Congestive heart failure beta blockers: Difference between revisions

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{{Congestive heart failure}}
{{Congestive heart failure}}
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'''Editor(s)-In-Chief:''' James Chang, M.D., Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School [mailto:jchang@caregroup.org] and [[User:C Michael Gibson|C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org], Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School
'''Editor(s)-In-Chief:''' James Chang, M.D., Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School [mailto:jchang@caregroup.org] and [[User:C Michael Gibson|C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com], Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School; {{AOEIC}} {{LG}} {{Mitra}} {{EdzelCo}}


==Indications for Beta Blockers in CHF==
==[[Beta Blockers]]==
A patient should be administered a "heart failure approved" beta blocker if:
===[[Indications]] for [[Beta Blockers]] Use===
A [[patient]] should be administered a "[[heart failure]] approved" or "evidence-based " [[beta blocker]] ([[metoprolol succinate]]<ref name="pmid10714728">{{cite journal |author=Hjalmarson A, Goldstein S, Fagerberg B, Wedel H, Waagstein F, Kjekshus J, Wikstrand J, El Allaf D, Vítovec J, Aldershvile J, Halinen M, Dietz R, Neuhaus KL, Jánosi A, Thorgeirsson G, Dunselman PH, Gullestad L, Kuch J, Herlitz J, Rickenbacher P, Ball S, Gottlieb S, Deedwania P |title=Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: the Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure (MERIT-HF). MERIT-HF Study Group |journal=[[JAMA : the Journal of the American Medical Association]] |volume=283 |issue=10 |pages=1295–302 |year=2000 |month=March |pmid=10714728 |doi= |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=10714728 |accessdate=2012-04-03}}</ref>, [[carvedilol]], [[bisoprilol|bisoprolol]]) if:


1. [[Left Ventricular Ejection Fraction]] ([[LVEF]]) ≤ 40%
1. The [[Left Ventricular Ejection Fraction]] ([[LVEF]]) is ≤ 40%


'''''or'''''
'''''or'''''


2. History of [[myocardial infarction]] ([[MI]])
2. There is a history of [[myocardial infarction]] ([[MI]])<ref name="pmid9709041">{{cite journal |author=Gottlieb SS, McCarter RJ, Vogel RA |title=Effect of beta-blockade on mortality among high-risk and low-risk patients after myocardial infarction |journal=[[The New England Journal of Medicine]] |volume=339 |issue=8 |pages=489–97 |year=1998 |month=August |pmid=9709041 |doi=10.1056/NEJM199808203390801 |url=http://dx.doi.org/10.1056/NEJM199808203390801 |accessdate=2012-04-03}}</ref>


==Background==
===Background===
* Blockade of compensatory sympathetic stimulation is associated with arrhythmic, ischemic, remodeling, and apoptotic benefits.
* [[Blockade]] of compensatory [[sympathetic]] stimulation is associated with [[arrhythmic]], [[ischemic]], [[remodeling]], and [[apoptotic]] benefits.
* Used as monotherapy or combined with conventional heart failure management, beta-blockers reduce the combined risk of morbidity and mortality.
* Used as [[monotherapy]] or combined with conventional [[heart failure]] [[management]], [[beta blockers]] reduce the combined risk of [[morbidity]] and [[mortality]].
*[[Beta blocker]] therapy is recommended for ANY patient with reduced left ventricular ejection fraction (≤ 40%) regardless of the etiology of left ventricular systolic dysfunction (ischemic or nonischemic) or presence/absence of symptoms. Patients with or without heart failure (in other words, even those with asymptomatic left ventricular systolic dysfunction) are included in this recommendation.
*[[Beta blocker]] therapy is recommended for ANY [[patient]] with reduced [[left ventricular ejection fraction]] (≤ 40%) regardless of the [[etiology]] of [[left ventricular systolic dysfunction]] ([[ischemic]] or [[nonischemic]]) or presence/absence of [[symptoms]]. [[Patients]] with or without [[heart failure]] (in other words, even those with [[asymptomatic]] [[left ventricular systolic dysfunction]]) are included in this recommendation.
*Beta blockers approved by the FDA for use in the treatment of heart failure are [[metoprolol succinate]] and [[carvedilol]]. In Europe, [[bisoprolol]] is also approved for use in heart failure. In addition, beta blocker therapy is indicated for patients with history of myocardial infarction whether or not left ventricular systolic dysfunction or heart failure is present.
*[[Beta blockers]] approved by the FDA for use in the [[treatment]] of [[heart failure]] are [[metoprolol succinate]] and [[carvedilol]]. In Europe, [[bisoprolol]] is also approved for use in [[heart failure]]. In addition, [[beta blocker]] [[therapy]] is indicated for [[patients]] with history of [[myocardial infarction]] whether or not [[left ventricular systolic dysfunction]] or [[heart failure]] is present.
*Beta blocker therapy should be initiated at low dosage and gradually uptitrated, as tolerated, toward target dosages of 200 mg daily for [[metoprolol succinate]] and 25 mg twice daily for [[carvedilol]], or to the maximum tolerated dosage.
*[[Beta blocker]] [[therapy]] should be initiated at low [[dosage]] and gradually uptitrated, as tolerated, toward target [[dosages]] of 200 mg daily for [[metoprolol succinate]] and 25 mg twice daily for [[carvedilol]], or to the maximum tolerated dosage.
* [[Lopressor]] should be used instead of [[atenolol]] in the patient with CHF.
* Other [[beta-blockers]] (such as [[atenolol]]) have not been demonstrated to have the same [[mortality]] benefits as [[carvedilol]] and [[metoprolol]] and should not be used for this purpose.
 
