The American College of Cardiology (ACC), American Heart Association (AHA) and Heart Failure Society of America (HFSA) have collaborated on new guidelines focused on the diagnosis, treatment and prevention of heart failure.
“One primary goal with the new guideline was to use recently published data to update our recommendations for the evaluation and management of heart failure,” Paul A. Heidenreich, MD, MS, chair of the guideline writing committee, said in a statement. “One focus was prevention of heart failure through optimizing blood pressure control and adherence to a healthy lifestyle.”
Compared to previous guidelines, these latest recommendations spend more time examining the prevention of heart failure among patients showing early warnings signs of “pre-heart failure.” The societies have also updated treatment recommendations for patients presenting with symptomatic heart failure to include SGLT2 inhibitors. This comes after the FDA approved an SGLT2 inhibitor, empagliflozin, as a treatment option for reducing the risk of cardiovascular mortality and hospitalization among adult heart failure patients, regardless of left ventricular ejection fraction, back in February.
Boehringer Ingelheim and Lilly, the manufacturers that developed empagliflozin, sent a statement in support of this update to Cardiovascular Business.
“The recommendations … are encouraging news, as they reflect the availability of more proven treatment options for adults with heart failure across the spectrum of ejection fraction,” according to the statement. “Additional treatments are critical, given heart failure affects over 6 million people in the U.S. and is a leading cause of hospitalization.”
The Stages of Heart Failure
Another key detail from these recommendations is updated stages of heart failure. These stages include:
- Stage A: At Risk for Heart Failure. “At risk, but without symptoms.”
- Stage B: Pre-Heart Failure. “No symptoms or signs of heart failure, but evidence of one of the following: structural heart disease, such as reduced ejection fraction, enlargement of the heart muscle, abnormalities in heart muscle contraction, or valve disease; increased filling pressures as measured via ultrasound; or risk factors from stage A plus increased levels of B-type natriuretic peptide or persistently elevated cardiac troponin, an indicator of heart muscle injury.”
- Stage C: Symptomatic Heart Failure. “Structural heart disease with current or previous symptoms of heart failure.”
- Stage D: Advanced Heart Failure: “Heart failure with symptoms that interfere with daily life, are difficult to control and result in recurrent hospitalizations despite continued guideline-directed medical therapy.”
As the recommendations point out, more than 121 million people in the United States have high blood pressure, another 100 million are obese and 28 million have diabetes; this means “a large proportion” of the country’s population can be viewed as a Stage A heart failure patient.
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Refined Heart Failure Classifications
The updated guidelines also provide new classifications for some key heart failure terms based on left ventricular ejection fraction (LVEF) measurements:
- HF with reduced ejection fraction (HFrEF) includes people with LVEF ≤40%.
- HF with improved ejection fraction (HFimpEF) includes individuals with previous LVEF ≤40% and a follow-up measurement of LVEF >40%.
- HF with mildly reduced ejection fraction (HFmrEF) includes people with LVEF 41-49% and evidence of increased LV filling pressures.
- HF with preserved ejection fraction (HFpEF) includes individuals with LVEF ≥50% and evidence of increased LV filling pressures.
The ACC/AHA/HFSA recommendations breakdown treatment guidelines for each patient group in significant detail.
This new document was published simultaneously in the Journal of the American College of Cardiology, Circulation and Journal of Cardiac Failure.
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.