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ACC, AHA, HFSA issue heart failure guideline

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A new collaborative guide published today by the American College of Obstetricians and Gynecologists, and community failure in heart failure (HF) in people showing early signs of “pre-heart failure,” and updating treatment strategies for people with heart failure to combine SGLT-2 inhibitors (SGLT2i). The guide also offers recommendations for the management of cardiac amyloidosis, coronary heart-oncology, diseases in the setting of coronary heart disease, and consideration of implantable devices and therapies for people with stage D.

Heart failure is a common condition that can usually be managed with medications and lifestyle changes. The most common causes heart attack include narrow heart arteries, heart attack, high blood pressure and valvular heart disease. Other causes may include, but are not limited to, family or cardiomyopathies, amyloidosis, lifestyle disorders, allergies or exposure to cardiovascular drugs, such as chemotherapy or other medications. Prevention is especially important for those at risk for HF or pre-HF.

“One of the first goals with the new guide is to use the recently published data to update our recommendations for the evaluation and management of heart disease,” said Paul A. Heidenreich, MD, MS, chairman of the steering committee. “One focus is on prevention of heart disease through improvement control of blood pressure and the pursuit of peace. “

ACC / AHA measures of heart failure, from AD, emphasize the progression of the disease, with progressive measures indicating more severe disease and reduced mortality. The new guide redesigns these measures to identify early HF risk factors, which is stage A, at HF ​​risk, and to provide treatment before systemic changes or signs of cardiac arrest occur, which is stage B, pre-HF. The steps are:

  • Step A: At HF Risk. At risk but without symptoms, systemic heart disease or blood test showing a weakened heart muscle. This includes people with high blood pressure, diabetes, chronic pain and obesity, exposure to drugs or treatments that can damage the heart (i.e. chemotherapy), or the risk of stroke for heart failure.
  • Step B: Pre-HF. There are no signs or symptoms of HF, but evidence of one of the following: systemic heart disease, such as dementia output volume, heart failure, abnormalities in heart rate, or valve disease; increase the pressure as measured by ultrasound; or risk factors from stage A and increased levels of B-type natriuretic peptide or troponin in the long heart, indicating weakening of the heart muscle.
  • Step C: HF symptoms. Cardiovascular system with current or past signs of heart failure. Symptoms include shortness of breath, coughing, swelling (in legs, feet, abdomen), fatigue and nausea.
  • Step D: High HF. HF with symptoms that interfere with daily life, are difficult to control and result in clinical recurrence despite continued management. medicine.

The New York Heart Association (Class I-IV) is used when people reach symptoms (stage C) or progress (stage D) HF, to describe their strengths and to determine treatment strategies.

With nearly 121.5 million people in the United States as well high blood pressure, 100 million with obesity, and 28 million with diabetes, most of the American population can be classified as stage A and at risk for HF. For people in this group this guide recommends controlling high blood pressure accordingly latest guides. Average blood pressure should be less than 120/80 mmHg. People with type 2 diabetes who have either been diagnosed with coronary heart disease or are at risk for cardiovascular disease are advised to consider SGLT2i drugs, which have been shown to improve survival in these al. ‘ummomin. In general, major cardiovascular risk factors are recommended to reduce the risk of HF: healthy lifestyle habits such as exercise, a healthy diet, avoiding smoking and maintaining a healthy weight.

While stage A (at risk) recommendations work for those in stage B, people with pre-HF have the potential to combine additional medications to prevent symptomatic HF. For people with stage B HF with left ventricular fibrillation (LVEF) ≤40%, ACE-inhibitors (angiotensin-converting-enzyme inhibitors, or ACEi) should be used to prevent HF symptoms from developing . Angiotensin receptor blockers (ARBs) may be prescribed to people with intolerance or inhibition to ACEi. Both medications help relax blood vessels and reduce high blood pressure. Cholesterol-lowering statins are recommended for people with a history of heart disease or severe vascular disease.

People who progress to stage C with HF symptoms should receive supervision from multiple organizations to facilitate treatment of the systemic care and self-care to learn to manage symptoms. Self-care support includes understanding the importance of taking medication as prescribed and maintaining good habits such as restricting sodium intake and being physically fit. They should also understand how to monitor themselves for HF symptoms and what to do about these symptoms. Research is recommended to identify potential medical or social problems for better self-care, education and support to reduce hospitalization and improve quality of life. People with C HF level should be fully vaccinated against respiratory infections including COVID-19.