 
 
===[[Dosing]]===
{| class="wikitable
![[Beta Blocker]] !! Starting [[dose]]!! [[Target dose]]
|-
| [[Bisoprolol]]||align="center"|1.25 mg [[QD]]||align="center"|10 mg [[QD]]
|-
| [[Carvedilol]]||align="center"|3.125 mg [[BID]]||align="center"|50 mg [[BID]]
|-
| [[Carvedilol CR]]||align="center"|10 mg [[QD]]||align="center"|80 mg [[QD]]
|-
| [[Metoprolol succinate]] (CR/XL)||align="center"|12.5–25 mg QD||align="center"| 200 mg [[QD]]
|-
| [[Nebivolol]]||align="center"|1.25 mg [[QD]]||align="center"| 10 mg [[QD]]
|}
 
== 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>==
 
 
====Beta Blockers====
 
{|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"|<nowiki>"</nowiki>'''1.''' In [[patients]] with [[HFrEF]], with current or previous [[symptoms]], use of 1 of the 3 [[beta blockers]] proven to reduce [[mortality]] (eg, bisoprolol, carvedilol,sustained-release metoprolol succinate) is recommended to reduce mortality and hospitalizations. <ref name="pmid10023943">{{cite journal| author=| title=The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. | journal=Lancet | year= 1999 | volume= 353 | issue= 9146 | pages= 9-13 | pmid=10023943 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10023943  }} </ref><ref name="pmid10376614">{{cite journal| author=| title=Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF) | journal=Lancet | year= 1999 | volume= 353 | issue= 9169 | pages= 2001-7 | pmid=10376614 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10376614  }} </ref><ref name="pmid12390947">{{cite journal| author=Packer M, Fowler MB, Roecker EB, Coats AJ, Katus HA, Krum H | display-authors=etal| title=Effect of carvedilol on the morbidity of patients with severe chronic heart failure: results of the carvedilol prospective randomized cumulative survival (COPERNICUS) study. | journal=Circulation | year= 2002 | volume= 106 | issue= 17 | pages= 2194-9 | pmid=12390947 | doi=10.1161/01.cir.0000035653.72855.bf | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12390947  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
 
|}
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:"White"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class Value Statement: High Value]]
 
|-
|bgcolor="White"|<nowiki>"</nowiki>'''2.''' In [[patients]] with [[HFrEF]], with current or previous [[symptoms]], [[beta blocker]] [[therapy]] provides high economic values. <ref name="pmid23433562">{{cite journal| author=Banka G, Heidenreich PA, Fonarow GC| title=Incremental cost-effectiveness of guideline-directed medical therapies for heart failure. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 13 | pages= 1440-6 | pmid=23433562 | doi=10.1016/j.jacc.2012.12.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23433562  }} </ref><ref name="pmid16360958">{{cite journal| author=Caro JJ, Migliaccio-Walle K, O'Brien JA, Nova W, Kim J, Hauch O | display-authors=etal| title=Economic implications of extended-release metoprolol succinate for heart failure in the MERIT-HF trial: a US perspective of the MERIT-HF trial. | journal=J Card Fail | year= 2005 | volume= 11 | issue= 9 | pages= 647-56 | pmid=16360958 | doi=10.1016/j.cardfail.2005.06.433 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16360958  }} </ref><ref name="pmid10190405">{{cite journal| author=Delea TE, Vera-Llonch M, Richner RE, Fowler MB, Oster G| title=Cost effectiveness of carvedilol for heart failure. | journal=Am J Cardiol | year= 1999 | volume= 83 | issue= 6 | pages= 890-6 | pmid=10190405 | doi=10.1016/s0002-9149(98)01066-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10190405  }} </ref><ref name="pmid11334781">{{cite journal| author=Gregory D, Udelson JE, Konstam MA| title=Economic impact of beta blockade in heart failure. | journal=Am J Med | year= 2001 | volume= 110 Suppl 7A | issue=  | pages= 74S-80S | pmid=11334781 | doi=10.1016/s0002-9343(98)00387-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11334781  }} </ref><ref name="pmid11485131">{{cite journal| author=Vera-Llonch M, Menzin J, Richner RE, Oster G| title=Cost-effectiveness results from the US Carvedilol Heart Failure Trials Program. | journal=Ann Pharmacother | year= 2001 | volume= 35 | issue= 7-8 | pages= 846-51 | pmid=11485131 | doi=10.1345/aph.10114 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11485131  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
 
