Congestive heart failure treatment of special populations: Difference between revisions

	Congestive Heart Failure Microchapters
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Latest revision as of 23:36, 22 June 2022

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

Overview

There is unfortunately insufficient data in subgroups of patients to mandate a change to guidelines recommendations regarding the management of heart failure. Dosages should be altered as needed in the elderly or in those with altered metabolism. African american patients may respond to the addition of hydralazine and nitrates to the standard of care in the treatment of heart failure.

Women

Women may not drive the same benefit from angiotensin-converting enzyme inhibitors in meta-analysis (mortality HR = 0.80 (95% CI 0.68-0.93) for men but HR = 0.90 (95% CI 0.78-1.05) for women) ^[1], but women do appear to drive the same benefit from beta blockers as men (HRs for mortality 063 & 0.66 respectively).^[1]

Race

ACE Inhibition

Blacks tend to have a poorer response to ACE inhibition, specifically in response to equivalent doses of enalapril (44% reduction in heart failure hospitalization among whites versus no benefit among black patients in SOLVD).^[2] Similar results have been observed with respect blood pressure management. In the SOLVD study quoted above, there was a 5 mm Hg reduction in systolic blood pressure among white patients but no reduction in systolic blood pressure among black patients. Despite the lack of improvement in hospitalization or systolic blood pressure, blacks did experience a reduction in mortality that was similar to that of white patients. Thus, ACE inhibitors should continue to be used in black patients.

Beta Blockers

Randomized trials have shown mixed benefits for blacks with beta blockers. In the BEST trial, bucindolol (they beta blocker with partial beta agonist activity) was not associated with the benefit in blacks^[3], however in the carvedilol trials blacks did sustain a benefit^[4]. It has been speculated that there may be differences in the beta adrenergic system between blacks and whites that account for these differences.

Hydralazine Plus Nitrates

Black patients appeared to derive particular benefit from the combination of hydralazine plus nitrates.^[5]

Diabetics

In general, the management of the diabetic patient with heart failure is similar to that of the non-diabetic patient. However, the thiazolidinediones (which can cause fluid retention) and metformin (which can cause lactic acidosis in the patient with congestive heart failure) are relatively contraindicated in the patient with congestive heart failure.

2022 AHA/ACC/HFSA Heart Failure Guideline/2009 and 2005 ACC/AHA Focused Update Guidelines for the Diagnosis and Management of Chronic Heart Failure in the Adult and 2006 ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (DO NOT EDIT) ^[6]^[7]^[8] ^[9]

Disparities and Vulnerable Populations (DO NOT EDIT) ^[6]

Class I
"1. In vulnerable patient populations at risk for health disparities, HF risk assessments and multidisciplinary management strategies should target both known risks for CVD and social determinants of health, as a means toward elimination of disparate HF outcomes. ^[10]^[11]^[12]^[13]^[14]^[15] (Level of Evidence: C-LD)"
"2. Evidence of health disparities should be monitored and addressed at the clinical practice and the health care system levels.^[16]^[17]^[18]^[19]^[20]^[21]^[22] (Level of Evidence: C-LD) "

Recommendations for Cardio-Oncology (DO NOT EDIT) ^[6]

Class I
"1. In patients who develop cancer therapy-related cardiomyopathy or HF, a multidisciplinary discussion involving the patient about the risk-benefit ratio of cancer therapy interruption, discontinuation, or continuation is recommended to improve management.^[10]^[11] (Level of Evidence: B-NR)"

Class IIa
"2. In asymptomatic patients with cancer therapy-related cardiomyopathy (EF<50%), ARB, ACEi, and beta blockers are reasonable to prevent progression to HF and improve cardiac function. ^[11]^[12]^[13](Level of Evidence: B-NR) "
"3. In patients with cardiovascular risk factors or known cardiac disease being considered for potentially cardiotoxic anticancer therapies, pretherapy evaluation of cardiac function is reasonable to establish baseline cardiac function and guide the choice of cancer therapy. ^[11]^[14]^[15]^[16]^[17]^[18]^[19]^[20]^[21]^[22]^[23]^[24]^[25](Level of Evidence: B-NR)"
"4. In patients with cardiovascular risk factors or known cardiac disease receiving potentially cardiotoxic anticancer therapies, monitoring of cardiac function is reasonable for the early identification of drug-induced cardiomyopathy.^[11]^[13]^[15]^[17] (Level of Evidence: B-NR) "

Class IIb
" 5. In patients at risk of cancer therapy-related cardiomyopathy, initiation of beta blockers and ACEI/ ARB for the primary prevention of drug-induced cardiomyopathy is of uncertain benefit. ^[26]^[27]^[28]^[29]^[30]^[31]^[32]^[33]^[34]^[35]^[36]^[37] (Level of Evidence: B-R)"
" 6. In patients being considered for potentially cardiotoxic therapies, serial measurement of cardiac troponin might be reasonable for further risk stratification. ^[38]^[39]^[40]^[41](Level of Evidence: C-LD)"

Treatment of Special Populations (DO NOT EDIT) ^[7]^[8]

Class I
"1. The addition of a fixed dose of isosorbide dinitrate and hydralazine to a standard medical regimen for HF, including ACEIs and beta-blockers, is recommended in order to improve outcomes for patients self-described as African Americans, with NYHA functional class III or IV HF. Others may benefit similarly, but this has not yet been tested. (Level of Evidence: A)"
"2. Groups of patients including (a) high-risk ethnic minority groups (e.g., blacks), (b) groups underrepresented in clinical trials, and (c) any groups believed to be underserved should, in the absence of specific evidence to direct otherwise, have clinical screening and therapy in a manner identical to that applied to the broader population. (Level of Evidence: B) "
"3. It is recommended that evidence-based therapy for HF be used in the elderly patient, with individualized consideration of the elderly patient’s altered ability to metabolize or tolerate standard medications. (Level of Evidence: C) "

Left Ventricular Dysfunction Due to Prior Myocardial Infarction (DO NOT EDIT) ^[9]

Class I
" 1. Aggressive attempts should be made to treat HF that may be present in some patients with LV dysfunction due to prior MI and ventricular tachyarrhythmias. (Level of Evidence: C)"
" 2. Aggressive attempts should be made to treat myocardial ischemia that may be present in some patients with ventricular tachyarrhythmias. (Level of Evidence: C)"
" 3. Coronary revascularization is indicated to reduce the risk of SCD in patients with VF when direct, clear evidence of acute myocardial ischemia is documented to immediately precede the onset of VF. (Level of Evidence: B)"
" 4. If coronary revascularization cannot be carried out and there is evidence of prior MI and significant LV dysfunction, the primary therapy of patients resuscitated from VF should be the ICD] in patients who are receiving chronic optimal medical therapy and those who have reasonable expectation of survival with a good functional status for more than 1 y. (Level of Evidence: A)"
" 5. ICD therapy is recommended for primary prevention to reduce total mortality by a reduction in SCD in patients with LV dysfunction due to prior MI who are at least 40 d post-MI, have an LVEF less than or equal to 30% to 40%, are NYHA functional class II or III, are receiving chronic optimal medical therapy, and who have reasonable expectation of survival with a good functional status for more than 1 y. (Level of Evidence: A)"
" 6. The ICD is effective therapy to reduce mortality by a reduction in SCD in patients with LV dysfunction due to prior MI who present with hemodynamically unstable sustained VT, are receiving chronic optimal medical therapy, and who have reasonable expectation of survival with a good functional status for more than 1 y. (Level of Evidence: A)"

Class III
" 1. Prophylactic antiarrhythmic drug therapy is not indicated to reduce mortality in patients with asymptomatic nonsustained ventricular arrhythmias. (Level of Evidence: B)"
" 2. Class IC antiarrhythmic drugs in patients with a past history of MI should not be used. (Level of Evidence: A)"

Class IIa
" 1. Implantation of an ICD is reasonable in patients with LV dysfunction due to prior MI who are at least 40 d post-MI, have an LVEF of less than or equal to 30% to 35%, are NYHA functional class I on chronic optimal medical therapy, and who have reasonable expectation of survival with a good functional status for more than 1 y. (Level of Evidence: B) "
" 2. Amiodarone, often in combination with beta blockers, can be useful for patients with LV dysfunction due to prior MI and symptoms due to VT unresponsive to beta-adrenergic blocking agents. (Level of Evidence: B)"
" 3. Sotalol is reasonable therapy to reduce symptoms resulting from VT for patients with LV dysfunction due to prior MI unresponsive to beta blocking agents. (Level of Evidence: C)"
" 4. Adjunctive therapies to the ICD, including catheter ablation or surgical resection, and pharmacological therapy with agents such as amiodarone or sotalol are reasonable to improve symptoms due to frequent episodes of ustained VT or VF in patients with LV dysfunction due to prior MI. (Level of Evidence: C)"
" 5. Amiodarone is reasonable therapy to reduce symptoms due to recurrent hemodynamically stable VT for patients with LV dysfunction due to prior [[MI\\ who cannot or refuse to have an ICD implanted. (Level of Evidence: C)"
" 6. Implantation is reasonable for [[treatment\\ of recurrent ventricular tachycardia in patients post-MI with normal or near normal ventricular function who are receiving chronic optimal medical therapy and who have reasonable expectation of survival] with a good functional status for more than 1 y. (Level of Evidence: C)"

Class IIb
" 1. Curative catheter ablation or amiodarone may be considered in lieu of ICD therapy to improve symptoms in patients with LV dysfunction due to prior MI and recurrent hemodynamically stable VT whose LVEF is greater than 40%. (Level of Evidence: B)"
" 2. Amiodarone may be reasonable therapy for patients with LV dysfunction due to prior MI with an ICD indication, as defined above, in patients who cannot or refuse to have an ICD implanted. (Level of Evidence: C)"

Heart Failure and Pregnancy (DO NOT EDIT) ^[6]

