According to the Centers for Disease Control (CDC), nearly 6.7 million adults aged 20 years or older in the United States are affected by heart failure. In 2022, heart failure accounted for 13.9% of all causes of mortality. Heart failure is a serious condition with no known cure, but various treatments such as healthy lifestyle changes, medications, devices, and procedures can significantly improve the quality of life for many individuals. Emphasizing the importance of clinical guidelines and recommendations that advocate for best practices among healthcare professionals is crucial.
In August, the American College of Cardiology (ACC) Solution Set Oversight Committee released an Expert Consensus Decision Pathway (ECDP) on Patients Hospitalized With Heart Failure. This updated version builds upon the 2019 edition, which can be found here.
The primary objective of this Expert Consensus Decision Pathway (ECDP) is to align with the most recent 2022 ACC/American Heart Association (AHA)/Heart Failure Society of American (HFSA) Heart Failure Guideline and also with the ECDP documents concerning optimization of therapy in chronic heart failure with reduced ejection fraction (HFrEF) and chronic heart failure with preserved ejection fraction (HFpEF).
In this discussion, we will delve into the key takeaways and insights surrounding the guideline’s recommendations for patients hospitalized with heart failure. Please note that this list does not encompass all major points. For a complete list of recommendations, refer to the full text guideline on the ACC website located here. Now, let’s begin!
Key Takeaways and Recommendations:
Guideline-Directed Medical Therapy (GDMT):
Emphasis on establishing all four pillars of GDMT for heart failure with reduced ejection fraction (HFrEF) during hospitalization, with appropriate follow-up to monitor tolerance and continue titration.
Clinical trajectories in HFrEF patients are primarily determined by the pace and extent of decongestion and hemodynamics. For inpatients who are responding well to diuresis and are hemodynamically stable, GDMT should be up-titrated as tolerated, with the goal of implementing all four components of GDMT for HFrEF. It is important to evaluate and address comorbidities, accelerate discharge planning, and continue IV diuretic agents until optimal decongestion is achieved. Patients should then transition to the oral dose estimated for maintenance.
In summary, the focus should be on establishing GDMT for HFrEF during hospitalization, monitoring tolerance, and continuing titration to optimize patient outcomes. Comorbidities should be addressed, and discharge planning should be expedited to ensure a smooth transition to maintenance therapy.
SGLT Inhibitors:
This update highlights the importance of incorporating SGLT inhibitor therapy throughout hospitalization, regardless of LVEF, and places a strong emphasis on initiating the other key components of therapy for HFrEF after stabilization.
Both SGLT inhibitors and mineralocorticoid antagonists have shown limited impact on reducing pressure. However, in the absence of contraindications, they can be started at any point during hospitalization and continued upon discharge if deemed appropriate.
There is substantial evidence supporting the use of SGLT inhibitors to further decrease morbidity and mortality in patients with chronic HF, regardless of their LVEF or whether they have type 2 diabetes mellitus (T2DM). It is now recommended to start or continue the use of SGLT inhibitors in the hospital setting for patients admitted with acute decompensated HF.
Strategies for Decongestion:
Updated guidance on diuretic and adjunctive therapy, including alternative agents and dosing strategies based on new data, are essential for achieving effective decongestant in patients. Establishing a proper diuretic regimen is important for optimal outcomes and early and effective use of diuretics is key for congestion management.
Neurohormonal Modulators:
Recommendations for optimizing therapies, such as beta-blockers and ARNI/ACE inhibitors/ARBs, should take into account factors such as previous tolerance, current hemodynamics, and kidney function.
Management Strategies:
Patient-Centered Care which emphasizes the importance of shared decision-making and tailoring treatment plans to align with patient preferences and values.
Multidisciplinary Approach which recognizes the value of a team-based approach involving cardiologists, nurses, pharmacists, and social workers. This collaborative effort ensures comprehensive care and enhances patient outcomes.
Additionally, Post-Hospitalization Management is vital for monitoring and managing heart failure after discharge. Utilizing telehealth and home health services can be beneficial in providing ongoing support and intervention as needed.
By incorporating these strategies into practice, the aim is for healthcare providers to deliver high-quality care that is personalized, comprehensive, and effective in managing heart failure.
These updates aim to improve the management and outcomes of patients hospitalized with heart failure by integrating the latest evidence and harmonizing with recent guidelines and ECDPs. These points aim to improve outcomes and streamline care for patients with heart failure, focusing on both immediate management and long-term health trajectory. For the most detailed and specific recommendations, it’s best to refer directly to the consensus documents.
Thank you for joining us for our Guidelines Spotlight on patients hospitalized with heart failure. We welcome your thoughts and feedback as we strive to bring you valuable insights in our upcoming spotlights.
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