Congestive heart failure treatment of patients who have concomitant disorders

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Congestive Heart Failure Microchapters

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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

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2] ;Edzel Lorraine Co, D.M.D., M.D. [3]


2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) [1]

COMORBIDITIES IN PATIENTS WITH HF (DO NOT EDIT) [1]

Management of Comorbidities in Patients With HF (DO NOT EDIT) [1]

Management of Anemia or Iron Deficiency

Class IIa
"1. In patients with HFrEF and iron deficiency with or without anemia, intravenous iron replacement is reasonable to improve functional status and QOL. [2][3][4][5](Level of Evidence: B-R) "
Class III (Harm)
"2. In patients with HF and anemia, erythropoeitin-stimulating agents should not be used to improve morbidity and mortality. [6][7](Level of Evidence: B-R) "

Management of Hypertension

Class I
"1. In patients with HFrEF and hypertension, uptitration of GDMT to the maximally tolerated target dose is recommended. [8][9](Level of Evidence: C-LD) "

Management of Diabetes

Class I
"1. In patients with HF and type 2 diabetes, the use of SGLT2i is recommended for the management of hyperglycemia and to reduce HF-related morbidity and mortality. [10][11][12][13] (Level of Evidence: A) "

Vote on and Suggest Revisions to the Current Guidelines

Sources

References

  1. 1.0 1.1 1.2 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).
  2. Anker SD, Comin Colet J, Filippatos G, Willenheimer R, Dickstein K, Drexler H; et al. (2009). "Ferric carboxymaltose in patients with heart failure and iron deficiency". N Engl J Med. 361 (25): 2436–48. doi:10.1056/NEJMoa0908355. PMID 19920054. Review in: Ann Intern Med. 2010 Apr 20;152(8):JC4-5
  3. Ponikowski P, van Veldhuisen DJ, Comin-Colet J, Ertl G, Komajda M, Mareev V; et al. (2015). "Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency†". Eur Heart J. 36 (11): 657–68. doi:10.1093/eurheartj/ehu385. PMC 4359359. PMID 25176939.
  4. Beck-da-Silva L, Piardi D, Soder S, Rohde LE, Pereira-Barretto AC, de Albuquerque D; et al. (2013). "IRON-HF study: a randomized trial to assess the effects of iron in heart failure patients with anemia". Int J Cardiol. 168 (4): 3439–42. doi:10.1016/j.ijcard.2013.04.181. PMID 23680589.
  5. Ponikowski P, Kirwan BA, Anker SD, McDonagh T, Dorobantu M, Drozdz J; et al. (2020). "Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, controlled trial". Lancet. 396 (10266): 1895–1904. doi:10.1016/S0140-6736(20)32339-4. PMID 33197395 Check |pmid= value (help). Review in: Ann Intern Med. 2021 Apr;174(4):JC45
  6. Swedberg K, Young JB, Anand IS, Cheng S, Desai AS, Diaz R; et al. (2013). "Treatment of anemia with darbepoetin alfa in systolic heart failure". N Engl J Med. 368 (13): 1210–9. doi:10.1056/NEJMoa1214865. PMID 23473338.
  7. Kang J, Park J, Lee JM, Park JJ, Choi DJ (2016). "The effects of erythropoiesis stimulating therapy for anemia in chronic heart failure: A meta-analysis of randomized clinical trials". Int J Cardiol. 218: 12–22. doi:10.1016/j.ijcard.2016.04.187. PMID 27209352.
  8. Banach M, Bhatia V, Feller MA, Mujib M, Desai RV, Ahmed MI; et al. (2011). "Relation of baseline systolic blood pressure and long-term outcomes in ambulatory patients with chronic mild to moderate heart failure". Am J Cardiol. 107 (8): 1208–14. doi:10.1016/j.amjcard.2010.12.020. PMC 3072746. PMID 21296319.
  9. Lee TT, Chen J, Cohen DJ, Tsao L (2006). "The association between blood pressure and mortality in patients with heart failure". Am Heart J. 151 (1): 76–83. doi:10.1016/j.ahj.2005.03.009. PMID 16368295.
  10. Zannad F, Ferreira JP, Pocock SJ, Anker SD, Butler J, Filippatos G; et al. (2020). "SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials". Lancet. 396 (10254): 819–829. doi:10.1016/S0140-6736(20)31824-9. PMID 32877652 Check |pmid= value (help).
  11. Kato ET, Silverman MG, Mosenzon O, Zelniker TA, Cahn A, Furtado RHM; et al. (2019). "Effect of Dapagliflozin on Heart Failure and Mortality in Type 2 Diabetes Mellitus". Circulation. 139 (22): 2528–2536. doi:10.1161/CIRCULATIONAHA.119.040130. PMID 30882238.
  12. McMurray JJV, Solomon SD, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA; et al. (2019). "Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction". N Engl J Med. 381 (21): 1995–2008. doi:10.1056/NEJMoa1911303. PMID 31535829. Review in: Ann Intern Med. 2020 Feb 18;172(4):JC16
  13. Packer M, Anker SD, Butler J, Filippatos G, Pocock SJ, Carson P; et al. (2020). "Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure". N Engl J Med. 383 (15): 1413–1424. doi:10.1056/NEJMoa2022190. PMID 32865377 Check |pmid= value (help). Review in: Ann Intern Med. 2020 Nov 17;173(10):JC51
  14. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW (May 2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (18): e895–e1032. doi:10.1161/CIR.0000000000001063. PMID 35363499 Check |pmid= value (help).
  15. Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 119 (14):1977-2016. DOI:10.1161/CIRCULATIONAHA.109.192064 PMID: 19324967
  16. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG et al. (2005) 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 112 (12):e154-235. DOI:10.1161/CIRCULATIONAHA.105.167586 PMID: 16160202

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