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ACC, AHA release guideline for treating heart failure

Wednesday June 5, 2013
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The American College of Cardiology and the American Heart Association have released an expanded clinical practice guideline for the management of patients with heart failure.

The guideline updates definitions and classifications for heart failure and increases emphasis on patient-centric outcomes such as quality of life, shared decision making, care coordination, transitions and palliative care.

Approximately 5.1 million Americans have clinically manifested heart failure, according to a news release. More than 670,000 cases are diagnosed annually and result in more than $30 billion of total healthcare costs.

Designed to assist clinicians in selecting the best management strategy for individual patients, the guideline provides expert analysis of data on prevention, diagnosis, risk stratification and treatment. Where data are lacking, evidence gaps are highlighted in the document.

Improving care quality, optimizing patient outcomes and favorably affecting the efficient use of healthcare resources are all goals of the guideline, which 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.

The guideline covers the full trajectory of both inpatient and outpatient care for patients with heart failure, from the initial evaluation through treatment stages A-D, including palliative care, and highlights quality improvement and optimal adherence to performance measures.

Specific diagnostic strategies addressed included laboratory diagnostic tests, noninvasive cardiac imaging, invasive evaluation and detailed family histories with consideration for genetic screening, where applicable. The full range of treatment interventions including diuretics, ACE inhibitors, angiotensin-receptor blockers, beta blockers, statins, device therapy, mechanical circulatory support systems, cardiac transplantation and surgical/percutaneous/transcatheter interventions were considered.

According to writing committee chair Clyde W. Yancy, MD, MSc, professor of medicine and chief of cardiology at Northwestern Universityís Feinberg School of Medicine, highlights of the 2013 guideline include updated definitions and classifications for heart failure, a more focused approach to dilated cardiomyopathies, critical new indications for aldosterone antagonists and important new considerations for more discriminant use of cardiac resynchronization device therapy.

The document also discusses greater adherence to performance measures and quality measures (with timely recommendations to reduce readmissions) and places an even greater emphasis on patient-centric outcomes, such as quality-of-life issues, shared decision making, care coordination, transition of care and palliative care.

The 2013 Heart Failure Guideline is described as a thorough reassessment of heart failure diagnosis and management that goes beyond the 2005 guideline and 2009 update. The guideline is among the first ACC/AHA guidance documents to utilize the new designation for optimal treatment. Termed "guideline-directed medical therapy," this new designation allows clinicians to easily determine the specific course of care deemed most important in the management of heart failure.

Yancy noted this important call-out of GDMT should be especially helpful for primary care physicians and physician extenders involved in the care of patients with heart failure. "Amongst the many treatment recommendations in this guideline addressing care, the unambiguous nature of 'GDMTí emphasizes what works best and should be widely deployed," he said in the news release.

Read the guidelines: http://content.onlinejacc.org/article.aspx?articleid=1695825.


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