Schroll S, Series F, Lewis K, Benjamin A, Escourrou P | display-authors=etal| title=Auto-servoventilation in heart failure with sleep apnoea: a randomised controlled trial. | journal=Eur Respir J | year= 2013 | volume= 42 | issue= 5 | pages= 1244-54 | pmid=23222879 | doi=10.1183/09031936.00083312 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23222879  }} </ref><ref name="pmid17562959">{{cite journal| author=Arzt M, Floras JS, Logan AG, Kimoff RJ, Series F, Morrison D | display-authors=etal| title=Suppression of central sleep apnea by continuous positive airway pressure and transplant-free survival in heart failure: a post hoc analysis of the Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure Trial (CANPAP). | journal=Circulation | year= 2007 | volume= 115 | issue= 25 | pages= 3173-80 | pmid=17562959 | doi=10.1161/CIRCULATIONAHA.106.683482 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17562959  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])'' <nowiki>"</nowiki>


{|class="wikitable" style="width:80%"
|-
|-
| colspan="1" style="text-align:center; background: LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III (No Benefit)]]
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' In patients with HF and obstructive sleeep apnea, continuous positive airway pressure may be reasonable to improve sleep quality and decrease daytime sleepiness.  <ref name="pmid23222879">{{cite journal| author=Arzt M, Schroll S, Series F, Lewis K, Benjamin A, Escourrou P | display-authors=etal| title=Auto-servoventilation in heart failure with sleep apnoea: a randomised controlled trial. | journal=Eur Respir J | year= 2013 | volume= 42 | issue= 5 | pages= 1244-54 | pmid=23222879 | doi=10.1183/09031936.00083312 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23222879  }} </ref><ref name="pmid28335841">{{cite journal| author=O'Connor CM, Whellan DJ, Fiuzat M, Punjabi NM, Tasissa G, Anstrom KJ | display-authors=etal| title=Cardiovascular Outcomes With Minute Ventilation-Targeted Adaptive Servo-Ventilation Therapy in Heart Failure: The CAT-HF Trial. | journal=J Am Coll Cardiol | year= 2017 | volume= 69 | issue= 12 | pages= 1577-1587 | pmid=28335841 | doi=10.1016/j.jacc.2017.01.041 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28335841  }} </ref><ref name="pmid26323938">{{cite journal| author=Cowie MR, Woehrle H, Wegscheider K, Angermann C, d'Ortho MP, Erdmann E | display-authors=etal| title=Adaptive Servo-Ventilation for Central Sleep Apnea in Systolic Heart Failure. | journal=N Engl J Med | year= 2015 | volume= 373 | issue= 12 | pages= 1095-105 | pmid=26323938 | doi=10.1056/NEJMoa1506459 | pmc=4779593 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26323938  }} </ref><ref name="pmid31797360">{{cite journal| author=Yamamoto S, Yamaga T, Nishie K, Nagata C, Mori R| title=Positive airway pressure therapy for the treatment of central sleep apnoea associated with heart failure. | journal=Cochrane Database Syst Rev | year= 2019 | volume= 12 | issue=  | pages= CD012803 | pmid=31797360 | doi=10.1002/14651858.CD012803.pub2 | pmc=6891032 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31797360  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>
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| bgcolor="LightCoral"|
'''1.'''
Statins are not beneficial as adjunctive therapy when prescribed solely for the diagnosis of HF in the absence of other indications, and routine use of statins for the treatment of HF is not indicated outside of current practice guidelines for the primary and secondary preven- tion of atherosclerotic vascular disease.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class III, Level of Evidence: A]])
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{|class="wikitable" style="width:80%"
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| colspan="1" style="text-align:center; background: LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
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| bgcolor="LemonChiffon"|
'''1.'''
PUFA supplementation is reasonable to use as adjunctive therapy in patients with NYHA class II to IV symptoms and HFrEF or HFpEF, unless contraindicated, to reduce mortality and cardiovascular hospitalizations.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class IIa, Level of Evidence: B]])
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{|class="wikitable" style="width:80%"
{|class="wikitable" style="width:80%"
|-
|-
| colspan="1" style="text-align:center; background: LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|colspan="1" style="text-align:center; background:LightCoral| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
|-
|-
| bgcolor="LemonChiffon"|
