Title
Clinical Assessment, Management, and Trajectory of Patients Hospitalized With Heart Failure
Authoring Organization
Publication Month/Year
August 8, 2024
Last Updated Month/Year
August 27, 2024
Supplemental Implementation Tools
Document Type
Consensus
Country of Publication
US
Document Objectives
This update focuses on modifications of the original figures dealing with initiation and titration of therapy. Characteristics of patients hospitalized for HF often differ from populations enrolled in outpatient trials, and thus strategies for initiation of GDMT may need to be adapted in these patients. A new figure describes titration strategies in patients with different presentations. Patients may have a new HFrEF diagnosis, in which case initiation of all 4 pillars of GDMT should be attempted. Patients with chronic HF on partial GDMT should receive personalized therapy to fill in gaps, considering a switch from an ACE inhibitor/ARB to ARNI, if appropriate. Caution is required for patients with chronic Class IV HFrEF with decompensated HF, some of whom may not tolerate neurohormonal antagonists, even in low doses. The description of management strategies in patients with different short-term clinical trajectories in the hospital has also been updated.
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Hospital
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Management
Diseases/Conditions (MeSH)
D006333 - Heart Failure
Keywords
heart failure
Source Citation
Maddox TM, Januzzi JL Jr, Allen LA, Breathett K, Brouse S, Butler J, Davis LL, Fonarow GC, Ibrahim NE, Lindenfeld J, Masoudi FA, Motiwala SR, Oliveros E, Walsh MN, Wasserman A, Yancy CW, Youmans QR. 2024 ACC Expert Consensus Decision Pathway for Treatment of Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2024 Apr 16;83(15):1444-1488. doi: 10.1016/j.jacc.2023.12.024. Epub 2024 Mar 8. PMID: 38466244.