Class I
" 1. In women with a history of HF or cardiomyopathy, including previous peripartum cardiomyopathy, patient-centered counseling regarding contraception and the risks of cardiovascular deterioration during pregnancy should be provided. ^[42]^[43]^[44]^[45]^[46]^[47]^[48]^[49] (Level of Evidence: C-LD) "

Class IIb
" 2.In women with acute HF caused by peripartum cardiomyopathy and LVEF < 30%, anticoagulation may be reasonable at diagnosis, until 6 to 8 weeks postpartum, although the eficacy and safety are uncertain.^[50]^[51]^[52]^[53](Level of Evidence: C-LD) "

Class III (Harm)
" 2.In women with HF or cardiomyopathy who are pregnant or currently planning for pregnancy, ACEi, ARB, ARNi, MRA, SGLT2i, ivabradine, and vericiguat should not be administered because of significant risks of [[fetal harm. ^[54]^[55]^[56](Level of Evidence: C-LD) "

Vote on and Suggest Revisions to the Current Guidelines

The CHF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines

Sources

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^[6]

2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation ^[8]

The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult ^[7]

References

↑ ^1.0 ^1.1 Shekelle PG, Rich MW, Morton SC, Atkinson CS, Tu W, Maglione M, Rhodes S, Barrett M, Fonarow GC, Greenberg B, Heidenreich PA, Knabel T, Konstam MA, Steimle A, Warner Stevenson L (2003). "Efficacy of angiotensin-converting enzyme inhibitors and beta-blockers in the management of left ventricular systolic dysfunction according to race, gender, and diabetic status: a meta-analysis of major clinical trials". Journal of the American College of Cardiology. 41 (9): 1529–38. PMID 12742294. Retrieved 2013-04-25. Unknown parameter |month= ignored (help)
↑ Exner DV, Dries DL, Domanski MJ, Cohn JN (2001). "Lesser response to angiotensin-converting-enzyme inhibitor therapy in black as compared with white patients with left ventricular dysfunction". The New England Journal of Medicine. 344 (18): 1351–7. doi:10.1056/NEJM200105033441802. PMID 11333991. Retrieved 2013-04-25. Unknown parameter |month= ignored (help)
↑ "A trial of the beta-blocker bucindolol in patients with advanced chronic heart failure". The New England Journal of Medicine. 344 (22): 1659–67. 2001. doi:10.1056/NEJM200105313442202. PMID 11386264. Retrieved 2013-04-25. Unknown parameter |month= ignored (help)
↑ Yancy CW, Fowler MB, Colucci WS, Gilbert EM, Bristow MR, Cohn JN, Lukas MA, Young ST, Packer M (2001). "Race and the response to adrenergic blockade with carvedilol in patients with chronic heart failure". The New England Journal of Medicine. 344 (18): 1358–65. doi:10.1056/NEJM200105033441803. PMID 11333992. Retrieved 2013-04-25. Unknown parameter |month= ignored (help)
↑ Carson P, Ziesche S, Johnson G, Cohn JN (1999). "Racial differences in response to therapy for heart failure: analysis of the vasodilator-heart failure trials. Vasodilator-Heart Failure Trial Study Group". Journal of Cardiac Failure. 5 (3): 178–87. PMID 10496190. Retrieved 2013-04-25. Unknown parameter |month= ignored (help)
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↑ Mehta LS, Fisher K, Rzeszut AK, Lipner R, Mitchell S, Dill M; et al. (2019). "Current Demographic Status of Cardiologists in the United States". JAMA Cardiol. 4 (10): 1029–1033. doi:10.1001/jamacardio.2019.3247. PMC 6739735 Check |pmc= value (help). PMID 31509160.
↑ Cauldwell M, Steer PJ, Swan L, Patel RR, Gatzoulis MA, Uebing A; et al. (2017). "Pre-pregnancy counseling for women with heart disease: A prospective study". Int J Cardiol. 240: 374–378. doi:10.1016/j.ijcard.2017.03.092. PMID 28377190.
↑ Roos-Hesselink JW, Ruys TP, Stein JI, Thilén U, Webb GD, Niwa K; et al. (2013). "Outcome of pregnancy in patients with structural or ischaemic heart disease: results of a registry of the European Society of Cardiology". Eur Heart J. 34 (9): 657–65. doi:10.1093/eurheartj/ehs270. PMID 22968232.
↑ Dawson AJ, Krastev Y, Parsonage WA, Peek M, Lust K, Sullivan EA (2018). "Experiences of women with cardiac disease in pregnancy: a systematic review and metasynthesis". BMJ Open. 8 (9): e022755. doi:10.1136/bmjopen-2018-022755. PMC 6169742. PMID 30269070 : 30269070 Check |pmid= value (help).
↑ Elkayam U, Tummala PP, Rao K, Akhter MW, Karaalp IS, Wani OR; et al. (2001). "Maternal and fetal outcomes of subsequent pregnancies in women with peripartum cardiomyopathy". N Engl J Med. 344 (21): 1567–71. doi:10.1056/NEJM200105243442101. PMID 11372007.
↑ Elkayam U (2014). "Risk of subsequent pregnancy in women with a history of peripartum cardiomyopathy". J Am Coll Cardiol. 64 (15): 1629–36. doi:10.1016/j.jacc.2014.07.961. PMID 25301468.
↑ Hilfiker-Kleiner D, Haghikia A, Masuko D, Nonhoff J, Held D, Libhaber E; et al. (2017). "Outcome of subsequent pregnancies in patients with a history of peripartum cardiomyopathy". Eur J Heart Fail. 19 (12): 1723–1728. doi:10.1002/ejhf.808. PMID 28345302.
↑ Yaméogo NV, Samadoulougou AK, Kagambèga LJ, Kologo KJ, Millogo GRC, Thiam A; et al. (2018). "Maternal and fetal prognosis of subsequent pregnancy in black African women with peripartum cardiomyopathy". BMC Cardiovasc Disord. 18 (1): 119. doi:10.1186/s12872-018-0856-7. PMC 6006934. PMID 29914408.
↑ Codsi E, Rose CH, Blauwet LA (2018). "Subsequent Pregnancy Outcomes in Patients With Peripartum Cardiomyopathy". Obstet Gynecol. 131 (2): 322–327. doi:10.1097/AOG.0000000000002439. PMID 29324614.
↑ Sliwa K, Förster O, Libhaber E, Fett JD, Sundstrom JB, Hilfiker-Kleiner D; et al. (2006). "Peripartum cardiomyopathy: inflammatory markers as predictors of outcome in 100 prospectively studied patients". Eur Heart J. 27 (4): 441–6. doi:10.1093/eurheartj/ehi481. PMID 16143707.
↑ Amos AM, Jaber WA, Russell SD (2006). "Improved outcomes in peripartum cardiomyopathy with contemporary". Am Heart J. 152 (3): 509–13. doi:10.1016/j.ahj.2006.02.008. PMID 16923422.
↑ Moulig V, Pfeffer TJ, Ricke-Hoch M, Schlothauer S, Koenig T, Schwab J; et al. (2019). "Long-term follow-up in peripartum cardiomyopathy patients with contemporary treatment: low mortality, high cardiac recovery, but significant cardiovascular co-morbidities". Eur J Heart Fail. 21 (12): 1534–1542. doi:10.1002/ejhf.1624. PMID 31724271.
↑ Laghari AH, Khan AH, Kazmi KA (2013). "Peripartum cardiomyopathy: ten year experience at a tertiary care hospital in Pakistan". BMC Res Notes. 6: 495. doi:10.1186/1756-0500-6-495. PMC 4222096. PMID 24289218.
↑ Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M; et al. (2018). "2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy". Eur Heart J. 39 (34): 3165–3241. doi:10.1093/eurheartj/ehy340. PMID 30165544.
↑ Bauersachs J, König T, van der Meer P, Petrie MC, Hilfiker-Kleiner D, Mbakwem A; et al. (2019). "Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy". Eur J Heart Fail. 21 (7): 827–843. doi:10.1002/ejhf.1493. PMID 31243866.
↑ Halpern DG, Weinberg CR, Pinnelas R, Mehta-Lee S, Economy KE, Valente AM (2019). "Use of Medication for Cardiovascular Disease During Pregnancy: JACC State-of-the-Art Review". J Am Coll Cardiol. 73 (4): 457–476. doi:10.1016/j.jacc.2018.10.075. PMID 30704579.

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[pmid28377190-42] Cauldwell M, Steer PJ, Swan L, Patel RR, Gatzoulis MA, Uebing A; et al. (2017). "Pre-pregnancy counseling for women with heart disease: A prospective study". Int J Cardiol. 240: 374–378. doi:10.1016/j.ijcard.2017.03.092. PMID 28377190.

[pmid22968232-43] Roos-Hesselink JW, Ruys TP, Stein JI, Thilén U, Webb GD, Niwa K; et al. (2013). "Outcome of pregnancy in patients with structural or ischaemic heart disease: results of a registry of the European Society of Cardiology". Eur Heart J. 34 (9): 657–65. doi:10.1093/eurheartj/ehs270. PMID 22968232.

[pmid:_30269070-44] Dawson AJ, Krastev Y, Parsonage WA, Peek M, Lust K, Sullivan EA (2018). "Experiences of women with cardiac disease in pregnancy: a systematic review and metasynthesis". BMJ Open. 8 (9): e022755. doi:10.1136/bmjopen-2018-022755. PMC 6169742. PMID 30269070 : 30269070 Check |pmid= value (help).

[pmid11372007-45] Elkayam U, Tummala PP, Rao K, Akhter MW, Karaalp IS, Wani OR; et al. (2001). "Maternal and fetal outcomes of subsequent pregnancies in women with peripartum cardiomyopathy". N Engl J Med. 344 (21): 1567–71. doi:10.1056/NEJM200105243442101. PMID 11372007.