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''3.''' In patients with NYHA class II to IV HFrEF and central sleep apnea, adaptive servo-ventilation causes harm. <ref name="pmid28335841">{{cite journal| author=O'Connor CM, Whellan DJ, Fiuzat M, Punjabi NM, Tasissa G, Anstrom KJ | display-authors=etal| title=Cardiovascular Outcomes With Minute Ventilation-Targeted Adaptive Servo-Ventilation Therapy in Heart Failure: The CAT-HF Trial. | journal=J Am Coll Cardiol | year= 2017 | volume= 69 | issue= 12 | pages= 1577-1587 | pmid=28335841 | doi=10.1016/j.jacc.2017.01.041 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28335841  }} </ref><ref name="pmid26323938">{{cite journal| author=Cowie MR, Woehrle H, Wegscheider K, Angermann C, d'Ortho MP, Erdmann E | display-authors=etal| title=Adaptive Servo-Ventilation for Central Sleep Apnea in Systolic Heart Failure. | journal=N Engl J Med | year= 2015 | volume= 373 | issue= 12 | pages= 1095-105 | pmid=26323938 | doi=10.1056/NEJMoa1506459 | pmc=4779593 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26323938  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>
'''1.'''
Lipid disorders should be controlled in accor- dance with contemporary guidelines.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class IIa, Level of Evidence: B]])
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===Obesity===
{|class="wikitable" style="width:80%"
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| colspan="1" style="text-align:center; background: LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
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| bgcolor="LightGreen"|
'''1.'''
Obesity should be controlled or avoided to prevent the development of HF along with other CVDs.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class I, Level of Evidence: C]])
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{|class="wikitable" style="width:80%"
=== Managment of [[Atrial Fibrilation]] in Heart Failure ===
{| class="wikitable" style="width:80%"
|-
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| colspan="1" style="text-align:center; background: LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III (Harm)]]
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
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| bgcolor="LightCoral"|
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' Patients with chronic HF with permanent-per-persistent-paroxysmal AF and a CHA2DS2-Vasc score of ≥2 (for men) and ≥3 (for women) should receive chronic anticoagulant therapy''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]]'' )<nowiki>"</nowiki>
'''1.'''
Sibutramine or ephedra weight loss preparations are contraindicated in HF. Use of ephedra weight-loss preparations may contribute to the development of HF and should be avoided.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class III, Level of Evidence: C]])
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| bgcolor="LightGreen" |<nowiki>''</nowiki>2. For patients with chronic HF with permanent-persistent-paroxysmal AF, DOAC is recommended over warfarin in eligible patients ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])'' <nowiki>"</nowiki>
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<ref name="pmid353635002">{{cite journal| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM | display-authors=etal| title=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. | journal=Circulation | year= 2022 | volume= 145 | issue= 18 | pages= e876-e894 | pmid=35363500 | doi=10.1161/CIR.0000000000001062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500  }}</ref>
{|class="wikitable" style="width:80%"
{| class="wikitable" style="width:80%"
|-
|-
| colspan="1" style="text-align:center; background: LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
| colspan="1" style="text-align:center; background:LemonChiffon" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
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| bgcolor="LemonChiffon"|
| bgcolor="LemonChiffon" |" 3'''.  ''' For patients with HF and symptoms caused by AF, AF ablation is reasonable to improve symptoms and QOL (Level of Evidence B-R)".
'''1.'''
Purposeful weight loss via healthy dietary intervention or physical activity for the purposes of improving health-related QOL or managing comorbidities such as diabetes mellitus, hypertension, or sleep apnea may be reasonable in obese patients with HF..
([[ACC AHA guidelines classification scheme#Level of Evidence|Class IIb, Level of Evidence: C]])
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| bgcolor="LemonChiffon" |<nowiki>''</nowiki> 4. For patients with AF and LVEF ≤50%, if a rhythm control strategy fails or is not desired, and ventricular rates remain rapid despite medi-cal therapy, atrioventricular nodal ablation with implantation of a CRT device is reasonable (Level of Evidence B-R)<nowiki>''</nowiki>
 
