![]() Additionally, whereas elevated natriuretic peptide levels support the diagnosis, the presence of normal values do not exclude it. According to the guideline authors, establishing the diagnosis of HFmrEF and HFpEF can be challenging, because HF signs and symptoms often are nonspecific, and they can overlap with other conditions. HF with preserved EF (HFpEF), the final category, describes patients with an LVEF greater than or equal to 50% and evidence of spontaneous or provokable increased LV filling pressures. Patients with an LVEF of between 41% and 49% and evidence of increased LV filling pressures (either spontaneous or provokable) are described as having HF with mildly reduced EF (HFmrEF). 1 The authors underscored the need for these patients to continue treatment-many patients with improvement in LVEF and biomarkers and resolution of symptoms relapse after 6 months following withdrawal of GDMT. The use of the term “improved LVEF” for these patients is new in the 2022 guideline the 2013 ACCF/AHA guideline had categorized these patients as having “HF with preserved EF-improved.” 1,4 Authors of the updated guideline emphasized that this patient subgroup is more appropriately characterized by HFimpEF, since improvement in LVEF does not necessarily represent full myocardial recovery or normalization of LV function. Patients who previously were in the HFrEF category and who have a follow-up measurement of LVEF greater than 40% are described as having HF with improved EF (HFimpEF). 1 The guideline now defines HF with reduced ejection fraction (HFrEF) as involving an LVEF less than or equal to 40%. The classification of HF by LV ejection fraction (LVEF) has been modified. Finally, stage D disease represents advanced HF this includes individuals who have HF symptoms that interfere with their daily lives and who are admitted to the hospital recurrently despite attempts to optimize their guideline-directed medical therapy (GDMT). Stage C HF corresponds to symptomatic HF this describes patients with structural heart disease and current or previous HF symptoms. Stage B disease is described as “pre-HF ” although patients may not have symptoms or signs of the disease, they display evidence of 1 of the following: structural heart disease, increased filling pressures, or risk factors plus increased natriuretic peptide levels or persistently elevated cardiac troponin levels in the absence of competing diagnoses that could result in abnormal biomarkers. Patients given a diagnosis of stage A HF may have such comorbidities as hypertension, cardiovascular disease (CVD), obesity, or diabetes exposure to cardiotoxic agents a genetic variant for cardiomyopathy or a family history of cardiomyopathy. The guideline describes persons with stage A disease as being “at risk for HF ” they lack HF symptoms, structural and/or functional heart disease, or abnormal cardiac biomarkers. 1 These patients are potential candidates for preventive targeted treatment strategies. 1,3 To address this need, guideline authors revised the stages of HF to emphasize those who are at risk, and highlighted the evolving role that structural cardiac changes and biomarkers play in identifying at-risk patients. The 2022 HF guideline emphasizes the need for primary prevention, which may help mitigate the health and economic burden associated with HF, which is projected to spread to 2.97% of the US population by 2030. What’s New in the 2022 ACC/AHA/HFSA Heart Failure Guideline Stages of HF Redefined 1 This article reviews key takeaways from the 2022 guideline and summarizes the guideline’s recommendations for SGLT2 inhibitor therapy. 1įocusing on HF prevention, management strategies, and implantable devices, the guideline addresses new recommendations for treatments (eg, for sodium-glucose cotransporter-2 inhibitors, angiotensin receptor-neprilysin inhibitors ), atrial fibrillation (AF) management, management strategies specific to cardiac amyloidosis and cardio-oncology, and the use of left ventricular (LV) assist devices. 1,2 As it emphasizes both the importance of applying clinical judgement and a shared decision-making approach, the 2022 guideline outlines management recommendations based upon up-to-date evidence. 1 This guideline consolidates and replaces the 2013 American College of Cardiology Foundation (ACCF)/AHA guideline for HF management and its subsequent 2017 focused update, which was developed by the ACC/AHA/HFSA. The American College of Cardiology (ACC), the American Heart Association (AHA), and the Heart Failure Society of America (HFSA) jointly published an updated clinical practice guideline for the management of heart failure (HF) in April 2022. ![]()
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