[pmid25301468-46] Elkayam U (2014). "Risk of subsequent pregnancy in women with a history of peripartum cardiomyopathy". J Am Coll Cardiol. 64 (15): 1629–36. doi:10.1016/j.jacc.2014.07.961. PMID 25301468.

[pmid28345302-47] Hilfiker-Kleiner D, Haghikia A, Masuko D, Nonhoff J, Held D, Libhaber E; et al. (2017). "Outcome of subsequent pregnancies in patients with a history of peripartum cardiomyopathy". Eur J Heart Fail. 19 (12): 1723–1728. doi:10.1002/ejhf.808. PMID 28345302.

[pmid29914408-48] Yaméogo NV, Samadoulougou AK, Kagambèga LJ, Kologo KJ, Millogo GRC, Thiam A; et al. (2018). "Maternal and fetal prognosis of subsequent pregnancy in black African women with peripartum cardiomyopathy". BMC Cardiovasc Disord. 18 (1): 119. doi:10.1186/s12872-018-0856-7. PMC 6006934. PMID 29914408.

[pmid29324614-49] Codsi E, Rose CH, Blauwet LA (2018). "Subsequent Pregnancy Outcomes in Patients With Peripartum Cardiomyopathy". Obstet Gynecol. 131 (2): 322–327. doi:10.1097/AOG.0000000000002439. PMID 29324614.

[pmid16143707-50] Sliwa K, Förster O, Libhaber E, Fett JD, Sundstrom JB, Hilfiker-Kleiner D; et al. (2006). "Peripartum cardiomyopathy: inflammatory markers as predictors of outcome in 100 prospectively studied patients". Eur Heart J. 27 (4): 441–6. doi:10.1093/eurheartj/ehi481. PMID 16143707.

[pmid16923422-51] Amos AM, Jaber WA, Russell SD (2006). "Improved outcomes in peripartum cardiomyopathy with contemporary". Am Heart J. 152 (3): 509–13. doi:10.1016/j.ahj.2006.02.008. PMID 16923422.

[pmid31724271-52] Moulig V, Pfeffer TJ, Ricke-Hoch M, Schlothauer S, Koenig T, Schwab J; et al. (2019). "Long-term follow-up in peripartum cardiomyopathy patients with contemporary treatment: low mortality, high cardiac recovery, but significant cardiovascular co-morbidities". Eur J Heart Fail. 21 (12): 1534–1542. doi:10.1002/ejhf.1624. PMID 31724271.

[pmid24289218-53] Laghari AH, Khan AH, Kazmi KA (2013). "Peripartum cardiomyopathy: ten year experience at a tertiary care hospital in Pakistan". BMC Res Notes. 6: 495. doi:10.1186/1756-0500-6-495. PMC 4222096. PMID 24289218.

[pmid30165544-54] Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M; et al. (2018). "2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy". Eur Heart J. 39 (34): 3165–3241. doi:10.1093/eurheartj/ehy340. PMID 30165544.

[pmid31243866-55] Bauersachs J, König T, van der Meer P, Petrie MC, Hilfiker-Kleiner D, Mbakwem A; et al. (2019). "Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy". Eur J Heart Fail. 21 (7): 827–843. doi:10.1002/ejhf.1493. PMID 31243866.

[pmid30704579-56] Halpern DG, Weinberg CR, Pinnelas R, Mehta-Lee S, Economy KE, Valente AM (2019). "Use of Medication for Cardiovascular Disease During Pregnancy: JACC State-of-the-Art Review". J Am Coll Cardiol. 73 (4): 457–476. doi:10.1016/j.jacc.2018.10.075. PMID 30704579.

