Congestive heart failure Treatment of associated conditions: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
(Created page with "__NOTOC__ {| class="infobox" style="float:right;" |- | 30px|link= Congestive heart failure resident survival guide|| <br> || <br> | Acute decompensated he...")
 
No edit summary
 
Line 4: Line 4:
| [[File:Siren.gif|30px|link= Congestive heart failure resident survival guide]]|| <br> || <br>
| [[File:Siren.gif|30px|link= Congestive heart failure resident survival guide]]|| <br> || <br>
| [[Acute decompensated heart failure resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
| [[Acute decompensated heart failure resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
|}
{| class="infobox" style="float:right;"
|-
| [[File:Critical_Pathways.gif|88px|link= Congestive heart failure critical pathways]]|| <br> || <br>
|}
|}
{{Congestive heart failure}}
{{Congestive heart failure}}
{{CMG}}
{{CMG}}; {{AE}} {{AKK}}


==Overview==
==Overview==
Treatment of the underlying cause of heart failure including [[ischemic heart disease]], [[hypertension]], renovascular disease, or [[valvular heart disease]] is critical in the management of the patient with congestive heart failure.
[[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 <ref name="pmid28461007">{{cite journal |vauthors=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 |title=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 |journal=[[J. Am. Coll. Cardiol.]] |volume=70 |issue=6 |pages=776–803 |year=2017 |pmid=28461007 |doi=10.1016/j.jacc.2017.04.025 |url=}}</ref>==


==Ischemic Heart Disease==
===Anemia===
Underlying ischemic heart disease is the most common cause of chronic congestive heart failure and is the underlying cause of heart failure in 50% to 75% of patients<ref name="pmid7977122">{{cite journal |author=Bortman G, Sellanes M, Odell DS, Ring WS, Olivari MT |title=Discrepancy between pre- and post-transplant diagnosis of end-stage dilated cardiomyopathy |journal=[[The American Journal of Cardiology]] |volume=74 |issue=9 |pages=921–4 |year=1994 |month=November |pmid=7977122 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/0002-9149(94)90587-8 |issn= |accessdate=2013-04-25}}</ref>.  Ischemic heart disease results in systolic dysfunction of the heart due to irreversible damage of the left ventricle if there has been a prior MI.  There can also be viable tissue that is stunned or hibernating as a cause of heart failure.  The management of these patients consists of risk factor modification (for example with the use of [[statins]] or [[beta blockers]] ) as well as the relief of angina (for example with the use of [[nitrates]] ). Revascularization (percuataneous coronary intervention or coronary artery bypass grafting) is indicated in the following scenarios:
 
*To improve symptoms.
{|class="wikitable" style="width:80%"
*To improve prognosis.  If there is a perfusion defect, revascularization may improve prognosis.  
|-
*To prevent recurrent [[heart failure]] decompensation.  If the patient has repeated episodes of [[congestive heart failure]] decompensation, revascularization may be indicated.
| colspan="1" style="text-align:center; background: LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III (No Benefit)]]
|-
| bgcolor="LightCoral"|
'''1.'''
In patients with HF and anemia, erythropoietin- stimulating agents should not be used to improve morbidity and mortality.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class III, Level of Evidence: B-R]])
|-
|}
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background: LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon"|
'''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.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class IIb, Level of Evidence: B-R]])
|-
|}


===2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure===
===Atrial Fibrillation===


{|class="wikitable" style="width:80%"
{|class="wikitable" style="width:80%"
Line 29: Line 45:
| bgcolor="LemonChiffon"|
| bgcolor="LemonChiffon"|
'''1.'''
'''1.'''
Coronary revascularization is reasonable in patients with CAD in whom symptoms (angina) or demonstrable myocardial ischemia is judged to be having an adverse effect on symptomatic HFpEF despite GDMT.
Management of AF according to published clinical practice guidelines in patients with HFpEF is reasonable to improve symptomatic HF.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class IIa, Level of Evidence: C]])
([[ACC AHA guidelines classification scheme#Level of Evidence|Class IIa, Level of Evidence: C]])
|-
|-
|}
|}


==Hypertension==
===Diabetes Mellitus===
Hypertension is a common underlying cause of congestive heart failure. There are 2 goals in the treatment of the congestive heart failure patient with hypertension:


