Congestive heart failure with preserved EF pharmacotherapy: Difference between revisions

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(/* 2021 European Society of Cardiology Guidelines (DO NOT EDIT) {{cite journal |vauthors=McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A |title=2021 ESC Guidelines for the d...)
(/* 2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) {{cite journal| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM | display-authors=etal| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2022 | volume= 145 | issue= 18 | pages= e876-e894 | pmid=35363500 | doi=10.1161/C...)
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== 2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) <ref name="pmid35363500">{{cite journal| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM | display-authors=etal| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2022 | volume= 145 | issue= 18 | pages= e876-e894 | pmid=35363500 | doi=10.1161/CIR.0000000000001062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500  }} </ref>===
=== 2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) <ref name="pmid35363500">{{cite journal| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM | display-authors=etal| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2022 | volume= 145 | issue= 18 | pages= e876-e894 | pmid=35363500 | doi=10.1161/CIR.0000000000001062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500  }} </ref>====


===[[Treatment]] of [[Patients]] with [[HF]] and preserved ejection fraction [[diastolic dysfunction|HFpEF]] (DO NOT EDIT) <ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref>===
====[[Treatment]] of [[Patients]] with [[HF]] and preserved ejection fraction [[diastolic dysfunction|HFpEF]] (DO NOT EDIT) <ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref>====


====[[HF]] With Preserved [[Ejection Fraction]]====
=====[[HF]] With Preserved [[Ejection Fraction]]=====


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Revision as of 20:15, 22 June 2022

Congestive Heart Failure Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Systolic Dysfunction
Diastolic Dysfunction
HFpEF
HFrEF

Causes

Differentiating Congestive heart failure from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Clinical Assessment

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

Cardiac MRI

Echocardiography

Exercise Stress Test

Myocardial Viability Studies

Cardiac Catheterization

Other Imaging Studies

Other Diagnostic Studies

Treatment

Invasive Hemodynamic Monitoring

Medical Therapy:

Summary
Acute Pharmacotherapy
Chronic Pharmacotherapy in HFpEF
Chronic Pharmacotherapy in HFrEF
Diuretics
ACE Inhibitors
Angiotensin receptor blockers
Aldosterone Antagonists
Beta Blockers
Ca Channel Blockers
Nitrates
Hydralazine
Positive Inotropics
Anticoagulants
Angiotensin Receptor-Neprilysin Inhibitor
Antiarrhythmic Drugs
Nutritional Supplements
Hormonal Therapies
Drugs to Avoid
Drug Interactions
Treatment of underlying causes
Associated conditions

Exercise Training

Surgical Therapy:

Biventricular Pacing or Cardiac Resynchronization Therapy (CRT)
Implantation of Intracardiac Defibrillator
Ultrafiltration
Cardiac Surgery
Left Ventricular Assist Devices (LVADs)
Cardiac Transplantation

ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
Patients with current or prior symptoms of heart failure (Stage C)
Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
Quality Metrics/Performance Measures

Implementation of Practice Guidelines

Congestive heart failure end-of-life considerations

Specific Groups:

Special Populations
Patients who have concomitant disorders
Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

Congestive heart failure with preserved EF pharmacotherapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Congestive heart failure with preserved EF pharmacotherapy

CDC on Congestive heart failure with preserved EF pharmacotherapy

Congestive heart failure with preserved EF pharmacotherapy in the news

Blogs on Congestive heart failure with preserved EF pharmacotherapy

Directions to Hospitals Treating Congestive heart failure with preserved EF pharmacotherapy

Risk calculators and risk factors for Congestive heart failure with preserved EF pharmacotherapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Seyedmahdi Pahlavani, M.D. [3]

Overview

Heart failure has been divided into three subgroups including heart failure reduced ejection fraction, heart failure mildly reduced EF, heart failure preserved EF. HFrEF is defined when LVEF≤ 40% and significant LV systolic dysfunction. Patients with a LVEF between 41% and 49% have mildly reduced LV systolic function or HFmrEF. Patients with ejection fractions between 40-50% may benefit from similar therapies to those with LVEF≤ 40%. HFpEF is explained in the presence of symptoms and signs of HF, and evidence of structural and/or functional cardiac abnormalities and/or raised natriuretic peptides (NPs), and LVEF≥ 50%. Patients with non-cardiovascular disease including anaemia, pulmonary, renal, thyroid, or hepatic disease may mimic symptoms and signs of HF, but in the absence of cardiac dysfunction, they are not diagnosed for HF. Neverthless, these disorders can coexist with HF and exacerbate the HF syndrome.