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@@ Line 1: / Line 1: @@
-{{Infobox_Disease |
+__NOTOC__
-  Name           = Heart failure |
+{| class="infobox" style="float:right;"
-  Image          = |
+|-
-  Caption        = |
+| [[File:Siren.gif|30px|link= Congestive heart failure resident survival guide]]|| <br> || <br>
-  DiseasesDB     = 16209 |
+| [[Acute decompensated heart failure resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
-  ICD10          = {{ICD10|I|50|0|i|50}} |
+|}
-  ICD9           = {{ICD9|428.0}} |
+{| class="infobox" style="float:right;"
-  ICDO           = |
+|-
-  OMIM           = |
+| [[File:Critical_Pathways.gif|88px|link= Congestive heart failure critical pathways]]|| <br> || <br>
-  MedlinePlus    = 000158 |
+|}
-  eMedicineSubj  = |
-  eMedicineTopic = |
-  MeshID         = D006333|
-}}
 {{Congestive heart failure}}
+{{CMG}} {{AE}} {{AE}} [[User:Edzelco|Edzel Lorraine Co, D.M.D., M.D.]] [Mailto:efco@alum.up.edu.ph]
+==Overview==
+There is unfortunately insufficient data in subgroups of patients to mandate a change to guidelines recommendations regarding the management of heart failure. Dosages should be altered as needed in the elderly or in those with altered metabolism.  African american patients may respond to the addition of [[hydralazine]] and [[nitrates]] to the standard of care in the treatment of heart failure.
+==Women==
+Women may not drive the same benefit from angiotensin-converting enzyme inhibitors in meta-analysis (mortality HR = 0.80 (95% CI 0.68-0.93) for men but HR = 0.90 (95% CI 0.78-1.05) for women) <ref name="pmid12742294">{{cite journal |author=Shekelle PG, Rich MW, Morton SC, Atkinson CS, Tu W, Maglione M, Rhodes S, Barrett M, Fonarow GC, Greenberg B, Heidenreich PA, Knabel T, Konstam MA, Steimle A, Warner Stevenson L |title=Efficacy of angiotensin-converting enzyme inhibitors and beta-blockers in the management of left ventricular systolic dysfunction according to race, gender, and diabetic status: a meta-analysis of major clinical trials |journal=[[Journal of the American College of Cardiology]] |volume=41 |issue=9 |pages=1529–38 |year=2003 |month=May |pmid=12742294 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109703002626 |issn= |accessdate=2013-04-25}}</ref>, but women do appear to drive the same benefit from beta blockers as men (HRs for mortality 063 & 0.66 respectively).<ref name="pmid12742294">{{cite journal |author=Shekelle PG, Rich MW, Morton SC, Atkinson CS, Tu W, Maglione M, Rhodes S, Barrett M, Fonarow GC, Greenberg B, Heidenreich PA, Knabel T, Konstam MA, Steimle A, Warner Stevenson L |title=Efficacy of angiotensin-converting enzyme inhibitors and beta-blockers in the management of left ventricular systolic dysfunction according to race, gender, and diabetic status: a meta-analysis of major clinical trials |journal=[[Journal of the American College of Cardiology]] |volume=41 |issue=9 |pages=1529–38 |year=2003 |month=May |pmid=12742294 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109703002626 |issn= |accessdate=2013-04-25}}</ref>
+==Race==
+===ACE Inhibition===
+Blacks tend to have a poorer response to [[ACE inhibition]], specifically in response to equivalent doses of [[enalapril]] (44% reduction in heart failure hospitalization among whites versus no benefit among black patients in SOLVD).<ref name="pmid11333991">{{cite journal |author=Exner DV, Dries DL, Domanski MJ, Cohn JN |title=Lesser response to angiotensin-converting-enzyme inhibitor therapy in black as compared with white patients with left ventricular dysfunction |journal=[[The New England Journal of Medicine]] |volume=344 |issue=18 |pages=1351–7 |year=2001 |month=May |pmid=11333991 |doi=10.1056/NEJM200105033441802 |url=http://www.nejm.org/doi/abs/10.1056/NEJM200105033441802?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dwww.ncbi.nlm.nih.gov |issn= |accessdate=2013-04-25}}</ref> Similar results have been observed with respect blood pressure management. In the SOLVD study quoted above, there was a 5 mm Hg reduction in [[systolic blood pressure]] among white patients but no reduction in [[systolic blood pressure]] among black patients. Despite the lack of improvement in hospitalization or [[systolic blood pressure]], blacks did experience a reduction in mortality that was similar to that of white patients. Thus, [[ACE inhibitors]] should continue to be used in black patients.
+===Beta Blockers===
+Randomized trials have shown mixed benefits for blacks with beta blockers. In the [[BEST]] trial, [[bucindolol]] (they beta blocker with partial beta agonist activity) was not associated with the benefit in blacks<ref name="pmid11386264">{{cite journal |author= |title=A trial of the beta-blocker bucindolol in patients with advanced chronic heart failure |journal=[[The New England Journal of Medicine]] |volume=344 |issue=22 |pages=1659–67 |year=2001 |month=May |pmid=11386264 |doi=10.1056/NEJM200105313442202 |url=http://www.nejm.org/doi/abs/10.1056/NEJM200105313442202?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dwww.ncbi.nlm.nih.gov |issn= |accessdate=2013-04-25}}</ref>, however in the [[carvedilol]] trials blacks did sustain a benefit<ref name="pmid11333992">{{cite journal |author=Yancy CW, Fowler MB, Colucci WS, Gilbert EM, Bristow MR, Cohn JN, Lukas MA, Young ST, Packer M |title=Race and the response to adrenergic blockade with carvedilol in patients with chronic heart failure |journal=[[The New England Journal of Medicine]] |volume=344 |issue=18 |pages=1358–65 |year=2001 |month=May |pmid=11333992 |doi=10.1056/NEJM200105033441803 |url=http://www.nejm.org/doi/abs/10.1056/NEJM200105033441803?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dwww.ncbi.nlm.nih.gov |issn= |accessdate=2013-04-25}}</ref>. It has been speculated that there may be differences in the beta adrenergic system between blacks and whites that account for these differences.
+===Hydralazine Plus Nitrates===
+Black patients appeared to derive particular benefit from the combination of [[hydralazine]] plus [[nitrates]].<ref name="pmid10496190">{{cite journal |author=Carson P, Ziesche S, Johnson G, Cohn JN |title=Racial differences in response to therapy for heart failure: analysis of the vasodilator-heart failure trials. Vasodilator-Heart Failure Trial Study Group |journal=[[Journal of Cardiac Failure]] |volume=5 |issue=3 |pages=178–87 |year=1999 |month=September |pmid=10496190 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S1071916499000196 |issn= |accessdate=2013-04-25}}</ref>
+==Diabetics==
+In general, the management of the [[diabetic]] patient with [[heart failure]] is similar to that of the non-diabetic patient.  However, the [[thiazolidinediones]] (which can cause [[fluid retention]]) and [[metformin]] (which can cause [[lactic acidosis]] in the patient with [[congestive heart failure]]) are relatively contraindicated in the patient with [[congestive heart failure]].
-{{CMG}}
+== 2022 AHA/ACC/HFSA Heart Failure Guideline/2009 and 2005 ACC/AHA Focused Update Guidelines for the Diagnosis and Management of Chronic Heart Failure in the Adult and 2006 ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (DO NOT EDIT) <ref name="pmid35363499">{{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: 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= e895-e1032 | pmid=35363499 | doi=10.1161/CIR.0000000000001063 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363499  }} </ref><ref name="pmid16160202">Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG et al. (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16160202 ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society.] Circulation 112 (12):e154-235. [http://dx.doi.org/10.1161/CIRCULATIONAHA.105.167586 DOI:10.1161/CIRCULATIONAHA.105.167586] PMID: [http://pubmed.gov/16160202 16160202]</ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] Circulation 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref> <ref name="pmid16935995">{{cite journal| author=Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M et al.|title=ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal=Circulation |year= 2006 | volume= 114 | issue= 10 | pages= e385-484 | pmid=16935995 | doi=10.1161/CIRCULATIONAHA.106.178233 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16935995}}</ref>==
+===Disparities and Vulnerable Populations (DO NOT EDIT) <ref name="pmid35363499">{{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: 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= e895-e1032 | pmid=35363499 | doi=10.1161/CIR.0000000000001063 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363499  }} </ref>===
+{|class="wikitable" style="width:80%"
+|-
+| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
+|-
+| bgcolor="LightGreen"| <nowiki>"</nowiki>'''1.''' In vulnerable [[patient]] populations at risk for [[health]] disparities, [[HF]] risk assessments and multidisciplinary management strategies should target both known risks for [[CVD]] and social determinants of [[health]], as a means toward elimination of disparate [[HF]] outcomes. <ref name="pmid26051012">{{cite journal| author=Colvin M, Sweitzer NK, Albert NM, Krishnamani R, Rich MW, Stough WG | display-authors=etal| title=Heart Failure in Non-Caucasians, Women, and Older Adults: A White Paper on Special Populations From the Heart Failure Society of America Guideline Committee. | journal=J Card Fail | year= 2015 | volume= 21 | issue= 8 | pages= 674-93 | pmid=26051012 | doi=10.1016/j.cardfail.2015.05.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26051012  }} </ref><ref name="pmid31992061">{{cite journal| author=Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP | display-authors=etal| title=Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. | journal=Circulation | year= 2020 | volume= 141 | issue= 9 | pages= e139-e596 | pmid=31992061 | doi=10.1161/CIR.0000000000000757 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31992061  }} </ref><ref name="pmid28655709">{{cite journal| author=Ziaeian B, Kominski GF, Ong MK, Mays VM, Brook RH, Fonarow GC| title=National Differences in Trends for Heart Failure Hospitalizations by Sex and Race/Ethnicity. | journal=Circ Cardiovasc Qual Outcomes | year= 2017 | volume= 10 | issue= 7 | pages=  | pmid=28655709 | doi=10.1161/CIRCOUTCOMES.116.003552 | pmc=5540644 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28655709  }} </ref><ref name="pmid32787445">{{cite journal| author=Nayak A, Hicks AJ, Morris AA| title=Understanding the Complexity of Heart Failure Risk and Treatment in Black Patients. | journal=Circ Heart Fail | year= 2020 | volume= 13 | issue= 8 | pages= e007264 | pmid=32787445 | doi=10.1161/CIRCHEARTFAILURE.120.007264 | pmc=7644144 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32787445  }} </ref><ref name="pmid29760227">{{cite journal| author=Schultz WM, Kelli HM, Lisko JC, Varghese T, Shen J, Sandesara P | display-authors=etal| title=Socioeconomic Status and Cardiovascular Outcomes: Challenges and Interventions. | journal=Circulation | year= 2018 | volume= 137 | issue= 20 | pages= 2166-2178 | pmid=29760227 | doi=10.1161/CIRCULATIONAHA.117.029652 | pmc=5958918 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29760227  }} </ref><ref name="pmid32755627">{{cite journal| author=Bevan GH, Josephson R, Al-Kindi SG| title=Socioeconomic Deprivation and Heart Failure Mortality in the United States. | journal=J Card Fail | year= 2020 | volume= 26 | issue= 12 | pages= 1106-1107 | pmid=32755627 | doi=10.1016/j.cardfail.2020.07.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32755627  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])''<nowiki>"</nowiki>