1. Reduce the [[preload]] and
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background: LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|
'''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.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class I, Level of Evidence: C]])
|-
|}


2. Reduce the [[afterload]]
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background: LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon"|
'''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.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class IIa, Level of Evidence: A]])
|-
| bgcolor="LemonChiffon"|
'''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.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class IIa, Level of Evidence: B]])
|-
|}
 
===Hyperlipidemia===
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background: LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|
'''1.'''
In patients with a recent or remote history of MI or acute coronary syndrome, statins should be used to prevent cardiovascular events.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class I, Level of Evidence: A]])
|-
|}
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background: LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III (No Benefit)]]
|-
| bgcolor="LightCoral"|
'''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.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class III, Level of Evidence: A]])
|-
|}


The following agents improve survival in the heart failure patient and are the preferred antihypertensive agents:
{|class="wikitable" style="width:80%"
*[[Beta blockers]]
|-
*[[Angiotensin-converting enzyme inhibitors]]
| colspan="1" style="text-align:center; background: LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
*[[Angiotensin receptor blockers]] in patients who cannot tolerate a [[angiotensin converting enzyme inhibitor]]
|-
*[[Aldosterone antagonist]]s
| bgcolor="LemonChiffon"|
'''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.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class IIa, Level of Evidence: B]])
|-
|}


Patients with bilateral [[renal artery stenosis]] tend to have a greater risk of flash [[pulmonary edema]] than those patients with unilateral [[renal artery stenosis]]<ref name="pmid2900930">{{cite journal |author=Pickering TG, Herman L, Devereux RB, Sotelo JE, James GD, Sos TA, Silane MF, Laragh JH |title=Recurrent pulmonary oedema in hypertension due to bilateral renal artery stenosis: treatment by angioplasty or surgical revascularisation |journal=[[Lancet]] |volume=2 |issue=8610 |pages=551–2 |year=1988 |month=September |pmid=2900930 |doi= |url= |issn= |accessdate=2013-a04-25}}</ref>. This combination of flash [[pulmonary edema]] and bilateral [[renal artery stenosis]] is known as [[Pickering syndrome]]<ref name="pmid21406441">{{cite journal |author=Messerli FH, Bangalore S, Makani H, Rimoldi SF, Allemann Y, White CJ, Textor S, Sleight P |title=Flash pulmonary oedema and bilateral renal artery stenosis: the Pickering syndrome |journal=[[European Heart Journal]] |volume=32 |issue=18 |pages=2231–5 |year=2011 |month=September |pmid=21406441 |doi=10.1093/eurheartj/ehr056 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=21406441 |issn= |accessdate=2013-04-25}}</ref>.  Is not unreasonable for patients with recurrent [[flash pulmonary edema]] and [[renal artery stenosis]] to undergo revascularization. The data in support of this recommendation however is modest.
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background: LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon"|
'''1.'''
Lipid disorders should be controlled in accor- dance with contemporary guidelines.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class IIa, Level of Evidence: B]])
|-
|}


===2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure===
===Obesity===


{|class="wikitable" style="width:80%"
{|class="wikitable" style="width:80%"
Line 57: Line 133:
| bgcolor="LightGreen"|
| bgcolor="LightGreen"|
'''1.'''
'''1.'''
In patients at increased risk, stage A HF, the optimal blood pressure in those with hypertension should be less than 130/80 mm Hg.
Obesity should be controlled or avoided to prevent the development of HF along with other CVDs.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class I, Level of Evidence: B-R]])
([[ACC AHA guidelines classification scheme#Level of Evidence|Class I, Level of Evidence: C]])
|-
|-
| bgcolor="LightGreen"|
|}
'''2.'''
 