Heart failure mildly reduced ejection fraction (HPmrEF), EF (41-49%)

The diagnosis of heart failure with mildly reduced ejection fraction

Clinical characteristics

Treatment

Angiotensin-converting enzyme inhibitors

Angiotensin receptor II type 1 receptor blockers

Beta-blockers

Mineralocorticoid receptor antagonists

Angiotensin receptor-neprilysin inhibitor

Other drugs

Devices

2021 European Society of Cardiology Guidelines (DO NOT EDIT) [4]

Medications indicated in patients with New York Heart Association (NYHA class II–IV) HFmrEF (heart failure with mildly reduced ejection fraction) (LVEF41-49%)

Recommedation for patients with NYHA class 2-4 heart failure with mildly reduced ejection fraction
Diuretics (Class I, Level of Evidence C):

Diuretics are recommended in patients with congestion and HFmrEF in order reduce symptoms and signs

ACEI (Class IIb, Level of Evidence C):

ACE-I may be considered for patients with HFmrEF to reduce the risk of HF hospitalization and death
ARB may be indicated for patients with HFmrEF to reduce the risk of HF hospitalization and death
Beta-blocker may be considered for patients with HFmrEF to reduce the risk of HF hospitalization and death,
MRA may be considered for patients with HFmrEF to reduce the risk of HF hospitalization and death
Sacubitril/valsartan may be considered for patients with HFmrEF to reduce the risk of HF hospitalization and death

Heart failure preserved ejection fraction (HFpEF)

Clinical characteristics

The diagnosis of heart failure preserved ejection fraction

  • Echocardiographic criteria:
  • LA size (LA volume index >32 mL/m2)
  • Mitral E velocity <90 cm/s
  • Septal e' velocity <9 cm/s
  • E/e' ratio >9
    The diagnosis is made when there are the following:

(1) Symptoms and signs of HF
(2) An LVEF ≥ 50%
(3) Evidence of cardiac structural and/or functional abnormalities consistent with the presence of LV diastolic dysfunction/ raised LV filling pressures, including raised NPs

  • In the presence of AF, the threshold for LA volume index is >40 mL/m2
  • Exercise stress thresholds include E/e' ratio at peak stress ≥ 15 or tricuspid regurgitation (TR) velocity at peak stress >3.4 m/s
  • LV global longitudinal strain <16%

2021 European Society of Cardiology Guidelines (DO NOT EDIT) [4]

Recommedation for treatment of patients with HFpEF (heart failure preserved ejection fraction)
(Class I, Level of Evidence C):

❑ Screening, treatment, investigation about underlying etiologies, and cardiovascular and non-cardiovascular comorbidities is recommended in patients with HFpEF
Diuretics are recommended in congested patients with HFpEF to improve symptoms and signs

2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) [8]=

Treatment of Patients with HF and preserved ejection fraction HFpEF (DO NOT EDIT) [9]

HF With Preserved Ejection Fraction
Class I
"1. Patients with HFpEF and hypertension should have medication titrated to attain blood pressure targets in accordance with published clinical practice guidelines to prevent morbidity. [10][11][12] (Level of Evidence: C-LD) "
Class IIa
"2. In patients with HFpEF, SGLT2i can be beneficial in decreasing HF hospitalizations and cardiovascular mortality. [13] (Level of Evidence:B-R) "
"3. In patients with HFpEF, management of AF can be useful to improve symptoms. (Level of Evidence: C-EO) "
Class IIb
"4. In selected patients with HFpEF, MRAs may be considered to decrease hospitalizations, particularly among patients with LVEF on the lower end of this spectrum. [14][15][16] (Level of Evidence:B-R) "
"5. In selected patients with HFpEF, the use of ARB may be considered to decrease hospitalizations, particularly among patients with LVEF on the lower end of this spectrum. [2][17](Level of Evidence: B-R) "
"6. In selected patients with HFpEF, ARNi may be considered to decrease hospitalizations, particularly among patients with LVEF on the lower end of this spectrum. [18][19](Level of Evidence: B-R) "
Class III (No Benefit)
"7. In patients with HFpEF, routine use of nitrates or phosphodiesterase-5 inhibitors to increase activity or QOL is ineffective. [20][21] (Level of Evidence:B-R) "