===Sleep Disorders===
 
{|class="wikitable" style="width:80%"
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| colspan="1" style="text-align:center; background: LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III (Harm)]]
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| bgcolor="LightCoral"|
'''1.'''
In patients with NYHA class II–IV HFrEF and central sleep apnea, adaptive servo-ventilation causes harm.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class III, Level of Evidence: B-R]])
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| bgcolor="LemonChiffon" |<nowiki>''</nowiki>5. For patients with chronic HF and permanent-persistent-paroxysmal AF, chronic anticoagulant therapy is reasonable for men and women with-out additional risk factors (Level of Evidence B- NR)<nowiki>''</nowiki>
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<ref name="pmid353635002" />


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==External Link==
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*[https://www.ahajournals.org/doi/epub/10.1161/CIR.0000000000001063.full.pdf 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines]<ref name="pmid35363499">{{cite journal |vauthors=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW |title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines |journal=Circulation |volume=145 |issue=18 |pages=e895–e1032 |date=May 2022 |pmid=35363499 |doi=10.1161/CIR.0000000000001063 |url=}} </ref>
| colspan="1" style="text-align:center; background: LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
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| bgcolor="LemonChiffon"|
'''1.'''
In patients with NYHA class II–IV HF and suspicion of sleep-disordered breathing or excessive daytime sleepiness, a formal sleep assessment is reasonable.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class IIa, Level of Evidence: C-LD]])
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{|class="wikitable" style="width:80%"
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| colspan="1" style="text-align:center; background: LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
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| bgcolor="LemonChiffon"|
'''1.'''
In patients with cardiovascular disease and obstructive sleep apnea, CPAP may be reasonable to improve sleep quality and daytime sleepiness.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class IIb, Level of Evidence: B-R]])
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==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 16:27, 1 December 2022
Resident
Survival
Guide
Congestive Heart Failure Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Systolic Dysfunction
Diastolic Dysfunction
HFpEF
HFrEF

Causes

Differentiating Congestive heart failure from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Clinical Assessment

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

Cardiac MRI

Echocardiography

Exercise Stress Test

Myocardial Viability Studies

Cardiac Catheterization

Other Imaging Studies

Other Diagnostic Studies

Treatment

Invasive Hemodynamic Monitoring

Medical Therapy:

Summary
Acute Pharmacotherapy
Chronic Pharmacotherapy in HFpEF
Chronic Pharmacotherapy in HFrEF
Diuretics
ACE Inhibitors
Angiotensin receptor blockers
Aldosterone Antagonists
Beta Blockers
Ca Channel Blockers
Nitrates
Hydralazine
Positive Inotropics
Anticoagulants
Angiotensin Receptor-Neprilysin Inhibitor
Antiarrhythmic Drugs
Nutritional Supplements
Hormonal Therapies
Drugs to Avoid
Drug Interactions
Treatment of underlying causes
Associated conditions

Exercise Training

Surgical Therapy:

Biventricular Pacing or Cardiac Resynchronization Therapy (CRT)
Implantation of Intracardiac Defibrillator
Ultrafiltration
Cardiac Surgery
Left Ventricular Assist Devices (LVADs)
Cardiac Transplantation

ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
Patients with current or prior symptoms of heart failure (Stage C)
Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
Quality Metrics/Performance Measures

Implementation of Practice Guidelines

Congestive heart failure end-of-life considerations

Specific Groups:

Special Populations
Patients who have concomitant disorders
Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

Congestive heart failure treatment of associated conditions On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Congestive heart failure treatment of associated conditions

CDC on Congestive heart failure treatment of associated conditions

Congestive heart failure treatment of associated conditions in the news

Blogs on Congestive heart failure treatment of associated conditions

Directions to Hospitals Treating Congestive heart failure treatment of associated conditions

Risk calculators and risk factors for Congestive heart failure treatment of associated conditions

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Arzu Kalayci, M.D. [2] Edzel Lorraine Co, DMD, MD[3]

Overview

Congestive heart failure can be associated with and exacerbated by rapid supraventricular as well as atrial fibrillation, ventricular arrhythmias, venous thromboembolism, renal insufficiency, and anemia.