+|-
+| bgcolor="LightGreen"| <nowiki>"</nowiki>'''2.''' Evidence of [[health]] disparities should be monitored and addressed at the clinical practice and the [[health care]] system levels.<ref name="pmid25098323">{{cite journal| author=Rodriguez CJ, Allison M, Daviglus ML, Isasi CR, Keller C, Leira EC | display-authors=etal| title=Status of cardiovascular disease and stroke in Hispanics/Latinos in the United States: a science advisory from the American Heart Association. | journal=Circulation | year= 2014 | volume= 130 | issue= 7 | pages= 593-625 | pmid=25098323 | doi=10.1161/CIR.0000000000000071 | pmc=4577282 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25098323  }} </ref><ref name="pmid29061565">{{cite journal| author=Carnethon MR, Pu J, Howard G, Albert MA, Anderson CAM, Bertoni AG | display-authors=etal| title=Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association. | journal=Circulation | year= 2017 | volume= 136 | issue= 21 | pages= e393-e423 | pmid=29061565 | doi=10.1161/CIR.0000000000000534 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29061565  }} </ref><ref name="pmid32316807">{{cite journal| author=Sterling MR, Ringel JB, Pinheiro LC, Safford MM, Levitan EB, Phillips E | display-authors=etal| title=Social Determinants of Health and 90-Day Mortality After Hospitalization for Heart Failure in the REGARDS Study. | journal=J Am Heart Assoc | year= 2020 | volume= 9 | issue= 9 | pages= e014836 | pmid=32316807 | doi=10.1161/JAHA.119.014836 | pmc=7428585 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32316807  }} </ref><ref name="pmid29852931">{{cite journal| author=Khariton Y, Nassif ME, Thomas L, Fonarow GC, Mi X, DeVore AD | display-authors=etal| title=Health Status Disparities by Sex, Race/Ethnicity, and Socioeconomic Status in Outpatients With Heart Failure. | journal=JACC Heart Fail | year= 2018 | volume= 6 | issue= 6 | pages= 465-473 | pmid=29852931 | doi=10.1016/j.jchf.2018.02.002 | pmc=6003698 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29852931  }} </ref><ref name="pmid32460555">{{cite journal| author=Breathett K, Sims M, Gross M, Jackson EA, Jones EJ, Navas-Acien A | display-authors=etal| title=Cardiovascular Health in American Indians and Alaska Natives: A Scientific Statement From the American Heart Association. | journal=Circulation | year= 2020 | volume= 141 | issue= 25 | pages= e948-e959 | pmid=32460555 | doi=10.1161/CIR.0000000000000773 | pmc=7351358 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32460555  }} </ref><ref name="pmid31658831">{{cite journal| author=Eberly LA, Richterman A, Beckett AG, Wispelwey B, Marsh RH, Cleveland Manchanda EC | display-authors=etal| title=Identification of Racial Inequities in Access to Specialized Inpatient Heart Failure Care at an Academic Medical Center. | journal=Circ Heart Fail | year= 2019 | volume= 12 | issue= 11 | pages= e006214 | pmid=31658831 | doi=10.1161/CIRCHEARTFAILURE.119.006214 | pmc=7183732 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31658831  }} </ref><ref name="pmid25204624">{{cite journal| author=Sentell T, Miyamura J, Ahn HJ, Chen JJ, Seto T, Juarez D| title=Potentially Preventable Hospitalizations for Congestive Heart Failure Among Asian Americans and Pacific Islanders in Hawai'i. | journal=J Immigr Minor Health | year= 2015 | volume= 17 | issue= 5 | pages= 1289-97 | pmid=25204624 | doi=10.1007/s10903-014-0098-4 | pmc=4362878 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25204624  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])'' <nowiki>"</nowiki>
+|-
+|}
-==Overview==
+===Recommendations for [[Cardio]]-[[Oncology]] (DO NOT EDIT) <ref name="pmid35363499">{{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: 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= e895-e1032 | pmid=35363499 | doi=10.1161/CIR.0000000000001063 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363499  }} </ref>===
-There is unfortunately insufficient data in subgroups of patients to mandate a change to guidelines recommendations regarding the management of heart failure. Dosages should be altered as needed in the elderly or those with altered metabolism.  Black patients may respond to the addition of [[hydralazine]] and [[nitrates]] to the standard of care in the treatment of heart failure.
-==ACC/AHA Guidelines- Treatment of Special Populations (DO NOT EDIT) <ref name="pmid16160202">Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG et al. (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16160202 ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society.] ''Circulation'' 112 (12):e154-235. [http://dx.doi.org/10.1161/CIRCULATIONAHA.105.167586 DOI:10.1161/CIRCULATIONAHA.105.167586] PMID: [http://pubmed.gov/16160202 16160202]</ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>==
+{|class="wikitable" style="width:80%"
-{{cquote|
+|-
-===[[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]]
-'''1.''' Groups of patients including (a) high-risk ethnic minority groups (e.g., blacks), (b) groups underrepresented in clinical trials, and (c) any groups believed to be underserved should, in the absence of specific evidence to direct otherwise, have clinical screening and therapy in a manner identical to that applied to the broader population. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
+|-
+| bgcolor="LightGreen"| <nowiki>"</nowiki>'''1.''' In [[patients]] who develop [[cancer]] [[therapy]]-related [[cardiomyopathy]] or [[HF]], a [[multidisciplinary]] discussion involving the [[patient]] about the risk-benefit ratio of [[cancer therapy]] interruption, discontinuation, or continuation is recommended to improve [[management]].<ref name="pmid26051012">{{cite journal| author=Colvin M, Sweitzer NK, Albert NM, Krishnamani R, Rich MW, Stough WG | display-authors=etal| title=Heart Failure in Non-Caucasians, Women, and Older Adults: A White Paper on Special Populations From the Heart Failure Society of America Guideline Committee. | journal=J Card Fail | year= 2015 | volume= 21 | issue= 8 | pages= 674-93 | pmid=26051012 | doi=10.1016/j.cardfail.2015.05.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26051012  }} </ref><ref name="pmid31992061">{{cite journal| author=Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP | display-authors=etal| title=Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. | journal=Circulation | year= 2020 | volume= 141 | issue= 9 | pages= e139-e596 | pmid=31992061 | doi=10.1161/CIR.0000000000000757 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31992061  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''<nowiki>"</nowiki>
+|-
-'''2.''' It is recommended that evidence-based therapy for [[HF]] be used in the elderly patient, with individualized consideration of the elderly patient’s altered ability to metabolize or tolerate standard medications. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
+|}
-===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]===
+{|class="wikitable" style="width:80%"
-'''1.''' The addition of [[isosorbide dinitrate]] and [[hydralazine]] to a standard medical regimen for [[HF]], including [[ACEIs]] and [[beta-blockers]], is reasonable and can be effective in blacks with NYHA functional class III or IV HF. Others may benefit similarly, but this has not yet been tested. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''}}
+|-
+| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
+|-
+| bgcolor="LemonChiffon"| <nowiki>"</nowiki>'''2.''' In [[asymptomatic]] [[patients]] with [[cancer]] [[therapy]]-related [[cardiomyopathy]] ([[EF]]<50%), [[ARB]], [[ACEi]], and [[beta blockers]] are reasonable to prevent progression to [[HF]] and improve [[cardiac function]]. <ref name="pmid31992061">{{cite journal| author=Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP | display-authors=etal| title=Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. | journal=Circulation | year= 2020 | volume= 141 | issue= 9 | pages= e139-e596 | pmid=31992061 | doi=10.1161/CIR.0000000000000757 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31992061  }} </ref><ref name="pmid28655709">{{cite journal| author=Ziaeian B, Kominski GF, Ong MK, Mays VM, Brook RH, Fonarow GC| title=National Differences in Trends for Heart Failure Hospitalizations by Sex and Race/Ethnicity. | journal=Circ Cardiovasc Qual Outcomes | year= 2017 | volume= 10 | issue= 7 | pages=  | pmid=28655709 | doi=10.1161/CIRCOUTCOMES.116.003552 | pmc=5540644 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28655709  }} </ref><ref name="pmid32787445">{{cite journal| author=Nayak A, Hicks AJ, Morris AA| title=Understanding the Complexity of Heart Failure Risk and Treatment in Black Patients. | journal=Circ Heart Fail | year= 2020 | volume= 13 | issue= 8 | pages= e007264 | pmid=32787445 | doi=10.1161/CIRCHEARTFAILURE.120.007264 | pmc=7644144 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32787445  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>
+|-
+| bgcolor="LemonChiffon"| <nowiki>"</nowiki>'''3.''' In [[patients]] with [[cardiovascular]] [[risk factors]] or known [[cardiac disease]] being considered for potentially [[cardiotoxic]] [[anticancer]] [[therapies]], pretherapy evaluation of [[cardiac function]] is reasonable to establish baseline [[cardiac function]] and guide the choice of [[cancer therapy]]. <ref name="pmid31992061">{{cite journal| author=Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP | display-authors=etal| title=Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. | journal=Circulation | year= 2020 | volume= 141 | issue= 9 | pages= e139-e596 | pmid=31992061 | doi=10.1161/CIR.0000000000000757 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31992061  }} </ref><ref name="pmid29760227">{{cite journal| author=Schultz WM, Kelli HM, Lisko JC, Varghese T, Shen J, Sandesara P | display-authors=etal| title=Socioeconomic Status and Cardiovascular Outcomes: Challenges and Interventions. | journal=Circulation | year= 2018 | volume= 137 | issue= 20 | pages= 2166-2178 | pmid=29760227 | doi=10.1161/CIRCULATIONAHA.117.029652 | pmc=5958918 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29760227  }} </ref><ref name="pmid32755627">{{cite journal| author=Bevan GH, Josephson R, Al-Kindi SG| title=Socioeconomic Deprivation and Heart Failure Mortality in the United States. | journal=J Card Fail | year= 2020 | volume= 26 | issue= 12 | pages= 1106-1107 | pmid=32755627 | doi=10.1016/j.cardfail.2020.07.