Management of Heart Failure

Synthèse

Messages clés

1. 1

   Guideline-directed medical therapy (GDMT) for heart failure (HF) with reduced ejection fraction (HFrEF) now includes 4 medication classes that include sodium-glucose cotransporter-2 inhibitors (SGLT2i).

2. 2

   SGLT2i have a Class of Recommendation 2a in HF with mildly reduced ejection fraction (HFmrEF).

3. 3

   New recommendations for HFpEF are made for SGLT2i, MRAs, and ARNi.

4. 4

   Improved LVEF is used to refer to those patients with previous HFrEF who now have an LVEF >40%. These patients should continue their HFrEF treatment.

5. 5

   Value statements were created for select recommendations where high-quality, cost-effectiveness studies of the intervention have been published.

6. 6

   Amyloid heart disease has new recommendations for treatment including screening for serum and urine monoclonal light chains, bone scintigraphy, genetic sequencing, tetramer stabilizer therapy, and anticoagulation.

7. 7

   Evidence supporting increased filling pressures is important for the diagnosis of HF if the LVEF is >40%.

8. 8

   Patients with advanced HF who wish to prolong survival should be referred to a team specializing in HF.

9. 9

   Primary prevention is important for those at risk for HF (stage A) or pre-HF (stage B). Stages of HF were revised to emphasize the new terminologies.