Congestive heart failure AHA recommendations
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Resident Survival Guide |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
2013 ACCF/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]
Initial and Serial Evaluation of the HF Patient (DO NOT EDIT)[1]
| Class I |
| "1. A thorough history and physical examination should be obtained/performed in patients presenting with HF to identify cardiac and noncardiac disorders or behaviors that might cause or accelerate the development or progression of HF. (Level of Evidence: C) " |
| "2. In patients with idiopathic DCM, a 3-generational family history should be obtained to aid in establishing the diagnosis of familial DCM. (Level of Evidence: C ) " |
| "3. Volume status and vital signs should be assessed at each patient encounter. This includes serial assessment of weight, as well as estimates of jugular venous pressure and the presence of peripheral edema or orthopnea.[3][4] (Level of Evidence: B ) " |
| "4. Initial laboratory evaluation of patients presenting with HF should include complete blood count, urinalysis, serum electrolytes (including calcium and magnesium), blood urea nitrogen, serum creatinine, glucose, fasting lipid profile, liver function tests, and thyroid-stimulating hormone. Serial monitoring, when indicated, should include serum electrolytes and renal function. A 12-lead ECG should be performed initially on all patients presenting with HF. (Level of Evidence: C) " |
| "5. In ambulatory patients with dyspnea, measurement of BNP or N-terminal pro-B-type natriuretic peptide (NT-proBNP) is useful to support clinical decision making regarding the diagnosis of HF, especially in the setting of clinical uncertainty.[5][6](Level of Evidence: A), Measurement of BNP or NT-proBNP is useful for establishing prognosis or disease severity in chronic HF.[7][8][9] (Level of Evidence: A) " |
| "6. Patients with suspected or new-onset HF, or those presenting with acute decompensated HF, should undergo a chest x-ray to assess heart size and pulmonary congestion and to detect alternative cardiac, pulmonary, and other diseases that may cause or contribute to the patient’s symptoms. A 2-dimensional echocardiogram with Doppler should be performed during initial evaluation of patients presenting with HF to assess ventricular function, size, wall thickness, wall motion, and valve function. Repeat measurement of EF and measurement of the severity of structural remodeling are useful to provide information in patients with HF who have had a significant change in clinical status; who have experienced or recovered from a clinical event; or who have received treatment, including GDMT, that might have had a significant effect on cardiac function; or who may be candidates for device therapy. (Level of Evidence: C) " |
| "7. (Level of Evidence: ) " |
| "8. (Level of Evidence: ) " |
| "9. (Level of Evidence: ) " |
| "10. (Level of Evidence: ) " |
| Class III (No Benefit)
|
| "1. (Level of Evidence: ) "
|
| "2. (Level of Evidence: ) " |
| Class IIa |
| "1. Validated multivariable risk scores can be useful to estimate subsequent risk of mortality in ambulatory or hospitalized patients with HF.[10][11] (Level of Evidence: B) " |
| "2. Screening for hemochromatosis or HIV is reasonable in selected patients who present with HF.[12](Level of Evidence: C) " |
| "3. Diagnostic tests for rheumatologic diseases, amyloidosis, or pheochromocytoma are reasonable inpatients presenting with HF in whom there is a clinical suspicion of these diseases.(Level of Evidence: C) " |
| "4. BNP or N-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided HF therapy can be useful to achieve optimal dosing of GDMT in select clinically euvolemic patients followed in a well-structured HF disease management program.[13][14](Level of Evidence: B) " |
| "5. Noninvasive imaging to detect myocardial ischemia and viability is reasonable in patients presenting with de novo HF who have known CAD and no angina unless the patient is not eligible for revascularization of any kind. Radionuclide ventriculography or magnetic resonance imaging can be useful to assess LVEF and volume when echocardiography is inadequate. (Level of Evidence: C) "
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| "6. Viability assessment is reasonable in select situations when planning revascularization in HF patients with CAD.[15][16](Level of Evidence: B) " |
| Class IIb |
| "1. The usefulness of serial measurement of BNP or N-terminal pro-B-type natriuretic peptide (NT-proBNP) to reduce hospitalization or mortality in patients with HF is not well established.[13][14](Level of Evidence: B), Measurement of other clinically available tests such as biomarkers of myocardial injury or fibrosis may be considered for additive risk stratification in patients with chronic HF. [17][18](Level of Evidence: B)" |
| "2. (Level of Evidence: ) " |
| "3. (Level of Evidence: ) " |
| "4. (Level of Evidence: ) " |
| "5. (Level of Evidence: ) " |
| "6. (Level of Evidence: ) " |
| "7. (Level of Evidence: ) " |
Vote on and Suggest Revisions to the Current Guidelines
External Links
- 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 [2]
- The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult [19]
References
- ↑ 1.0 1.1 1.2 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.
- ↑ 2.0 2.1 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
- ↑ Butman SM, Ewy GA, Standen JR, Kern KB, Hahn E (1993). "Bedside cardiovascular examination in patients with severe chronic heart failure: importance of rest or inducible jugular venous distension". J Am Coll Cardiol. 22 (4): 968–74. PMID 8409071.
- ↑ Stevenson LW, Perloff JK (1989). "The limited reliability of physical signs for estimating hemodynamics in chronic heart failure". JAMA. 261 (6): 884–8. PMID 2913385.