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32755627  }} </ref><ref name="pmid25098323">{{cite journal| author=Rodriguez CJ, Allison M, Daviglus ML, Isasi CR, Keller C, Leira EC | display-authors=etal| title=Status of cardiovascular disease and stroke in Hispanics/Latinos in the United States: a science advisory from the American Heart Association. | journal=Circulation | year= 2014 | volume= 130 | issue= 7 | pages= 593-625 | pmid=25098323 | doi=10.1161/CIR.0000000000000071 | pmc=4577282 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25098323  }} </ref><ref name="pmid29061565">{{cite journal| author=Carnethon MR, Pu J, Howard G, Albert MA, Anderson CAM, Bertoni AG | display-authors=etal| title=Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association. | journal=Circulation | year= 2017 | volume= 136 | issue= 21 | pages= e393-e423 | pmid=29061565 | doi=10.1161/CIR.0000000000000534 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29061565  }} </ref><ref name="pmid32316807">{{cite journal| author=Sterling MR, Ringel JB, Pinheiro LC, Safford MM, Levitan EB, Phillips E | display-authors=etal| title=Social Determinants of Health and 90-Day Mortality After Hospitalization for Heart Failure in the REGARDS Study. | journal=J Am Heart Assoc | year= 2020 | volume= 9 | issue= 9 | pages= e014836 | pmid=32316807 | doi=10.1161/JAHA.119.014836 | pmc=7428585 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32316807  }} </ref><ref name="pmid29852931">{{cite journal| author=Khariton Y, Nassif ME, Thomas L, Fonarow GC, Mi X, DeVore AD | display-authors=etal| title=Health Status Disparities by Sex, Race/Ethnicity, and Socioeconomic Status in Outpatients With Heart Failure. | journal=JACC Heart Fail | year= 2018 | volume= 6 | issue= 6 | pages= 465-473 | pmid=29852931 | doi=10.1016/j.jchf.2018.02.002 | pmc=6003698 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29852931  }} </ref><ref name="pmid32460555">{{cite journal| author=Breathett K, Sims M, Gross M, Jackson EA, Jones EJ, Navas-Acien A | display-authors=etal| title=Cardiovascular Health in American Indians and Alaska Natives: A Scientific Statement From the American Heart Association. | journal=Circulation | year= 2020 | volume= 141 | issue= 25 | pages= e948-e959 | pmid=32460555 | doi=10.1161/CIR.0000000000000773 | pmc=7351358 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32460555  }} </ref><ref name="pmid31658831">{{cite journal| author=Eberly LA, Richterman A, Beckett AG, Wispelwey B, Marsh RH, Cleveland Manchanda EC | display-authors=etal| title=Identification of Racial Inequities in Access to Specialized Inpatient Heart Failure Care at an Academic Medical Center. | journal=Circ Heart Fail | year= 2019 | volume= 12 | issue= 11 | pages= e006214 | pmid=31658831 | doi=10.1161/CIRCHEARTFAILURE.119.006214 | pmc=7183732 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31658831  }} </ref><ref name="pmid25204624">{{cite journal| author=Sentell T, Miyamura J, Ahn HJ, Chen JJ, Seto T, Juarez D| title=Potentially Preventable Hospitalizations for Congestive Heart Failure Among Asian Americans and Pacific Islanders in Hawai'i. | journal=J Immigr Minor Health | year= 2015 | volume= 17 | issue= 5 | pages= 1289-97 | pmid=25204624 | doi=10.1007/s10903-014-0098-4 | pmc=4362878 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25204624  }} </ref><ref name="pmid29554692">{{cite journal| author=Brown AF, Liang LJ, Vassar SD, Escarce JJ, Merkin SS, Cheng E | display-authors=etal| title=Trends in Racial/Ethnic and Nativity Disparities in Cardiovascular Health Among Adults Without Prevalent Cardiovascular Disease in the United States, 1988 to 2014. | journal=Ann Intern Med | year= 2018 | volume= 168 | issue= 8 | pages= 541-549 | pmid=29554692 | doi=10.7326/M17-0996 | pmc=6499476 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29554692  }} </ref><ref name="pmid32059630">{{cite journal| author=Lawson CA, Zaccardi F, Squire I, Okhai H, Davies M, Huang W | display-authors=etal| title=Risk Factors for Heart Failure: 20-Year Population-Based Trends by Sex, Socioeconomic Status, and Ethnicity. | journal=Circ Heart Fail | year= 2020 | volume= 13 | issue= 2 | pages= e006472 | pmid=32059630 | doi=10.1161/CIRCHEARTFAILURE.119.006472 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32059630  }} </ref><ref name="pmid25090666">{{cite journal| author=Brewer LC, Cooper LA| title=Race, discrimination, and cardiovascular disease. | journal=Virtual Mentor | year= 2014 | volume= 16 | issue= 6 | pages= 455-60 | pmid=25090666 | doi= | pmc=5955868 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25090666  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''<nowiki>"</nowiki>
+|-
+| bgcolor="LemonChiffon"| <nowiki>"</nowiki>'''4.''' In [[patients]] with [[cardiovascular]] [[risk factors]] or known [[cardiac disease]] receiving potentially [[cardiotoxic]] [[anticancer]] [[therapies]], monitoring of [[cardiac function]] is reasonable for the early identification of [[drug-induced cardiomyopathy]].<ref name="pmid31992061">{{cite journal| author=Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP | display-authors=etal| title=Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. | journal=Circulation | year= 2020 | volume= 141 | issue= 9 | pages= e139-e596 | pmid=31992061 | doi=10.1161/CIR.0000000000000757 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31992061  }} </ref><ref name="pmid32787445">{{cite journal| author=Nayak A, Hicks AJ, Morris AA| title=Understanding the Complexity of Heart Failure Risk and Treatment in Black Patients. | journal=Circ Heart Fail | year= 2020 | volume= 13 | issue= 8 | pages= e007264 | pmid=32787445 | doi=10.1161/CIRCHEARTFAILURE.120.007264 | pmc=7644144 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32787445  }} </ref><ref name="pmid32755627">{{cite journal| author=Bevan GH, Josephson R, Al-Kindi SG| title=Socioeconomic Deprivation and Heart Failure Mortality in the United States. | journal=J Card Fail | year= 2020 | volume= 26 | issue= 12 | pages= 1106-1107 | pmid=32755627 | doi=10.1016/j.cardfail.2020.07.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32755627  }} </ref><ref name="pmid29061565">{{cite journal| author=Carnethon MR, Pu J, Howard G, Albert MA, Anderson CAM, Bertoni AG | display-authors=etal| title=Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association. | journal=Circulation | year= 2017 | volume= 136 | issue= 21 | pages= e393-e423 | pmid=29061565 | doi=10.1161/CIR.0000000000000534 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29061565  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>
+|-
+|}
-== ACC/AHA/ESC 2006 Guidelines for Management of Left Ventricular Dysfunction Due to Prior Myocardial Infarction (DO NOT EDIT) <ref name="pmid16935995">{{cite journal| author=Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M et al.| title=ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal=Circulation | year= 2006 | volume= 114 | issue= 10 | pages= e385-484 | pmid=16935995 | doi=10.1161/CIRCULATIONAHA.106.178233 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16935995}}</ref> ==
+{|class="wikitable" style="width:80%"
+|-
+| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class IIb]]
+|-
+|bgcolor="LemonChiffon"| <nowiki>"</nowiki> '''5.''' In [[patients]] at risk of [[cancer therapy]]-related [[cardiomyopathy]], initiation of [[beta blockers]] and [[ACEI]]/ [[ARB]] for the [[primary prevention]] of [[drug-induced cardiomyopathy]] is of uncertain benefit. <ref name="pmid31510778">{{cite journal| author=Cresci S, Pereira NL, Ahmad F, Byku M, de Las Fuentes L, Lanfear DE | display-authors=etal| title=Heart Failure in the Era of Precision Medicine: A Scientific Statement From the American Heart Association. | journal=Circ Genom Precis Med | year= 2019 | volume= 12 | issue= 10 | pages= 458-485 | pmid=31510778 | doi=10.1161/HCG.0000000000000058 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31510778  }} </ref><ref name="pmid32349541">{{cite journal| author=White-Williams C, Rossi LP, Bittner VA, Driscoll A, Durant RW, Granger BB | display-authors=etal| title=Addressing Social Determinants of Health in the Care of Patients With Heart Failure: A Scientific Statement From the American Heart Association. | journal=Circulation | year= 2020 | volume= 141 | issue= 22 | pages= e841-e863 | pmid=32349541 | doi=10.1161/CIR.0000000000000767 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32349541  }} </ref><ref name="pmid31800034">{{cite journal| author=Lam CSP, Arnott C, Beale AL, Chandramouli C, Hilfiker-Kleiner D, Kaye DM | display-authors=etal| title=Sex differences in heart failure. | journal=Eur Heart J | year= 2019 | volume= 40 | issue= 47 | pages= 3859-3868c | pmid=31800034 | doi=10.1093/eurheartj/ehz835 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31800034  }} </ref><ref name="pmid15265849">{{cite journal| author=Roger VL, Weston SA, Redfield MM, Hellermann-Homan JP, Killian J, Yawn BP | display-authors=etal| title=Trends in heart failure incidence and survival in a community-based population. | journal=JAMA | year= 2004 | volume= 292 | issue= 3 | pages= 344-50 | pmid=15265849 | doi=10.1001/jama.292.3.344 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15265849  }} </ref><ref name="pmid19960128">{{cite journal| author=Ehrmann Feldman D, Xiao Y, Bernatsky S, Haggerty J, Leffondré K, Tousignant P | display-authors=etal| title=Consultation with cardiologists for persons with new-onset chronic heart failure: a population-based study. | journal=Can J Cardiol | year= 2009 | volume= 25 | issue= 12 | pages= 690-4 | pmid=19960128 | doi=10.1016/s0828-282x(09)70528-8 | pmc=2807830 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19960128  }} </ref><ref name="pmid23751166">{{cite journal| author=Feldman DE, Huynh T, Des Lauriers J, Giannetti N, Frenette M, Grondin F | display-authors=etal| title=Gender and other disparities in referral to specialized heart failure clinics following emergency department visits. | journal=J Womens Health (Larchmt) | year= 2013 | volume= 22 | issue= 6 | pages= 526-31 | pmid=23751166 | doi=10.1089/jwh.2012.4107 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23751166  }} </ref><ref name="pmid22287589">{{cite journal| author=Al-Khatib SM, Hellkamp AS, Hernandez AF, Fonarow GC, Thomas KL, Al-Khalidi HR | display-authors=etal| title=Trends in use of implantable cardioverter-defibrillator therapy among patients hospitalized for heart failure: have the previously observed sex and racial disparities changed over time? | journal=Circulation | year= 2012 | volume= 125 | issue= 9 | pages= 1094-101 | pmid=22287589 | doi=10.1161/CIRCULATIONAHA.111.066605 | pmc=3670671 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22287589  }} </ref><ref name="pmid30779645">{{cite journal| author=Hsich EM| title=Sex Differences in Advanced Heart Failure Therapies. | journal=Circulation | year= 2019 | volume= 139 | issue= 8 | pages= 1080-1093 | pmid=30779645 | doi=10.1161/CIRCULATIONAHA.118.037369 | pmc=6383806 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30779645  }} </ref><ref name="pmid32876652">{{cite journal| author=Rethy L, Petito LC, Vu THT, Kershaw K, Mehta R, Shah NS | display-authors=etal| title=Trends in the Prevalence of Self-reported Heart Failure by Race/Ethnicity and Age From 2001 to 2016. | journal=JAMA Cardiol | year= 2020 | volume= 5 | issue= 12 | pages= 1425-1429 | pmid=32876652 | doi=10.1001/jamacardio.2020.3654 | pmc=7489385 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32876652  }} </ref><ref name="pmid18955644">{{cite journal| author=Bahrami H, Kronmal R, Bluemke DA, Olson J, Shea S, Liu K | display-authors=etal| title=Differences in the incidence of congestive heart failure by ethnicity: the multi-ethnic study of atherosclerosis. | journal=Arch Intern Med | year= 2008 | volume= 168 | issue= 19 | pages= 2138-45 | pmid=18955644 | doi=10.1001/archinte.168.19.2138 | pmc=3038918 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18955644  }} </ref><ref name="pmid31072580">{{cite journal| author=Glynn P, Lloyd-Jones DM, Feinstein MJ, Carnethon M, Khan SS| title=Disparities in Cardiovascular Mortality Related to Heart Failure in the United States. | journal=J Am Coll Cardiol | year= 2019 | volume= 73 | issue= 18 | pages= 2354-2355 | pmid=31072580 | doi=10.1016/j.jacc.2019.02.042 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31072580  }} </ref><ref name="pmid33170755">{{cite journal| author=Churchwell K, Elkind MSV, Benjamin RM, Carson AP, Chang EK, Lawrence W | display-authors=etal| title=Call to Action: Structural Racism as a Fundamental Driver of Health Disparities: A Presidential Advisory From the American Heart Association. | journal=Circulation | year= 2020 | volume= 142 | issue= 24 | pages= e454-e468 | pmid=33170755 | doi=10.1161/CIR.0000000000000936 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33170755  }} </ref> ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B-R]])''<nowiki>"</nowiki>
