Congestive heart failure AHA recommendations for hospitalized patient

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ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
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Obstructive Sleep Apnea in the Patient with CHF
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahmoud Sakr, M.D. [2] Edzel Lorraine Co, D.M.D., M.D. [3]

2022 AHA/ACC/HFSA Heart Failure Guideline/ 2013 ACC/AHA Guideline, 2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Heart Failure in the Adult (DO NOT EDIT) [1][2][3]

PATIENTS HOSPITALIZED WITH ACUTE DECOMPENSATED HF 2022 AHA/ACC/HFSA Heart Failure Guideline/ 2013 ACC/AHA Guideline, 2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Heart Failure in the Adult (DO NOT EDIT) [1][2][3]

Assessment of Patients Hospitalized With Decompensated HF (DO NOT EDIT) [1][2][3]

Class I
"1. In patients hospitalized with HF, severity of congestion and adequacy of perfusion should be assessed to guide triage and initial therapy. [4] [5][6][7][8] (Level of Evidence: B-NR) "
"2. In patients hospitalized with HF, the common precipitating factors and the overall patient trajectory should be assessed to guide appropriate therapy. [8][9] (Level of Evidence: B-NR) "
"3. For patients admitted with HF, treatment should address reversible factors, establish optimal volume status, and advance GDMT toward targets for outpatient therapy.[9] (Level of Evidence: B-NR) "


Maintenance or Optimization of GDMT During Hospitalization (DO NOT EDIT) [1][2][3]

Class I
"1. In patients with HFrEF requiring hospitalization, preexisting GDMT should be continued and optimized to improve outcomes, unless contraindicated. [10][11][12][13][14] (Level of Evidence: B-NR) "
"2. In patients experiencing mild decrease of renal function or asymptomatic reduction of blood pressure during HF hospitalization, diuresis and other GDMT should not routinely be discontinued. [15][16]

[17][18][19][20](Level of Evidence: B-NR) "

"3.In patients with HFrEF, GDMT should be initiated during hospitalization after clinical stability is achieved.[11][12][14][21][22][23][24][25][26][27] (Level of Evidence: B-NR) "
"4.In patients with HFrEF, if discontinuation of GDMT is necessary during hospitalization, it should be reinitiated and further optimized as soon as possible. [28][29][30][31] (Level of Evidence: B-NR) "