2022 ACC/AHA/HFSA Heart Failure Guidelines (DO NOT EDIT) [1]

Iron Deficiency or Anemia

Class IIa
"1. In patients with HFrEF and iron deficiency with or without anemia, intravenous iron replacement is reasonable to improve functional status and QOL. [2][3][4][5](Level of Evidence: B-R) "
Class III (Harm)
"2. In patients with HF and anemia, erythropoeitin-stimulating agents should not be used to improve morbidity and mortality. [6][7](Level of Evidence: B-R) "

Diabetes Mellitus

Class I
"7. In patients with HF and type 2 diabetes, the use of SGLT2i is recommended for the management of hyperglycemia and to reduce HF-related morbidity and mortality. [8][9][10][11] (Level of Evidence: A) "

Sleep Disorders

Class IIa
"1. In patients with HF and suspicion of sleep-disordered breathing, a formal sleep assessment is reasonable to confirm the diagnosis and differentiate between obstructive and central sleep apnea. [12][13](Level of Evidence: C-LD) "
"2. In patients with HF and obstructive sleeep apnea, continuous positive airway pressure may be reasonable to improve sleep quality and decrease daytime sleepiness. [12][14][15][16](Level of Evidence: B-R) "
Class III (Harm)
"3. In patients with NYHA class II to IV HFrEF and central sleep apnea, adaptive servo-ventilation causes harm. [14][15] (Level of Evidence: B-R) "

Managment of Atrial Fibrilation in Heart Failure

Class I
"1. Patients with chronic HF with permanent-per-persistent-paroxysmal AF and a CHA2DS2-Vasc score of ≥2 (for men) and ≥3 (for women) should receive chronic anticoagulant therapy(Level of Evidence: A )"
''2. For patients with chronic HF with permanent-persistent-paroxysmal AF, DOAC is recommended over warfarin in eligible patients (Level of Evidence: C-LD) "

[17]

Class IIa
" 3.   For patients with HF and symptoms caused by AF, AF ablation is reasonable to improve symptoms and QOL (Level of Evidence B-R)".
'' 4. For patients with AF and LVEF ≤50%, if a rhythm control strategy fails or is not desired, and ventricular rates remain rapid despite medi-cal therapy, atrioventricular nodal ablation with implantation of a CRT device is reasonable (Level of Evidence B-R)''
''5. For patients with chronic HF and permanent-persistent-paroxysmal AF, chronic anticoagulant therapy is reasonable for men and women with-out additional risk factors (Level of Evidence B- NR)''

[17]