- ↑ Costello-Boerrigter LC, Boerrigter G, Redfield MM, Rodeheffer RJ, Urban LH, Mahoney DW; et al. (2006). "Amino-terminal pro-B-type natriuretic peptide and B-type natriuretic peptide in the general community: determinants and detection of left ventricular dysfunction". J Am Coll Cardiol. 47 (2): 345–53. doi:10.1016/j.jacc.2005.09.025. PMC 2647136. PMID 16412859.
- ↑ Vasan RS, Benjamin EJ, Larson MG, Leip EP, Wang TJ, Wilson PW; et al. (2002). "Plasma natriuretic peptides for community screening for left ventricular hypertrophy and systolic dysfunction: the Framingham heart study". JAMA. 288 (10): 1252–9. PMID 12215132.
- ↑ Tang WH, Girod JP, Lee MJ, Starling RC, Young JB, Van Lente F; et al. (2003). "Plasma B-type natriuretic peptide levels in ambulatory patients with established chronic symptomatic systolic heart failure". Circulation. 108 (24): 2964–6. doi:10.1161/01.CIR.0000106903.98196.B6. PMID 14662703.
- ↑ Berger R, Huelsman M, Strecker K, Bojic A, Moser P, Stanek B; et al. (2002). "B-type natriuretic peptide predicts sudden death in patients with chronic heart failure". Circulation. 105 (20): 2392–7. PMID 12021226.
- ↑ Neuhold S, Huelsmann M, Strunk G, Stoiser B, Struck J, Morgenthaler NG; et al. (2008). "Comparison of copeptin, B-type natriuretic peptide, and amino-terminal pro-B-type natriuretic peptide in patients with chronic heart failure: prediction of death at different stages of the disease". J Am Coll Cardiol. 52 (4): 266–72. doi:10.1016/j.jacc.2008.03.050. PMID 18634981.
- ↑ Aaronson KD, Schwartz JS, Chen TM, Wong KL, Goin JE, Mancini DM (1997). "Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation". Circulation. 95 (12): 2660–7. PMID 9193435.
- ↑ Wedel H, McMurray JJ, Lindberg M, Wikstrand J, Cleland JG, Cornel JH; et al. (2009). "Predictors of fatal and non-fatal outcomes in the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA): incremental value of apolipoprotein A-1, high-sensitivity C-reactive peptide and N-terminal pro B-type natriuretic peptide". Eur J Heart Fail. 11 (3): 281–91. doi:10.1093/eurjhf/hfn046. PMC 2645061. PMID 19168876.
- ↑ Okonko DO, Mandal AK, Missouris CG, Poole-Wilson PA (2011). "Disordered iron homeostasis in chronic heart failure: prevalence, predictors, and relation to anemia, exercise capacity, and survival". J Am Coll Cardiol. 58 (12): 1241–51. doi:10.1016/j.jacc.2011.04.040. PMID 21903058.
- ↑ 13.0 13.1 Januzzi JL, Rehman SU, Mohammed AA, Bhardwaj A, Barajas L, Barajas J; et al. (2011). "Use of amino-terminal pro-B-type natriuretic peptide to guide outpatient therapy of patients with chronic left ventricular systolic dysfunction". J Am Coll Cardiol. 58 (18): 1881–9. doi:10.1016/j.jacc.2011.03.072. PMID 22018299.
- ↑ 14.0 14.1 Lainchbury JG, Troughton RW, Strangman KM, Frampton CM, Pilbrow A, Yandle TG; et al. (2009). "N-terminal pro-B-type natriuretic peptide-guided treatment for chronic heart failure: results from the BATTLESCARRED (NT-proBNP-Assisted Treatment To Lessen Serial Cardiac Readmissions and Death) trial". J Am Coll Cardiol. 55 (1): 53–60. doi:10.1016/j.jacc.2009.02.095. PMID 20117364. Review in: Ann Intern Med. 2010 Apr 20;152(8):JC4-4
- ↑ Rizzello V, Poldermans D, Biagini E, Schinkel AF, Boersma E, Boccanelli A; et al. (2009). "Prognosis of patients with ischaemic cardiomyopathy after coronary revascularisation: relation to viability and improvement in left ventricular ejection fraction". Heart. 95 (15): 1273–7. doi:10.1136/hrt.2008.163972. PMID 19443475.
- ↑ Senior R, Kaul S, Lahiri A (1999). "Myocardial viability on echocardiography predicts long-term survival after revascularization in patients with ischemic congestive heart failure". J Am Coll Cardiol. 33 (7): 1848–54. PMID 10362184.
- ↑ Horwich TB, Patel J, MacLellan WR, Fonarow GC (2003). "Cardiac troponin I is associated with impaired hemodynamics, progressive left ventricular dysfunction, and increased mortality rates in advanced heart failure". Circulation. 108 (7): 833–8. doi:10.1161/01.CIR.0000084543.79097.34. PMID 12912820.
- ↑ Lok DJ, Van Der Meer P, de la Porte PW, Lipsic E, Van Wijngaarden J, Hillege HL; et al. (2010). "Prognostic value of galectin-3, a novel marker of fibrosis, in patients with chronic heart failure: data from the DEAL-HF study". Clin Res Cardiol. 99 (5): 323–8. doi:10.1007/s00392-010-0125-y. PMC 2858799. PMID 20130888.
- ↑ 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.105.167586PMID: 16160202