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References

  1. ↑ 1.0 1.1 1.2 1.3 Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM; et al. (2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (18): e876–e894. doi:10.1161/CIR.0000000000001062. PMID 35363500 Check |pmid= value (help).
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE; et al. (2013). "2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. doi:10.1016/j.jacc.2013.05.019. PMID 23747642.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) 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. DOI:10.1161/CIRCULATIONAHA.109.192064 PMID: 19324967
  4. ↑ Drazner MH, Hellkamp AS, Leier CV, Shah MR, Miller LW, Russell SD; et al. (2008). "Value of clinician assessment of hemodynamics in advanced heart failure: the ESCAPE trial". Circ Heart Fail. 1 (3): 170–7. doi:10.1161/CIRCHEARTFAILURE.108.769778. PMC 2724723. PMID 19675681.
  5. ↑ Chioncel O, Mebazaa A, Maggioni AP, Harjola VP, Rosano G, Laroche C; et al. (2019). "Acute heart failure congestion and perfusion status - impact of the clinical classification on in-hospital and long-term outcomes; insights from the ESC-EORP-HFA Heart Failure Long-Term Registry". Eur J Heart Fail. 21 (11): 1338–1352. doi:10.1002/ejhf.1492. PMID 31127678.
  6. ↑ Cleland JG, Chiswell K, Teerlink JR, Stevens S, Fiuzat M, Givertz MM; et al. (2014). "Predictors of postdischarge outcomes from information acquired shortly after admission for acute heart failure: a report from the Placebo-Controlled Randomized Study of the Selective A1 Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized With Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function (PROTECT) Study". Circ Heart Fail. 7 (1): 76–87. doi:10.1161/CIRCHEARTFAILURE.113.000284. PMID 24281134.
  7. ↑ Ambrosy AP, Pang PS, Khan S, Konstam MA, Fonarow GC, Traver B; et al. (2013). "Clinical course and predictive value of congestion during hospitalization in patients admitted for worsening signs and symptoms of heart failure with reduced ejection fraction: findings from the EVEREST trial". Eur Heart J. 34 (11): 835–43. doi:10.1093/eurheartj/ehs444. PMID 23293303.
  8. ↑ 8.0 8.1 Hollenberg SM, Warner Stevenson L, Ahmad T, Amin VJ, Bozkurt B, Butler J; et al. (2019). "2019 ACC Expert Consensus Decision Pathway on Risk Assessment, Management, and Clinical Trajectory of Patients Hospitalized With Heart Failure: A Report of the American College of Cardiology Solution Set Oversight Committee". J Am Coll Cardiol. 74 (15): 1966–2011. doi:10.1016/j.jacc.2019.08.001. PMID 31526538.
  9. ↑ 9.0 9.1 Kapoor JR, Kapoor R, Ju C, Heidenreich PA, Eapen ZJ, Hernandez AF; et al. (2016). "Precipitating Clinical Factors, Heart Failure Characterization, and Outcomes in Patients Hospitalized With Heart Failure With Reduced, Borderline, and Preserved Ejection Fraction". JACC Heart Fail. 4 (6): 464–72. doi:10.1016/j.jchf.2016.02.017. PMID 27256749.
  10. ↑ Fonarow GC, Abraham WT, Albert NM, Stough WG, Gheorghiade M, Greenberg BH; et al. (2008). "Influence of beta-blocker continuation or withdrawal on outcomes in patients hospitalized with heart failure: findings from the OPTIMIZE-HF program". J Am Coll Cardiol. 52 (3): 190–9. doi:10.1016/j.jacc.2008.03.048. PMID 18617067.
  11. ↑ 11.0 11.1 Gilstrap LG, Fonarow GC, Desai AS, Liang L, Matsouaka R, DeVore AD; et al. (2017). "Initiation, Continuation, or Withdrawal of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers and Outcomes in Patients Hospitalized With Heart Failure With Reduced Ejection Fraction". J Am Heart Assoc. 6 (2). doi:10.1161/JAHA.116.004675. PMC 5523765. PMID 28189999.
  12. ↑ 12.0 12.1 Maisel A, Xue Y, van Veldhuisen DJ, Voors AA, Jaarsma T, Pang PS; et al. (2014). "Effect of spironolactone on 30-day death and heart failure rehospitalization (from the COACH Study)". Am J Cardiol. 114 (5): 737–42. doi:10.1016/j.amjcard.2014.05.062. PMID 25129066.
  13. ↑ Prins KW, Neill JM, Tyler JO, Eckman PM, Duval S (2015). "Effects of Beta-Blocker Withdrawal in Acute Decompensated Heart Failure: A Systematic Review and Meta-Analysis". JACC Heart Fail. 3 (8): 647–53. doi:10.1016/j.jchf.2015.03.008. PMC 4777602. PMID 26251094.
  14. ↑ 14.0 14.1 Tran RH, Aldemerdash A, Chang P, Sueta CA, Kaufman B, Asafu-Adjei J; et al. (2018). "Guideline-Directed Medical Therapy and Survival Following Hospitalization in Patients with Heart Failure". Pharmacotherapy. 38 (4): 406–416. doi:10.1002/phar.2091. PMC 5902433. PMID 29423950.
  15. ↑ Peri-Okonny PA, Mi X, Khariton Y, Patel KK, Thomas L, Fonarow GC; et al. (2019). "Target Doses of Heart Failure Medical Therapy and Blood Pressure: Insights From the CHAMP-HF Registry". JACC Heart Fail. 7 (4): 350–358. doi:10.1016/j.jchf.2018.11.011. PMC 6440823. PMID 30738978.
