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Published by American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines · ACC/AHA Class of Recommendation and Level of Evidence
Heart failure remains a leading cause of morbidity and mortality globally. This 2022 guideline replaces the 2013 ACCF/AHA Guideline and the 2017 focused update to provide contemporary, evidence-based approaches to manage patients with heart failure, with the intent to improve quality of care and align with patients' interests.
Key Takeaways
Replaces the '2013 ACCF/AHA Guideline for the Management of Heart Failure' and the '2017 ACC/AHA/HFSA Focused Update'. It introduces the new terminology of 'HFimpEF' (HF with improved EF) and 'HFmrEF' (HF with mildly reduced EF). It includes SGLT2 inhibitors as a core part of GDMT for HFrEF and offers new recommendations for their use in HFmrEF and HFpEF. It formally incorporates value statements and modernizes the staging terminology ('At Risk for HF' and 'Pre-HF').
In patients with HF, vital signs and evidence of clinical congestion should be assessed at each encounter to guide overall management, including adjustment of diuretics and other medications.
In patients presenting with dyspnea, measurement of B-type natriuretic peptide (BNP) or N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) is useful to support a diagnosis or exclusion of HF.
In patients with type 2 diabetes and either established CVD or at high cardiovascular risk, SGLT2i should be used to prevent hospitalizations for HF.
In patients with HFrEF and NYHA class II to III symptoms, the use of ARNi is recommended to reduce morbidity and mortality.
In patients with HFrEF, with current or previous symptoms, use of 1 of the 3 beta blockers proven to reduce mortality (e.g., bisoprolol, carvedilol, sustained-release metoprolol succinate) is recommended to reduce mortality and hospitalizations.
In patients with HFrEF and NYHA class II to IV symptoms, an MRA (spironolactone or eplerenone) is recommended to reduce morbidity and mortality, if eGFR is >30 mL/min/1.73 m2 and serum potassium is <5.0 mEq/L.
In patients with symptomatic chronic HFrEF, SGLT2i are recommended to reduce hospitalization for HF and cardiovascular mortality, irrespective of the presence of type 2 diabetes.
In patients with HFmrEF, SGLT2i can be beneficial in decreasing HF hospitalizations and cardiovascular mortality.
In patients with HFimpEF after treatment, GDMT should be continued to prevent relapse of HF and LV dysfunction, even in patients who may become asymptomatic.
In patients with HFpEF, SGLT2i can be beneficial in decreasing HF hospitalizations and cardiovascular mortality.
Clinical Topic
Heart Failure
Objectives
To provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure.
Target Patient Population
Adult patients with or at risk of developing heart failure
Diagnostic Criteria
A complex clinical syndrome with symptoms and signs that result from any structural or functional impairment of ventricular filling or ejection of blood, further classified by LVEF (HFrEF ≤40%, HFmrEF 41%-49%, HFpEF ≥50%) and supported by objective measures like increased filling pressures or elevated natriuretic peptides.
Target Providers
Therapeutic Area
Cardiovascular DiseaseGuideline Scope
Care Settings
Special Populations
System: ACC/AHA Class of Recommendation and Level of Evidence
Evidence Levels
Recommendation Strength
Contraindications
Monitoring Guidance
Regular checks of serum potassium levels and renal function should be performed according to clinical status after initiating MRA therapy. Routine monitoring of cardiac function is reasonable for early identification of drug-induced cardiomyopathy in cancer patients.
Difficulty
advanced
Learning Paths