Top Things to Know: 2013 ACCF/AHA Guideline for the Management of Heart Failure
Published: June 05, 2013
- Approximately 5.1 million Americans have symptoms of heart failure (HF), with over 670,000 new HF diagnoses made each year. Americans 40 years old and older have a 20% lifetime risk of developing HF.
- The 2013 HF guidelines update the previous 2005 Heart Failure Guidelines and the 2009 focused update.
- Expert analysis addresses causes, prevention, diagnosis, risk stratification, stages, and treatments. Areas not included are HF in children or adults with congenital heart lesions.
- These most recent HF guidelines were developed to help providers in decision-making for individual patients. Goals include improving quality of care, optimizing patient outcomes, and improving the efficient use of healthcare resources.
- Guideline-directed medical therapy (GDMT) is used here for one of the first times to indicate optimal treatment. It is intended to help clinicians determine the most appropriate course of HF treatment.
- HF may develop because of many underlying disorders and present with a wide spectrum of clinical symptoms. No single test can diagnose HF.
- An updated definition of HF includes ejection fraction (EF): reduced EF, HfrEF, and (systolic HF) and preserved EF, HFpEF (diastolic HF).
- In comparison to the New York Heart Association (NYHA) functional classification, the ACCF/AHA HF stages include additional information on the severity of HF for individuals and populations, relying on risk factors and structural abnormalities in HF development and progression.
- The importance of adherence to performance and quality measures is addressed. Patient-centric outcomes is a part of the discussion, where quality-of-life, shared decisions, coordination and transition of care, and palliative care are considered.
- Despite advances in knowledge, treatment options, and quality, gaps still exist. The use of biomarkers to optimize medical therapy, the cardiorenal syndrome, understanding the management of sodium in HF, novel pharmacological therapies, and the inclusion of populations such as older women in clinical trials, and better quality definitions are just some of the areas still to be better understood and defined going forward.
Citation
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJV, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WHW, Tsai EJ, Wilkoff BL. 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. Circulation. 2013: published online before print June 5, 2013, 10.1161/CIR.0b013e31829e8776.