GUIDELINES: UPDATED COMPREHENSIVE HEART FAILURE MANAGEMENT
A member of my family has been living with heart failure (HF) for year. She was recently admitted to a prestigious private hospital in Istanbul, Turkey with a fever of unknown origin, listlessness and anorexia. Her condition was misdiagnosed, and a wrong treatment was applied. This made me rush to Istanbul to help her.
I believe that corporate medicine is taking over the medical care in every country, including America, and is more interested in profit seeking behaviors than caregiving behaviors.
I thought it would be helpful to review this important and updated guidelines for many millions of people who are suffering from HF and their doctors.
Sponsoring Organizations: American Heart Association, American College of Cardiology, and the Heart Failure Society of America.
Key Points:
1- Many millions of people are in a stage-A HF including those with high blood pressure, obesity, and diabetes. Treating patients with these risk factors should be aggressive. In patients with diabetes, use SGLT-2 inhibitors. Healthy lifestyles are useful in preventing HF in stage-A patients.
2- For patients with stage-B HF (pre-HF with no sign or symptoms of HF, but with evidence of structural heart disease or elevated pressures) with reduced left ventricular ejection fraction (LVEF), treat with ACE inhibitors or ARBs and Beta-blockers to prevent development of symptomatic HF. Implantable cardioverter-defibrillators (ICDs) are recommended for those who qualify according to standard guidelines. Do not use calcium-channel blockers.
3- Patients with stage-C HF (symptomatic patients) should receive care from a multidisciplinary team. Medical therapy should include the agents used in stage-B disease but also SGLT-2 inhibitors for those with symptomatic HF with reduced ejection fraction, regardless of diabetes status, and ARNIs are recommended. Titrate guidelines-directed medical therapy upward to achieve target doses shown to be effective in randomized, control trials. Use diuretics as needed.
4- For stage-D Fuse pharmacologic therapy as above and, additionally, implantable cardiac devices, such as ICDs and cardiac resynchronization therapy (e.g., left ventricular assist device, heart transplant). Manage cardiac amyloid.
5- Use ICDs in patients with genetic arrhythmic cardiomyopathies with high risk features for sudden death and LVEF <45%.
6- AF management should follow a rhythm control strategy with ablation for those in whom it is appropriate.
Reference- NEJM Journal Watch Cardiology.