External Link


References

  1. ↑ Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM; et al. (2022). "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". Circulation. 145 (18): e876–e894. doi:10.1161/CIR.0000000000001062. PMID 35363500 Check |pmid= value (help).
  2. ↑ Anker SD, Comin Colet J, Filippatos G, Willenheimer R, Dickstein K, Drexler H; et al. (2009). "Ferric carboxymaltose in patients with heart failure and iron deficiency". N Engl J Med. 361 (25): 2436–48. doi:10.1056/NEJMoa0908355. PMID 19920054. Review in: Ann Intern Med. 2010 Apr 20;152(8):JC4-5
  3. ↑ Ponikowski P, van Veldhuisen DJ, Comin-Colet J, Ertl G, Komajda M, Mareev V; et al. (2015). "Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency†". Eur Heart J. 36 (11): 657–68. doi:10.1093/eurheartj/ehu385. PMC 4359359. PMID 25176939.
  4. ↑ Beck-da-Silva L, Piardi D, Soder S, Rohde LE, Pereira-Barretto AC, de Albuquerque D; et al. (2013). "IRON-HF study: a randomized trial to assess the effects of iron in heart failure patients with anemia". Int J Cardiol. 168 (4): 3439–42. doi:10.1016/j.ijcard.2013.04.181. PMID 23680589.
  5. ↑ Ponikowski P, Kirwan BA, Anker SD, McDonagh T, Dorobantu M, Drozdz J; et al. (2020). "Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, controlled trial". Lancet. 396 (10266): 1895–1904. doi:10.1016/S0140-6736(20)32339-4. PMID 33197395 Check |pmid= value (help). Review in: Ann Intern Med. 2021 Apr;174(4):JC45
  6. ↑ Swedberg K, Young JB, Anand IS, Cheng S, Desai AS, Diaz R; et al. (2013). "Treatment of anemia with darbepoetin alfa in systolic heart failure". N Engl J Med. 368 (13): 1210–9. doi:10.1056/NEJMoa1214865. PMID 23473338.
  7. ↑ Kang J, Park J, Lee JM, Park JJ, Choi DJ (2016). "The effects of erythropoiesis stimulating therapy for anemia in chronic heart failure: A meta-analysis of randomized clinical trials". Int J Cardiol. 218: 12–22. doi:10.1016/j.ijcard.2016.04.187. PMID 27209352.
  8. ↑ Zannad F, Ferreira JP, Pocock SJ, Anker SD, Butler J, Filippatos G; et al. (2020). "SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials". Lancet. 396 (10254): 819–829. doi:10.1016/S0140-6736(20)31824-9. PMID 32877652 Check |pmid= value (help).
  9. ↑ Kato ET, Silverman MG, Mosenzon O, Zelniker TA, Cahn A, Furtado RHM; et al. (2019). "Effect of Dapagliflozin on Heart Failure and Mortality in Type 2 Diabetes Mellitus". Circulation. 139 (22): 2528–2536. doi:10.1161/CIRCULATIONAHA.119.040130. PMID 30882238.
  10. ↑ McMurray JJV, Solomon SD, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA; et al. (2019). "Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction". N Engl J Med. 381 (21): 1995–2008. doi:10.1056/NEJMoa1911303. PMID 31535829. Review in: Ann Intern Med. 2020 Feb 18;172(4):JC16
  11. ↑ Packer M, Anker SD, Butler J, Filippatos G, Pocock SJ, Carson P; et al. (2020). "Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure". N Engl J Med. 383 (15): 1413–1424. doi:10.1056/NEJMoa2022190. PMID 32865377 Check |pmid= value (help). Review in: Ann Intern Med. 2020 Nov 17;173(10):JC51
  12. ↑ 12.0 12.1 Arzt M, Schroll S, Series F, Lewis K, Benjamin A, Escourrou P; et al. (2013). "Auto-servoventilation in heart failure with sleep apnoea: a randomised controlled trial". Eur Respir J. 42 (5): 1244–54. doi:10.1183/09031936.00083312. PMID 23222879.
  13. ↑ Arzt M, Floras JS, Logan AG, Kimoff RJ, Series F, Morrison D; et al. (2007). "Suppression of central sleep apnea by continuous positive airway pressure and transplant-free survival in heart failure: a post hoc analysis of the Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure Trial (CANPAP)". Circulation. 115 (25): 3173–80. doi:10.1161/CIRCULATIONAHA.106.683482. PMID 17562959.
  14. ↑ 14.0 14.1 O'Connor CM, Whellan DJ, Fiuzat M, Punjabi NM, Tasissa G, Anstrom KJ; et al. (2017). "Cardiovascular Outcomes With Minute Ventilation-Targeted Adaptive Servo-Ventilation Therapy in Heart Failure: The CAT-HF Trial". J Am Coll Cardiol. 69 (12): 1577–1587. doi:10.1016/j.jacc.2017.01.041. PMID 28335841.
  15. ↑ 15.0 15.1 Cowie MR, Woehrle H, Wegscheider K, Angermann C, d'Ortho MP, Erdmann E; et al. (2015). "Adaptive Servo-Ventilation for Central Sleep Apnea in Systolic Heart Failure". N Engl J Med. 373 (12): 1095–105. doi:10.1056/NEJMoa1506459. PMC 4779593. PMID 26323938.
  16. ↑ Yamamoto S, Yamaga T, Nishie K, Nagata C, Mori R (2019). "Positive airway pressure therapy for the treatment of central sleep apnoea associated with heart failure". Cochrane Database Syst Rev. 12: CD012803. doi:10.1002/14651858.CD012803.pub2. PMC 6891032 Check |pmc= value (help). PMID 31797360.
  17. ↑ 17.0 17.1 Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM; et al. (2022). "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". Circulation. 145 (18): e876–e894. doi:10.1161/CIR.0000000000001062. PMID 35363500 Check |pmid= value (help).
  18. ↑ Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW (May 2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (18): e895–e1032. doi:10.1161/CIR.0000000000001063. PMID 35363499 Check |pmid= value (help).

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