References

  1. Tsuji K, Sakata Y, Nochioka K, Miura M, Yamauchi T, Onose T, Abe R, Oikawa T, Kasahara S, Sato M, Shiroto T, Takahashi J, Miyata S, Shimokawa H (October 2017). "Characterization of heart failure patients with mid-range left ventricular ejection fraction-a report from the CHART-2 Study". Eur J Heart Fail. 19 (10): 1258–1269. doi:10.1002/ejhf.807. PMID 28370829.
  2. 2.0 2.1 Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, Michelson EL, Olofsson B, Ostergren J (September 2003). "Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial". Lancet. 362 (9386): 777–81. doi:10.1016/S0140-6736(03)14285-7. PMID 13678871.
  3. Flather MD, Shibata MC, Coats AJ, Van Veldhuisen DJ, Parkhomenko A, Borbola J, Cohen-Solal A, Dumitrascu D, Ferrari R, Lechat P, Soler-Soler J, Tavazzi L, Spinarova L, Toman J, Böhm M, Anker SD, Thompson SG, Poole-Wilson PA (February 2005). "Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS)". Eur Heart J. 26 (3): 215–25. doi:10.1093/eurheartj/ehi115. PMID 15642700.
  4. 4.0 4.1 McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland J, Coats A, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam C, Lyon AR, McMurray J, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano G, Ruschitzka F, Kathrine Skibelund A (September 2021). "2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure". Eur Heart J. 42 (36): 3599–3726. doi:10.1093/eurheartj/ehab368. PMID 34447992 Check |pmid= value (help). Vancouver style error: initials (help)
  5. Borlaug BA (September 2020). "Evaluation and management of heart failure with preserved ejection fraction". Nat Rev Cardiol. 17 (9): 559–573. doi:10.1038/s41569-020-0363-2. PMID 32231333 Check |pmid= value (help).
  6. Barandiarán Aizpurua A, Sanders-van Wijk S, Brunner-La Rocca HP, Henkens M, Heymans S, Beussink-Nelson L, Shah SJ, van Empel V (March 2020). "Validation of the HFA-PEFF score for the diagnosis of heart failure with preserved ejection fraction". Eur J Heart Fail. 22 (3): 413–421. doi:10.1002/ejhf.1614. PMID 31472035. Vancouver style error: initials (help)
  7. Ho JE, Zern EK, Wooster L, Bailey CS, Cunningham T, Eisman AS, Hardin KM, Zampierollo GA, Jarolim P, Pappagianopoulos PP, Malhotra R, Nayor M, Lewis GD (July 2019). "Differential Clinical Profiles, Exercise Responses, and Outcomes Associated With Existing HFpEF Definitions". Circulation. 140 (5): 353–365. doi:10.1161/CIRCULATIONAHA.118.039136. PMID 31132875.
  8. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM; et al. (2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (18): e876–e894. doi:10.1161/CIR.0000000000001062. PMID 35363500 Check |pmid= value (help).
  9. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202
  10. Thomopoulos C, Parati G, Zanchetti A (2016). "Effects of blood-pressure-lowering treatment in hypertension: 9. Discontinuations for adverse events attributed to different classes of antihypertensive drugs: meta-analyses of randomized trials". J Hypertens. 34 (10): 1921–32. doi:10.1097/HJH.0000000000001052. PMID 27454050.
  11. Williamson JD, Supiano MA, Applegate WB, Berlowitz DR, Campbell RC, Chertow GM; et al. (2016). "Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial". JAMA. 315 (24): 2673–82. doi:10.1001/jama.2016.7050. PMC 4988796. PMID 27195814. Review in: Ann Intern Med. 2016 Aug 16;165(4):JC14 Review in: Evid Based Med. 2017 Mar;22(1):30
