Feature | June 06, 2013

ACC/AHA Update Guideline for Management of Heart Failure

Update increases emphasis on quality of life, care coordination, palliative care

June 6, 2013 — The American College of Cardiology and the American Heart Association released an expanded clinical practice guideline for the management of patients with heart failure, updating definitions and classifications for heart failure and increasing emphasis on patient-centric outcomes such as quality of life, shared decision making, care coordination, transitions and palliative care.

Approximately 5.1 million Americans have clinically manifested heart failure, which is a complex clinical syndrome that occurs when the heart’s ventricles cannot properly fill with or eject blood. More than 670,000 new cases are diagnosed annually and result in more than $30 billion of total healthcare costs.

Designed to assist clinicians in selecting the best management strategy for individual patients, the 2013 guideline provides expert analysis of data on prevention, diagnosis, risk stratification and treatment. Where data are lacking, evidence gaps are highlighted in the document.

Improving care quality, optimizing patient outcomes, and favorably affecting the efficient use of healthcare resources are all goals of the document, which was developed in collaboration with the American Academy of Family Physicians, American College of Chest Physicians, Heart Rhythm Society and the International Society for Heart and Lung Transplantation. The 2013 Heart Failure Guideline is a thorough reassessment of heart failure diagnosis and management that goes beyond the previous 2005 Heart Failure Guideline and corresponding 2009 focused update. 

To draft the document, the ACC and AHA selected a multidisciplinary group of experts in cardiac care and asked them to perform a comprehensive literature review and to create a series of pertinent evidence tables. Writing committee members then weighed the strength of this evidence for or against certain tests or treatments and considered patient-specific modifiers that may influence care choices.

The guideline covers the full trajectory of both inpatient and outpatient care for patients with heart failure, from the initial evaluation through treatment stages A-D, including palliative care, and highlight quality improvement and optimal adherence to performance measures. Specific diagnostic strategies addressed included laboratory diagnostic tests, noninvasive cardiac imaging, invasive evaluation and detailed family histories with consideration for genetic screening, where applicable. The full range of treatment interventions including diuretics, ACE inhibitors, angiotensin-receptor blockers, beta blockers, statins, device therapy, mechanical circulatory support systems, cardiac transplantation and surgical/percutaneous/transcatheter interventions were considered.

According to writing committee chair Clyde W. Yancy, M.D., MSc, professor of medicine and chief of cardiology at Northwestern University Feinberg School of Medicine, highlights of the 2013 guideline include updated definitions and classifications for heart failure, a more focused approach to dilated cardiomyopathies, critical new indications for aldosterone antagonists and important new considerations for more discriminate use of cardiac resynchronization device therapy (CRT).

The document also discusses greater adherence to performance measures and quality measures (with timely recommendations to reduce readmissions) and places an even greater emphasis on patient-centric outcomes, such as quality-of-life issues, shared decision making, care coordination, transition of care, and palliative care.

The 2013 Heart Failure Guideline is among the first ACC/AHA guidance documents to utilize the new designation for optimal treatment. Termed “guideline-directed medical therapy” (GDMT), this new designation allows clinicians to easily determine the specific course of care deemed most important in the management of heart failure. Yancy noted that this important “call-out” of GDMT should be especially helpful for primary care physicians and physician extenders involved in the care of patients with heart failure.

“Amongst the many treatment recommendations in this guideline addressing care, the unambiguous nature of ‘GDMT’ emphasizes what works best and should be widely deployed,” he stated.

Writing committee vice chair Mariell Jessup, M.D., professor of medicine at the Perelman School of Medicine, University of Pennsylvania, adds that providing a more thorough analysis of heart failure with preserved ejection fraction (HFpEF) was a major focus of the 2013 guideline.

“From epidemiology through clinical presentation and therapeutics, medical and surgical, we have exercised every opportunity to make specific mention of issues related to HFpEF,” Jessup said. “In today’s clinical environment, at least half — if not more — of the patients we see today with heart failure have a preserved ejection fraction. It is critical to develop a frame through which we can all see these patients and further our research efforts into best therapies for this important iteration of heart failure.”

Yancy said the importance of the guideline cannot be underestimated. “Available data are clear that adherence to evidence-based guideline-directed care for heart failure improves outcomes,” he said. “The emphasis in this guideline on quality of care and performance improvement is well-placed and merits a firm embrace by those who see and treat patients with heart failure.”

The work of the writing committee was supported exclusively by the ACC and AHA without commercial support.  Writing committee members volunteered their time and were required to disclose all healthcare-related relationships, including those existing one year before the initiation of the writing project.

Full text of the report, “2013 ACCF/AHA Guideline for the Management of Heart Failure,” will be published online and in the Aug. 27 print issue of the Journal of the American College of Cardiology. It will also be accessible on the ACC  and AHA websites.

For more information: www.cardiosource.org, www.my.americanheart.org 

Related Content

Medtronic, CRT, cardiac resynchroniazation therapy devices, heart failure, medication adherence, retrospective analysis, HFSA 2016
News | Heart Failure| September 20, 2016
Medtronic plc announced the results of an analysis that reveals patients increasingly adhere to heart failure...
EBR Systems, FDA, WiSE Technology, Wireless Stimulation Endocardially, SOLVE-CRT study

The WiSE CRT System uses a tiny implant in the left ventricle to synchronize the heart, overcoming limitations of traditional cardiac resynchronization therapy (CRT) in heart failure patients. Graphic courtesy of Business Wire.

News | Cardiac Resynchronization Therapy Devices (CRT)| September 15, 2016
EBR Systems Inc. announced the U.S. Food and Drug Administration (FDA) has granted an Investigational Device Exemption...
SynCardia, Chapter 11 reorganization, sale, Total Artificial Heart
News | Artificial Heart| September 13, 2016
August 29, 2016 — SynCardia Systems, manufacturer of the...
Carmat, bioprosthetic artificial heart, PIVOTAL study, first implantation, heart failure
News | Artificial Heart| September 09, 2016
Carmat announced that the first implantation of its bioprosthetic artificial heart within the framework of the PIVOTAL...
Sponsored Content | Videos | Heart Failure| September 02, 2016
The Respicardia Remede System is a pacemaker-like implantable device designed to improve cardiovascular health by res
Respicardia, Remede, pacemaker for sleep apnea, central sleep apnea treatment

The Respicardia Remede System is a pacemaker-like implantable device designed to improve cardiovascular health by restoring natural breathing during sleep in patients with central sleep apnea.

News | Heart Failure| September 02, 2016
September 2, 2016 — Results from an international, randomized study show that an implanted nerve stimulator significa
News | Cardiac Resynchronization Therapy Devices (CRT)| August 30, 2016
August 30, 2016 — Medtronic plc announced results from the...
Merlin, Merlin@home, SJM, St. Jude Medical Merlin, cybersecurity

St. Jude Medical said recent claims of the cyber attack vulnerability of its [email protected] remote monitoring system and its implantable EP devices are not true.

Feature | EP Lab| August 29, 2016 | Dave Fornell
August 29, 2016 — Investment research firm Muddy Waters Capital released a report Aug. 25 saying it believes St.
News | Heart Failure| August 23, 2016
August 23, 2016 — A new study of more than 13,000 people has found that so-called morbid obesity appears to stand alo
Overlay Init