Congestive heart failure treatment of associated conditions

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Pathophysiology

Systolic Dysfunction
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HFpEF
HFrEF

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Differentiating Congestive heart failure from other Diseases

Epidemiology and Demographics

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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

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Risk calculators and risk factors for Congestive heart failure treatment of associated conditions

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Arzu Kalayci, M.D. [2]

Overview

Congestive heart failure can be associated with and exacerbated by rapid supraventricular as well as atrial fibrillation, ventricular arrhythmias, venous thromboembolism, renal insufficiency, and anemia.

2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure [1]

Anemia

Class III (No Benefit)

1. In patients with HF and anemia, erythropoietin- stimulating agents should not be used to improve morbidity and mortality. (Class III, Level of Evidence: B-R)

Class IIb

1. In patients with NYHA class II and III HF and iron deficiency (ferritin <100 ng/mL or 100 to 300 ng/mL if transferrin saturation is <20%), intravenous iron replacement might be reasonable to improve functional status and QoL. (Class IIb, Level of Evidence: B-R)

Atrial Fibrillation

Class IIa

1. Management of AF according to published clinical practice guidelines in patients with HFpEF is reasonable to improve symptomatic HF. (Class IIa, Level of Evidence: C)

Diabetes Mellitus

Class I

1. For patients with diabetes mellitus (who are all at high risk for developing HF), blood sugar should be controlled in accordance with contemporary guidelines. (Class I, Level of Evidence: C)

Class IIa

1. ACE inhibitors can be useful to prevent HF in patients at high risk for developing HF who have a history of atherosclerotic vascular disease, diabetes mellitus, or hypertension with associated cardiovascular risk factors. (Class IIa, Level of Evidence: A)

2. ARBs can be useful to prevent HF in patients at high risk for developing HF who have a history of atherosclerotic vascular disease, diabetes mellitus, or hypertension with associated cardiovascular risk factors. (Class IIa, Level of Evidence: B)

Hyperlipidemia

Class I

1. In patients with a recent or remote history of MI or acute coronary syndrome, statins should be used to prevent cardiovascular events. (Class I, Level of Evidence: A)

Class III (No Benefit)

1. Statins are not beneficial as adjunctive therapy when prescribed solely for the diagnosis of HF in the absence of other indications, and routine use of statins for the treatment of HF is not indicated outside of current practice guidelines for the primary and secondary preven- tion of atherosclerotic vascular disease. (Class III, Level of Evidence: A)

Class IIa

1. PUFA supplementation is reasonable to use as adjunctive therapy in patients with NYHA class II to IV symptoms and HFrEF or HFpEF, unless contraindicated, to reduce mortality and cardiovascular hospitalizations. (Class IIa, Level of Evidence: B)

Class IIa

1. Lipid disorders should be controlled in accor- dance with contemporary guidelines. (Class IIa, Level of Evidence: B)

Obesity

Class I

1. Obesity should be controlled or avoided to prevent the development of HF along with other CVDs. (Class I, Level of Evidence: C)

Class III (Harm)

1. Sibutramine or ephedra weight loss preparations are contraindicated in HF. Use of ephedra weight-loss preparations may contribute to the development of HF and should be avoided. (Class III, Level of Evidence: C)

Class IIb

1. Purposeful weight loss via healthy dietary intervention or physical activity for the purposes of improving health-related QOL or managing comorbidities such as diabetes mellitus, hypertension, or sleep apnea may be reasonable in obese patients with HF.. (Class IIb, Level of Evidence: C)

Sleep Disorders

Class III (Harm)

1. In patients with NYHA class II–IV HFrEF and central sleep apnea, adaptive servo-ventilation causes harm. (Class III, Level of Evidence: B-R)

Class IIa

1. In patients with NYHA class II–IV HF and suspicion of sleep-disordered breathing or excessive daytime sleepiness, a formal sleep assessment is reasonable. (Class IIa, Level of Evidence: C-LD)

Class IIb

1. In patients with cardiovascular disease and obstructive sleep apnea, CPAP may be reasonable to improve sleep quality and daytime sleepiness. (Class IIb, Level of Evidence: B-R)

References

  1. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM, Drazner MH, Filippatos GS, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN, Stevenson LW, Westlake C (2017). "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America". J. Am. Coll. Cardiol. 70 (6): 776–803. doi:10.1016/j.jacc.2017.04.025. PMID 28461007.



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