  12. SPRINT Research Group. Wright JT, Williamson JD, Whelton PK, Snyder JK, Sink KM; et al. (2015). "A Randomized Trial of Intensive versus Standard Blood-Pressure Control". N Engl J Med. 373 (22): 2103–16. doi:10.1056/NEJMoa1511939. PMC 4689591. PMID 26551272. Review in: Ann Intern Med. 2016 Feb 16;164(4):JC15 Review in: Evid Based Med. 2016 Jun;21(3):101
  13. Anker SD, Butler J, Filippatos G, Ferreira JP, Bocchi E, Böhm M; et al. (2021). "Empagliflozin in Heart Failure with a Preserved Ejection Fraction". N Engl J Med. 385 (16): 1451–1461. doi:10.1056/NEJMoa2107038. PMID 34449189 Check |pmid= value (help). Review in: Ann Intern Med. 2022 Jan;175(1):JC4
  14. Pitt B, Pfeffer MA, Assmann SF, Boineau R, Anand IS, Claggett B; et al. (2014). "Spironolactone for heart failure with preserved ejection fraction". N Engl J Med. 370 (15): 1383–92. doi:10.1056/NEJMoa1313731. PMID 24716680. Review in: Ann Intern Med. 2014 Oct 21;161(8):JC6
  15. Pfeffer MA, Claggett B, Assmann SF, Boineau R, Anand IS, Clausell N; et al. (2015). "Regional variation in patients and outcomes in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial". Circulation. 131 (1): 34–42. doi:10.1161/CIRCULATIONAHA.114.013255. PMID 25406305.
  16. Solomon SD, Claggett B, Desai AS, Packer M, Zile M, Swedberg K; et al. (2016). "Influence of Ejection Fraction on Outcomes and Efficacy of Sacubitril/Valsartan (LCZ696) in Heart Failure with Reduced Ejection Fraction: The Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) Trial". Circ Heart Fail. 9 (3): e002744. doi:10.1161/CIRCHEARTFAILURE.115.002744. PMID 26915374.
  17. Lund LH, Claggett B, Liu J, Lam CS, Jhund PS, Rosano GM; et al. (2018). "Heart failure with mid-range ejection fraction in CHARM: characteristics, outcomes and effect of candesartan across the entire ejection fraction spectrum". Eur J Heart Fail. 20 (8): 1230–1239. doi:10.1002/ejhf.1149. PMID 29431256.
  18. Solomon SD, McMurray JJV, Anand IS, Ge J, Lam CSP, Maggioni AP; et al. (2019). "Angiotensin-Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction". N Engl J Med. 381 (17): 1609–1620. doi:10.1056/NEJMoa1908655. PMID 31475794.
  19. Solomon SD, Vaduganathan M, L Claggett B, Packer M, Zile M, Swedberg K; et al. (2020). "Sacubitril/Valsartan Across the Spectrum of Ejection Fraction in Heart Failure". Circulation. 141 (5): 352–361. doi:10.1161/CIRCULATIONAHA.119.044586. PMID 31736342. Review in: Ann Intern Med. 2020 Jun 16;172(12):JC65
  20. Redfield MM, Anstrom KJ, Levine JA, Koepp GA, Borlaug BA, Chen HH; et al. (2015). "Isosorbide Mononitrate in Heart Failure with Preserved Ejection Fraction". N Engl J Med. 373 (24): 2314–24. doi:10.1056/NEJMoa1510774. PMC 4712067. PMID 26549714.
  21. Redfield MM, Chen HH, Borlaug BA, Semigran MJ, Lee KL, Lewis G; et al. (2013). "Effect of phosphodiesterase-5 inhibition on exercise capacity and clinical status in heart failure with preserved ejection fraction: a randomized clinical trial". JAMA. 309 (12): 1268–77. doi:10.1001/jama.2013.2024. PMC 3835156. PMID 23478662.

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