Patients with HFrEF and hypertension should be prescribed GDMT titrated to attain systolic blood pressure less than 130 mm Hg.
{|class="wikitable" style="width:80%"
([[ACC AHA guidelines classification scheme#Level of Evidence|Class I, Level of Evidence: C-EO]])
|-
| colspan="1" style="text-align:center; background: LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III (Harm)]]
|-
|-
| bgcolor="LightGreen"|
| bgcolor="LightCoral"|
'''3.'''
'''1.'''
Patients with HFpEF and persistent hypertension after management of volume overload should be prescribed GDMT titrated to attain systolic blood pressure less than 130 mm Hg.
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.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class I, Level of Evidence: C-LD]])
([[ACC AHA guidelines classification scheme#Level of Evidence|Class III, Level of Evidence: C]])
|-
|-
|}
|}
Line 74: Line 151:
{|class="wikitable" style="width:80%"
{|class="wikitable" style="width:80%"
|-
|-
| colspan="1" style="text-align:center; background: LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
| colspan="1" style="text-align:center; background: LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|-
| bgcolor="LemonChiffon"|
| bgcolor="LemonChiffon"|
'''1.'''
'''1.'''
The use of beta-blocking agents, ACE inhibitors, and ARBs in patients with hypertension is reasonable to control blood pressure in patients with HFpEF.
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..
([[ACC AHA guidelines classification scheme#Level of Evidence|Class IIa, Level of Evidence: C]])
([[ACC AHA guidelines classification scheme#Level of Evidence|Class IIb, Level of Evidence: C]])
|-
|-
|}
|}


==Valvular Heart Disease==
===Sleep Disorders===
In 10% to 12% of patients, valvular heart disease is the underlying cause of congestive heart failure<ref name="pmid12748317">{{cite journal |author=Jessup M, Brozena S |title=Heart failure |journal=[[The New England Journal of Medicine]] |volume=348 |issue=20 |pages=2007–18 |year=2003 |month=May |pmid=12748317 |doi=10.1056/NEJMra021498 |url=http://www.nejm.org/doi/abs/10.1056/NEJMra021498?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed |issn= |accessdate=2013-04-25}}</ref>.  It should also be noted that as the heart dilates in the setting of [[heart failure]], there is often secondary [[mitral regurgitation]] and [[tricuspid regurgitation]] in many patients with a [[dilated cardiomyopathy]].  Please consult of the chapters on either [[mitral regurgitation]] or [[aortic regurgitation]] regarding the treatment of [[valvular heart disease]].  In general, once the left ventricular systolic diameter begins to increase, mitral valve repair ( left ventricular end systolic diameter greater than 45 mm) or aortic valve replacement (left ventricular end systolic diameter greater than 55 mm) is often indicated.


==Other Underlying Disorders That May Warrant Treatment==
{|class="wikitable" style="width:80%"
There are a variety of other systemic or cardiovascular disorders that may secondarily cause [[heart failure]], and these primary disorders may warrant treatment as well:
|-
| colspan="1" style="text-align:center; background: LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III (Harm)]]
|-
| bgcolor="LightCoral"|
'''1.'''
In patients with NYHA class II–IV HFrEF and central sleep apnea, adaptive servo-ventilation causes harm.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class III, Level of Evidence: B-R]])
|-
|}


*[[Alcohol abuse]]:  the patient should be directed to the appropriate rehabilitation program
{|class="wikitable" style="width:80%"
*[[Cocaine abuse]]: the patient should be directed to the appropriate rehabilitation program
|-
*[[Hemochromatosis]]
| colspan="1" style="text-align:center; background: LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
*[[Myocarditis]]
|-
*[[Obstructive sleep apnea]]: a vigorous weight loss program should be implemented
| bgcolor="LemonChiffon"|
*[[Sarcoidosis]]
'''1.'''
*[[Systemic lupus erythematosus]]
In patients with NYHA class II–IV HF and suspicion of sleep-disordered breathing or excessive daytime sleepiness, a formal sleep assessment is reasonable.
*[[Thyroid storm]]
([[ACC AHA guidelines classification scheme#Level of Evidence|Class IIa, Level of Evidence: C-LD]])
|-
|}
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background: LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon"|
'''1.'''
In patients with cardiovascular disease and obstructive sleep apnea, CPAP may be reasonable to improve sleep quality and daytime sleepiness.
([[ACC AHA guidelines classification scheme#Level of Evidence|Class IIb, Level of Evidence: B-R]])
|-
|}


==References==
==References==

Latest revision as of 14:49, 19 September 2021
Resident
Survival
Guide
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 Treatment of associated conditions 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 Treatment of associated conditions

CDC on Congestive heart failure Treatment of associated conditions

Congestive heart failure Treatment of associated conditions in the news

Blogs on Congestive heart failure Treatment of associated conditions

Directions to Hospitals Treating Congestive heart failure Treatment of associated conditions

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.

Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=Congestive_heart_failure_Treatment_of_associated_conditions&oldid=1714488"