+|-
+|bgcolor="LemonChiffon"| <nowiki>"</nowiki> '''6.''' In [[patients]] being considered for potentially [[cardiotoxic]] [[therapies]], serial measurement of [[cardiac]] [[troponin]] might be reasonable for further [[risk stratification]]. <ref name="pmid27476982">{{cite journal| author=Butrous H, Hummel SL| title=Heart Failure in Older Adults. | journal=Can J Cardiol | year= 2016 | volume= 32 | issue= 9 | pages= 1140-7 | pmid=27476982 | doi=10.1016/j.cjca.2016.05.005 | pmc=5503696 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27476982  }} </ref><ref name="pmid21447803">{{cite journal| author=Allen LA, Hernandez AF, Peterson ED, Curtis LH, Dai D, Masoudi FA | display-authors=etal| title=Discharge to a skilled nursing facility and subsequent clinical outcomes among older patients hospitalized for heart failure. | journal=Circ Heart Fail | year= 2011 | volume= 4 | issue= 3 | pages= 293-300 | pmid=21447803 | doi=10.1161/CIRCHEARTFAILURE.110.959171 | pmc=4096790 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21447803  }} </ref><ref name="pmid31312783">{{cite journal| author=Silver JK, Bean AC, Slocum C, Poorman JA, Tenforde A, Blauwet CA | display-authors=etal| title=Physician Workforce Disparities and Patient Care: A Narrative Review. | journal=Health Equity | year= 2019 | volume= 3 | issue= 1 | pages= 360-377 | pmid=31312783 | doi=10.1089/heq.2019.0040 | pmc=6626972 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31312783  }} </ref><ref name="pmid31509160">{{cite journal| author=Mehta LS, Fisher K, Rzeszut AK, Lipner R, Mitchell S, Dill M | display-authors=etal| title=Current Demographic Status of Cardiologists in the United States. | journal=JAMA Cardiol | year= 2019 | volume= 4 | issue= 10 | pages= 1029-1033 | pmid=31509160 | doi=10.1001/jamacardio.2019.3247 | pmc=6739735 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31509160  }} </ref>''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C-LD]])''<nowiki>"</nowiki>
+|}
-=== Recommendations for Left Ventricular Dysfunction Due to Prior Myocardial Infarction ===
+===[[Treatment]] of Special [[Populations]] (DO NOT EDIT) <ref name="pmid16160202">Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG et al. (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16160202 ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society.] Circulation 112 (12):e154-235. [http://dx.doi.org/10.1161/CIRCULATIONAHA.105.167586 DOI:10.1161/CIRCULATIONAHA.105.167586] PMID: [http://pubmed.gov/16160202 16160202]</ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] Circulation 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref> ===
-{|class="wikitable"
+{|class="wikitable" style="width:80%"
+|-
+| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
+|-
+| bgcolor="LightGreen"| <nowiki>"</nowiki>'''1.''' The addition of a fixed [[dose]] of [[isosorbide dinitrate]] and [[hydralazine]] to a standard [[medical]] regimen for [[HF]], including [[ACEIs]] and [[beta-blockers]], is recommended in order to improve outcomes for [[patients]] self-described as African Americans, with [[NYHA]] functional class III or IV [[HF]]. Others may benefit similarly, but this has not yet been tested. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
+|-
+| bgcolor="LightGreen"| <nowiki>"</nowiki>'''2.''' Groups of [[patient]]s including (a) high-risk ethnic minority groups (e.g., blacks), (b) groups underrepresented in [[clinical trials]], and (c) any groups believed to be underserved should, in the absence of specific evidence to direct otherwise, have [[clinical screening]] and [[therapy]] in a manner identical to that applied to the broader [[population]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
+|-
+| bgcolor="LightGreen"| <nowiki>"</nowiki>'''3.''' It is recommended that evidence-based [[therapy]] for [[HF]] be used in the [[elderly]] [[patient]], with individualized consideration of the [[elderly]] [[patient]]’s altered ability to metabolize or tolerate standard [[medications]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
+|}
+===[[Left Ventricular]] [[Dysfunction]] Due to Prior [[Myocardial Infarction]] (DO NOT EDIT) <ref name="pmid16935995">{{cite journal| author=Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M et al.|title=ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal=Circulation |year= 2006 | volume= 114 | issue= 10 | pages= e385-484 | pmid=16935995 | doi=10.1161/CIRCULATIONAHA.106.178233 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16935995}}</ref> ===
+{|class="wikitable" style="width:80%"
 |-
 | colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class I]]
+|-
+| bgcolor="LightGreen"| <nowiki>"</nowiki> '''1.''' Aggressive attempts should be made to treat [[HF]] that may be present in some [[patients]] with [[LV dysfunction]] due to prior [[MI]] and [[ventricular tachyarrhythmia]]s. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
+|-
+| bgcolor="LightGreen"| <nowiki>"</nowiki> '''2.''' Aggressive attempts should be made to treat [[myocardial ischemia]] that may be present in some [[patients]] with [[ventricular tachyarrhythmia]]s. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
+|-
+| bgcolor="LightGreen"| <nowiki>"</nowiki> '''3.''' [[Coronary revascularization]] is indicated to reduce the risk of [[SCD]] in [[patients]] with [[VF]] when direct, clear evidence of [[acute myocardial ischemia]] is documented to immediately precede the onset of [[VF]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
+|-
+| bgcolor="LightGreen"| <nowiki>"</nowiki> '''4.''' If [[coronary revascularization]] cannot be carried out and there is evidence of prior [[MI]] and significant [[LV dysfunction]], the primary [[therapy]] of [[patients]] resuscitated from [[VF]] should be the [[ICD]]] in [[patients]] who are receiving chronic optimal [[medical therapy]] and those who have reasonable expectation of [[survival]] with a good functional status for more than 1 y. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
+|-
+| bgcolor="LightGreen"| <nowiki>"</nowiki> '''5.''' [[ICD]] therapy is recommended for [[primary prevention]] to reduce total [[mortality]] by a reduction in [[SCD]] in [[patients]] with [[LV dysfunction]] due to prior [[MI]] who are at least 40 d post-[[MI]], have an [[LVEF]] less than or equal to 30% to 40%, are [[NYHA]] functional class II or III, are receiving chronic optimal [[medical therapy]], and who have reasonable expectation of survival with a good functional status for more than 1 y. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
+|-
+| bgcolor="LightGreen"| <nowiki>"</nowiki> '''6.''' The [[ICD]] is effective [[therapy]] to reduce [[mortality]] by a reduction in [[SCD]] in [[patients]] with [[LV dysfunction]] due to prior [[MI]] who present with [[hemodynamically]] unstable sustained [[VT]], are receiving chronic optimal [[medical therapy]], and who have reasonable expectation of [[survival]] with a good functional status for more than 1 y. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: A]])''<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]]
+|-
+|bgcolor="LightCoral"| <nowiki>"</nowiki> '''1.''' [[Prophylactic]] [[antiarrhythmic]] [[drug therapy]] is not indicated to reduce [[mortality]] in [[patients]] with [[asymptomatic]] nonsustained [[ventricular arrhythmias]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"| <nowiki>"</nowiki> '''1.''' Aggressive attempts should be made to treat HF that may be present in some patients with LV dysfunction due to prior MI and ventricular tachyarrhythmias. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
+|bgcolor="LightCoral"| <nowiki>"</nowiki> '''2.''' Class IC [[antiarrhythmic drug]]s in [[patients]] with a past [[history]] of [[MI]] should not be used. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
+|}
+{|class="wikitable" style="width:80%"
+|-
+| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class IIa]]
+|-
+|bgcolor="LemonChiffon"| <nowiki>"</nowiki> '''1.''' Implantation of an [[ICD]] is reasonable in [[patients]] with [[LV dysfunction]] due to prior [[MI]] who are at least 40 d post-[[MI]], have an [[LVEF]] of less than or equal to 30% to 35%, are [[NYHA]] functional class I on chronic optimal [[medical therapy]], and who have reasonable expectation of [[survival]] with a good functional status for more than 1 y. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
+|-
+|bgcolor="LemonChiffon"| <nowiki>"</nowiki> '''2.''' [[Amiodarone]], often in combination with [[beta blockers]], can be useful for [[patients]] with [[LV dysfunction]] due to prior [[MI]] and [[symptoms]] due to [[VT]] unresponsive to [[beta-adrenergic blocking agents]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
+|-
+|bgcolor="LemonChiffon"| <nowiki>"</nowiki> '''3.''' [[Sotalol]] is reasonable [[therapy]] to reduce [[symptoms]] resulting from [[VT]] for patients with [[LV dysfunction]] due to prior [[MI]] unresponsive to [[beta blocking agents]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
+|-
+|bgcolor="LemonChiffon"| <nowiki>"</nowiki> '''4.''' [[Adjunctive therapies]] to the [[ICD]], including [[catheter ablation]] or [[surgical resection]], and [[pharmacological therapy]] with agents such as [[amiodarone]] or [[sotalol]] are reasonable to improve [[symptoms]] due to frequent episodes of [[ustained VT]] or [[VF]] in [[patients]] with [[LV dysfunction]] due to prior [[MI]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"| <nowiki>"</nowiki> '''2.''' Aggressive attempts should be made to treat myocardial ischemia that may be present in some patients with ventricular tachyarrhythmias. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
+|bgcolor="LemonChiffon"| <nowiki>"</nowiki> '''5.''' [[Amiodarone]] is reasonable [[therapy]] to reduce [[symptoms]] due to recurrent hemodynamically stable [[VT]] for [[patients]] with [[LV dysfunction]] due to prior [[MI\\ who cannot or refuse to have an [[ICD]] implanted. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
+|-
+|bgcolor="LemonChiffon"| <nowiki>"</nowiki> '''6.''' Implantation is reasonable for [[treatment\\ of recurrent [[ventricular tachycardia]] in [[patients]] post-[[MI]] with normal or near normal [[ventricular function]] who are receiving chronic optimal [[medical therapy]] and who have reasonable expectation of [[survival]]] with a good functional status for more than 1 y. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
