AHA and ACC update heart failure guidelines

New and revised recommendations on the treatment of heart failure were released last week jointly by the American College of Cardiology Foundation and American Heart Association.

The 2013 joint guideline updates definitions and classifications for heart failure, with recommendations on all steps of care from initial evaluation, including testing and risk scoring, to outpatient, inpatient and interventional treatment. It increases emphasis on patient-centric outcomes such as quality of life, shared decision making, care coordination, transitions and palliative care.

Changes were made in recommendations on heart failure with preserved ejection fraction, inpatient care and stage D heart failure, among other issues. The guideline also provides new advice on the best approach to dilated cardiomyopathies, expanded use of aldosterone antagonism and more discriminate use of cardiac resynchronization therapy. The document also discusses performance measures and quality measures, including some recommendations to reduce readmissions.

The guideline includes tables of recommendations, classified by their level of evidence support, and a new designation of certain treatments as guideline-directed medical therapy or GDMT.

The document was developed in collaboration with the American Academy of Family Physicians, American College of Chest Physicians, Heart Rhythm Society, and the International Society for Heart and Lung Transplantation and was published online by the Journal of the American College of Cardiology and appeared in Circulation on June 5.