“In recent years, there has been an increase in the scientific knowledge that evaluates how best to treat heart disease. With this new guide, the writing committee hopes to inform the best treatment options for the majority of patients suffering from it. and heart disease, ”said Heidenreich. .

Left ventricular ejection fraction (LVEF) informs and predicts treatment for people with HF. The left ventricle of the heart is responsible for pumping blood to other parts of the body. The amount of blood expelled from the left ventricle is measured as a bone called ejection fraction. In general, a LVEF of ≥50-55% is considered normal.

For people with level C HF, the new guide recalculates the four current HF levels based on LVEF with new words:

  • HF with reduced excretory fraction (HFrEF) includes people with LVEF ≤40%.
  • HF with improved excretory fraction (HFimpEF) includes individuals with a previous LVEF ≤40% and an LVEF follow-up ratio> 40%.
  • HF with abnormal discharge rate (HFmrEF) includes people with LVEF 41-49% and evidence of increased LV pressure.
  • HF with protected excretory components (HFpEF) includes individuals with a LVEF ≥50% and evidence of increased LV pressure.

“After careful consideration of the new evidence, the current clinical practice guidelines include four treatment modalities including SGLT-2 inhibitors. Irrespective of the type of diabetes mellitus. no, the DAPA-HF and EMPEROR-HF tests showed the benefit of treating patients with HFrEF with SGLT. -2 inhibitors, showing a 30% reduction in recurrence of coronary heart disease.This is a major improvement in the reduction deaths in this vulnerable population, ”said Biykem Bozkurt, MD, Ph.D., vice-president of the writing committee.

Medications for people with HFrEF include four different types of medications, in addition to diuretics, which are recommended for patients with dehydration. The use of angiotensin-neprilysin (ARNi) receptor antagonists is recommended, and if this is not possible, the use of ACEi is recommended. ARBs are recommended for people who are intolerant or potentially allergic to ACEi drugs. Mineralocorticoid antagonists (MRA) or beta blockers are also recommended as in the previous guide. SGLT2i is now recommended for people with chronic HFrEF symptoms regardless of the presence of type 2 diabetes.

People with HFmrEF or those with LVEF 41-49% should first be treated with SGLT2i with diuretics as needed. ARNi, ACEi, ARB, MRA and beta blockers are considered weak recommendations in this population, because the evidence in this population is weak. As LVEF may change over time, people with HFmrEF should experience a recurrence of LVEF.

People with HFpEF and high blood pressure should aim for high blood pressure according to clinical guidelines. For people with HFpEF, SGLT2i may be useful in reducing HF hospitalizations and cardiac death. Management of atrial fibrillation may improve symptoms. In selected individuals with HFpEF, MRAs, ARBs and ARNi may be considered, especially among individuals with LVEF at the lower end of the HFpEF spectrum.

The guide also includes recommendations for implanted cardiac devices and treatment of cardiac revascularization, diagnosis and management of cardiac amyloidosis, special counsel for people with stage D development HF, recommendations for the management of atrial fibrillation. valvular heart disease in HF and cardio-oncology.

This new heart attack theory replaces the 2013 ACCF / AHA Guide for Cardiovascular Management and the 2017 ACC / AHA / HFSA Focus 2013 ACCF / AHA Guide to Managing Heart Failure. The guide aims at all physicians involved in the treatment of people with heart disease with or without heart failure.

“Guideline 2022 AHA / ACC / HFSA for the Management of Heart Disease” will be published simultaneously in Journal of the American Academy of Cardiologynewspaper Round and Heart Failure Journal.


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Learn more:
Guide to AHA / ACC / HFSA 2022 for the Management of Heart Disease, Journal of the American Academy of Cardiology (2022). DOI: 10.1016 / j.jacc.2021.12.012

hint: ACC, AHA, HFSA Heart Attack Guide (2022, April 1) Retrieved 1 April 2022 from https://medicalxpress.com/news/2022-04-acc-aha-hfsa-issue-heart.html

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