+|}
+{|class="wikitable" style="width:80%"
 |-
-| bgcolor="LightGreen"| <nowiki>"</nowiki> '''3.''' Coronary revascularization is indicated to reduce the risk of SCD in patients with VF when direct, clear evidence of acute myocardial ischemia is documented to immediately precede the onset of VF. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
+| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class IIb]]
+|-
+|bgcolor="LemonChiffon"| <nowiki>"</nowiki> '''1.''' Curative [[catheter ablation]] or [[amiodarone]] may be considered in lieu of [[ICD therapy]] to improve [[symptoms]] in [[patients]] with [[LV dysfunction]] due to prior [[MI]] and recurrent hemodynamically stable [[VT]] whose [[LVEF]] is greater than 40%. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
+|-
+|bgcolor="LemonChiffon"| <nowiki>"</nowiki> '''2.''' [[Amiodarone]] may be reasonable [[therapy]] for [[patients]] with [[LV dysfunction]] due to prior [[MI]] with an [[ICD]] indication, as defined above, in patients who cannot or refuse to have an [[ICD]] implanted. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
+|}
+===[[Heart Failure]] and [[Pregnancy]] (DO NOT EDIT) <ref name="pmid35363499">{{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: 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= e895-e1032 | pmid=35363499 | doi=10.1161/CIR.0000000000001063 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363499  }} </ref>===
+{|class="wikitable" style="width:80%"
 |-
-| bgcolor="LightGreen"| <nowiki>"</nowiki> '''4.''' If coronary revascularization cannot be carried out and there is evidence of prior MI and significant LV dysfunction, the primary therapy of patients resuscitated from VF should be the ICD in patients who are receiving chronic optimal medical therapy and those who have reasonable expectation of survival with a good functional status for more than 1 y. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
+| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class I]]
+|-
+|bgcolor="LightGreen"| <nowiki>"</nowiki> '''1.''' In [[women]] with a history of [[HF]] or [[cardiomyopathy]], including previous [[peripartum cardiomyopathy]], [[patient]]-centered counseling regarding [[contraception]] and the risks of [[cardiovascular]] deterioration during [[pregnancy]] should be provided. <ref name="pmid28377190">{{cite journal| author=Cauldwell M, Steer PJ, Swan L, Patel RR, Gatzoulis MA, Uebing A | display-authors=etal| title=Pre-pregnancy counseling for women with heart disease: A prospective study. | journal=Int J Cardiol | year= 2017 | volume= 240 | issue=  | pages= 374-378 | pmid=28377190 | doi=10.1016/j.ijcard.2017.03.092 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28377190  }} </ref><ref name="pmid22968232">{{cite journal| author=Roos-Hesselink JW, Ruys TP, Stein JI, Thilén U, Webb GD, Niwa K | display-authors=etal| title=Outcome of pregnancy in patients with structural or ischaemic heart disease: results of a registry of the European Society of Cardiology. | journal=Eur Heart J | year= 2013 | volume= 34 | issue= 9 | pages= 657-65 | pmid=22968232 | doi=10.1093/eurheartj/ehs270 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22968232  }} </ref><ref name="pmid: 30269070">{{cite journal| author=Dawson AJ, Krastev Y, Parsonage WA, Peek M, Lust K, Sullivan EA| title=Experiences of women with cardiac disease in pregnancy: a systematic review and metasynthesis. | journal=BMJ Open | year= 2018 | volume= 8 | issue= 9 | pages= e022755 | pmid=: 30269070 | doi=10.1136/bmjopen-2018-022755 | pmc=6169742 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30269070  }} </ref><ref name="pmid11372007">{{cite journal| author=Elkayam U, Tummala PP, Rao K, Akhter MW, Karaalp IS, Wani OR | display-authors=etal| title=Maternal and fetal outcomes of subsequent pregnancies in women with peripartum cardiomyopathy. | journal=N Engl J Med | year= 2001 | volume= 344 | issue= 21 | pages= 1567-71 | pmid=11372007 | doi=10.1056/NEJM200105243442101 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11372007  }} </ref><ref name="pmid25301468">{{cite journal| author=Elkayam U| title=Risk of subsequent pregnancy in women with a history of peripartum cardiomyopathy. | journal=J Am Coll Cardiol | year= 2014 | volume= 64 | issue= 15 | pages= 1629-36 | pmid=25301468 | doi=10.1016/j.jacc.2014.07.961 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25301468  }} </ref><ref name="pmid28345302">{{cite journal| author=Hilfiker-Kleiner D, Haghikia A, Masuko D, Nonhoff J, Held D, Libhaber E | display-authors=etal| title=Outcome of subsequent pregnancies in patients with a history of peripartum cardiomyopathy. | journal=Eur J Heart Fail | year= 2017 | volume= 19 | issue= 12 | pages= 1723-1728 | pmid=28345302 | doi=10.1002/ejhf.808 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28345302  }} </ref><ref name="pmid29914408">{{cite journal| author=Yaméogo NV, Samadoulougou AK, Kagambèga LJ, Kologo KJ, Millogo GRC, Thiam A | display-authors=etal| title=Maternal and fetal prognosis of subsequent pregnancy in black African women with peripartum cardiomyopathy. | journal=BMC Cardiovasc Disord | year= 2018 | volume= 18 | issue= 1 | pages= 119 | pmid=29914408 | doi=10.1186/s12872-018-0856-7 | pmc=6006934 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29914408  }} </ref><ref name="pmid29324614">{{cite journal| author=Codsi E, Rose CH, Blauwet LA| title=Subsequent Pregnancy Outcomes in Patients With Peripartum Cardiomyopathy. | journal=Obstet Gynecol | year= 2018 | volume= 131 | issue= 2 | pages= 322-327 | pmid=29324614 | doi=10.1097/AOG.0000000000002439 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29324614  }} </ref>  ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C-LD]])'' <nowiki>"</nowiki>
+|}
+{|class="wikitable" style="width:80%"
 |-
-| bgcolor="LightGreen"| <nowiki>"</nowiki> '''5.''' ICD therapy is recommended for primary prevention to reduce total mortality by a reduction in SCD in patients with LV dysfunction due to prior MI who are at least 40 d post-MI, have an LVEF less than or equal to 30% to 40%, are NYHA functional class II or III, are receiving chronic optimal medical therapy, and who have reasonable expectation of survival with a good functional status for more than 1 y. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: A]])'' (See Section 1.2.)<nowiki>"</nowiki>
+| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class IIb]]
+|-
+|bgcolor="LemonChiffon"| <nowiki>"</nowiki> '''2.'''In [[women]] with acute [[HF]] caused by [[peripartum cardiomyopathy]] and [[LVEF]] < 30%, [[anticoagulation]] may be reasonable at [[diagnosis]], until 6 to 8 weeks [[postpartum]], although the [[eficacy]] and [[safety]] are uncertain.<ref name="pmid16143707">{{cite journal| author=Sliwa K, Förster O, Libhaber E, Fett JD, Sundstrom JB, Hilfiker-Kleiner D | display-authors=etal| title=Peripartum cardiomyopathy: inflammatory markers as predictors of outcome in 100 prospectively studied patients. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 4 | pages= 441-6 | pmid=16143707 | doi=10.1093/eurheartj/ehi481 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16143707  }} </ref><ref name="pmid16923422">{{cite journal| author=Amos AM, Jaber WA, Russell SD| title=Improved outcomes in peripartum cardiomyopathy with contemporary. | journal=Am Heart J | year= 2006 | volume= 152 | issue= 3 | pages= 509-13 | pmid=16923422 | doi=10.1016/j.ahj.2006.02.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16923422  }} </ref><ref name="pmid31724271">{{cite journal| author=Moulig V, Pfeffer TJ, Ricke-Hoch M, Schlothauer S, Koenig T, Schwab J | display-authors=etal| title=Long-term follow-up in peripartum cardiomyopathy patients with contemporary treatment: low mortality, high cardiac recovery, but significant cardiovascular co-morbidities. | journal=Eur J Heart Fail | year= 2019 | volume= 21 | issue= 12 | pages= 1534-1542 | pmid=31724271 | doi=10.1002/ejhf.1624 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31724271  }} </ref><ref name="pmid24289218">{{cite journal| author=Laghari AH, Khan AH, Kazmi KA| title=Peripartum cardiomyopathy: ten year experience at a tertiary care hospital in Pakistan. | journal=BMC Res Notes | year= 2013 | volume= 6 | issue=  | pages= 495 | pmid=24289218 | doi=10.1186/1756-0500-6-495 | pmc=4222096 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24289218  }} </ref>''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C-LD]])'' <nowiki>"</nowiki>
+|}
+{|class="wikitable" style="width:80%"
 |-
-| bgcolor="LightGreen"| <nowiki>"</nowiki> '''6.''' The ICD is effective therapy to reduce mortality by a reduction in SCD in patients with LV dysfunction due to prior MI who present with hemodynamically unstable sustained VT, are receiving chronic optimal medical therapy, and who have reasonable expectation of survival with a good functional status for more than 1 y. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
+| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class III]] ([[Harm]])
+|-
+|bgcolor="LightCoral"| <nowiki>"</nowiki> '''2.'''In [[women]] with [[HF]] or [[cardiomyopathy]] who are [[pregnant]] or currently planning for [[pregnancy]], [[ACEi]], [[ARB]], [[ARNi]], [[MRA]], [[SGLT2i]], [[ivabradine]], and [[vericiguat]] should not be administered because of significant risks of [[fetal [[harm]]. <ref name="pmid30165544">{{cite journal| author=Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M | display-authors=etal| title=2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. | journal=Eur Heart J | year= 2018 | volume= 39 | issue= 34 | pages= 3165-3241 | pmid=30165544 | doi=10.1093/eurheartj/ehy340 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30165544  }} </ref><ref name="pmid31243866">{{cite journal| author=Bauersachs J, König T, van der Meer P, Petrie MC, Hilfiker-Kleiner D, Mbakwem A | display-authors=etal| title=Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy. | journal=Eur J Heart Fail | year= 2019 | volume= 21 | issue= 7 | pages= 827-843 | pmid=31243866 | doi=10.1002/ejhf.1493 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31243866  }} </ref><ref name="pmid30704579">{{cite journal| author=Halpern DG, Weinberg CR, Pinnelas R, Mehta-Lee S, Economy KE, Valente AM| title=Use of Medication for Cardiovascular Disease During Pregnancy: JACC State-of-the-Art Review. | journal=J Am Coll Cardiol | year= 2019 | volume= 73 | issue= 4 | pages= 457-476 | pmid=30704579 | doi=10.1016/j.jacc.2018.10.075 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30704579  }} </ref>''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C-LD]])'' <nowiki>"</nowiki>
 |}
@@ Line 60: / Line 174: @@
 *[[The Living Guidelines: Diagnosis and Management of Chronic Heart Failure | The CHF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
-==Guidelines Resources==
+==Sources==
+*[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>
 *[http://content.onlinejacc.org/cgi/reprint/53/15/1343.pdf 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation] <ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>
@@ Line 67: / Line 183: @@
 ==References==
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