  16. ↑ Böhm M, Young R, Jhund PS, Solomon SD, Gong J, Lefkowitz MP; et al. (2017). "Systolic blood pressure, cardiovascular outcomes and efficacy and safety of sacubitril/valsartan (LCZ696) in patients with chronic heart failure and reduced ejection fraction: results from PARADIGM-HF". Eur Heart J. 38 (15): 1132–1143. doi:10.1093/eurheartj/ehw570. PMC 6251522. PMID 28158398.
  17. ↑ Montero-Perez-Barquero M, Flather M, Roughton M, Coats A, Böhm M, Van Veldhuisen DJ; et al. (2014). "Influence of systolic blood pressure on clinical outcomes in elderly heart failure patients treated with nebivolol: data from the SENIORS trial". Eur J Heart Fail. 16 (9): 1009–15. doi:10.1002/ejhf.136. PMID 25044535.
  18. ↑ Anand IS, Rector TS, Kuskowski M, Thomas S, Holwerda NJ, Cohn JN (2008). "Effect of baseline and changes in systolic blood pressure over time on the effectiveness of valsartan in the Valsartan Heart Failure Trial". Circ Heart Fail. 1 (1): 34–42. doi:10.1161/CIRCHEARTFAILURE.107.736975. PMID 19808268.
  19. ↑ Ahmad T, Jackson K, Rao VS, Tang WHW, Brisco-Bacik MA, Chen HH; et al. (2018). "Worsening Renal Function in Patients With Acute Heart Failure Undergoing Aggressive Diuresis Is Not Associated With Tubular Injury". Circulation. 137 (19): 2016–2028. doi:10.1161/CIRCULATIONAHA.117.030112. PMC 6066176. PMID 29352071.
  20. ↑ Brunner-La Rocca HP, Knackstedt C, Eurlings L, Rolny V, Krause F, Pfisterer ME; et al. (2015). "Impact of worsening renal function related to medication in heart failure". Eur J Heart Fail. 17 (2): 159–68. doi:10.1002/ejhf.210. PMID 25808849.
  21. ↑ Fonarow GC, Abraham WT, Albert NM, Stough WG, Gheorghiade M, Greenberg BH; et al. (2007). "Carvedilol use at discharge in patients hospitalized for heart failure is associated with improved survival: an analysis from Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF)". Am Heart J. 153 (1): 82.e1–11. doi:10.1016/j.ahj.2006.10.008. PMID 17174643.
  22. ↑ Hernandez AF, Hammill BG, O'Connor CM, Schulman KA, Curtis LH, Fonarow GC (2009). "Clinical effectiveness of beta-blockers in heart failure: findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) Registry". J Am Coll Cardiol. 53 (2): 184–92. doi:10.1016/j.jacc.2008.09.031. PMC 3513266. PMID 19130987.
  23. ↑ Bhatia V, Bajaj NS, Sanam K, Hashim T, Morgan CJ, Prabhu SD; et al. (2015). "Beta-blocker Use and 30-day All-cause Readmission in Medicare Beneficiaries with Systolic Heart Failure". Am J Med. 128 (7): 715–21. doi:10.1016/j.amjmed.2014.11.036. PMC 6756434 Check |pmc= value (help). PMID 25554369.
  24. ↑ Sanam K, Bhatia V, Bajaj NS, Gaba S, Morgan CJ, Fonarow GC; et al. (2016). "Renin-Angiotensin System Inhibition and Lower 30-Day All-Cause Readmission in Medicare Beneficiaries with Heart Failure". Am J Med. 129 (10): 1067–73. doi:10.1016/j.amjmed.2016.05.008. PMC 5039055. PMID 27262781.
  25. ↑ Hernandez AF, Mi X, Hammill BG, Hammill SC, Heidenreich PA, Masoudi FA; et al. (2012). "Associations between aldosterone antagonist therapy and risks of mortality and readmission among patients with heart failure and reduced ejection fraction". JAMA. 308 (20): 2097–107. doi:10.1001/jama.2012.14795. PMID 23188026.
  26. ↑ Bhatt DL, Szarek M, Steg PG, Cannon CP, Leiter LA, McGuire DK; et al. (2021). "Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure". N Engl J Med. 384 (2): 117–128. doi:10.1056/NEJMoa2030183. PMID 33200892 Check |pmid= value (help).
  27. ↑ Velazquez EJ, Morrow DA, DeVore AD, Duffy CI, Ambrosy AP, McCague K; et al. (2019). "Angiotensin-Neprilysin Inhibition in Acute Decompensated Heart Failure". N Engl J Med. 380 (6): 539–548. doi:10.1056/NEJMoa1812851. PMID 30415601.
  28. ↑ Greene SJ, Butler J, Albert NM, DeVore AD, Sharma PP, Duffy CI; et al. (2018). "Medical Therapy for Heart Failure With Reduced Ejection Fraction: The CHAMP-HF Registry". J Am Coll Cardiol. 72 (4): 351–366. doi:10.1016/j.jacc.2018.04.070. PMID 30025570.
  29. ↑ Deschaseaux C, McSharry M, Hudson E, Agrawal R, Turner SJ (2016). "Treatment Initiation Patterns, Modifications, and Medication Adherence Among Newly Diagnosed Heart Failure Patients: A Retrospective Claims Database Analysis". J Manag Care Spec Pharm. 22 (5): 561–71. doi:10.18553/jmcp.2016.22.5.561. PMID 27123917.
  30. ↑ Wirtz HS, Sheer R, Honarpour N, Casebeer AW, Simmons JD, Kurtz CE; et al. (2020). "Real-World Analysis of Guideline-Based Therapy After Hospitalization for Heart Failure". J Am Heart Assoc. 9 (16): e015042. doi:10.1161/JAHA.119.015042. PMC 7660806 Check |pmc= value (help). PMID 32805181 Check |pmid= value (help).
  31. ↑ Greene SJ, Fonarow GC, DeVore AD, Sharma PP, Vaduganathan M, Albert NM; et al. (2019). "Titration of Medical Therapy for Heart Failure With Reduced Ejection Fraction". J Am Coll Cardiol. 73 (19): 2365–2383. doi:10.1016/j.jacc.2019.02.015. PMC 7197490 Check |pmc= value (help). PMID 30844480.
  32. ↑ Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG et al. (2005) 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. DOI:10.1161/CIRCULATIONAHA.105.167586 PMID: 16160202

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