|}
 
==External Links==
*[https://www.ahajournals.org/doi/epub/10.1161/CIR.0000000000001063.full.pdf 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]<ref name="pmid35363499">{{cite journal |vauthors=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 |title=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 |journal=Circulation |volume=145 |issue=18 |pages=e895–e1032 |date=May 2022 |pmid=35363499 |doi=10.1161/CIR.0000000000001063 |url=}} </ref>
 
*[http://circ.ahajournals.org/content/112/12/e154.full.pdf The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult] <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>
 
*[http://content.onlinejacc.org/cgi/reprint/53/15/1343.pdf 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] <ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 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. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>
 
==References==
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Latest revision as of 20:44, 22 June 2022
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Editor(s)-In-Chief: James Chang, M.D., Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School [2] and C. Michael Gibson, M.S., M.D. [3], Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [4] Mitra Chitsazan, M.D.[5] Edzel Lorraine Co, DMD, MD[6]

Beta Blockers

Indications for Beta Blockers Use

A patient should be administered a "heart failure approved" or "evidence-based " beta blocker (metoprolol succinate[1], carvedilol, bisoprolol) if:

1. The Left Ventricular Ejection Fraction (LVEF) is ≤ 40%

or

2. There is a history of myocardial infarction (MI)[2]

Background


Dosing

Beta Blocker Starting dose Target dose
Bisoprolol 1.25 mg QD 10 mg QD
Carvedilol 3.125 mg BID 50 mg BID
Carvedilol CR 10 mg QD 80 mg QD
Metoprolol succinate (CR/XL) 12.5–25 mg QD 200 mg QD
Nebivolol 1.25 mg QD 10 mg QD

2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) [3]

Beta Blockers

Class I
"1. In patients with HFrEF, with current or previous symptoms, use of 1 of the 3 beta blockers proven to reduce mortality (eg, bisoprolol, carvedilol,sustained-release metoprolol succinate) is recommended to reduce mortality and hospitalizations. [4][5][6](Level of Evidence: A) "
Class Value Statement: High Value
"2. In patients with HFrEF, with current or previous symptoms, beta blocker therapy provides high economic values. [7][8][9][10][11] (Level of Evidence: A) "

External Links

References

  1. ↑ Hjalmarson A, Goldstein S, Fagerberg B, Wedel H, Waagstein F, Kjekshus J, Wikstrand J, El Allaf D, Vítovec J, Aldershvile J, Halinen M, Dietz R, Neuhaus KL, Jánosi A, Thorgeirsson G, Dunselman PH, Gullestad L, Kuch J, Herlitz J, Rickenbacher P, Ball S, Gottlieb S, Deedwania P (2000). "Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: the Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure (MERIT-HF). MERIT-HF Study Group". JAMA : the Journal of the American Medical Association. 283 (10): 1295–302. PMID 10714728. Retrieved 2012-04-03. Unknown parameter |month= ignored (help)
  2. ↑ Gottlieb SS, McCarter RJ, Vogel RA (1998). "Effect of beta-blockade on mortality among high-risk and low-risk patients after myocardial infarction". The New England Journal of Medicine. 339 (8): 489–97. doi:10.1056/NEJM199808203390801. PMID 9709041. Retrieved 2012-04-03. Unknown parameter |month= ignored (help)
  3. ↑ 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).
  4. ↑ "The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial". Lancet. 353 (9146): 9–13. 1999. PMID 10023943.
  5. ↑ "Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF)". Lancet. 353 (9169): 2001–7. 1999. PMID 10376614.
  6. ↑ Packer M, Fowler MB, Roecker EB, Coats AJ, Katus HA, Krum H; et al. (2002). "Effect of carvedilol on the morbidity of patients with severe chronic heart failure: results of the carvedilol prospective randomized cumulative survival (COPERNICUS) study". Circulation. 106 (17): 2194–9. doi:10.1161/01.cir.0000035653.72855.bf. PMID 12390947.
  7. ↑ Banka G, Heidenreich PA, Fonarow GC (2013). "Incremental cost-effectiveness of guideline-directed medical therapies for heart failure". J Am Coll Cardiol. 61 (13): 1440–6. doi:10.1016/j.jacc.2012.12.022. PMID 23433562.
  8. ↑ Caro JJ, Migliaccio-Walle K, O'Brien JA, Nova W, Kim J, Hauch O; et al. (2005). "Economic implications of extended-release metoprolol succinate for heart failure in the MERIT-HF trial: a US perspective of the MERIT-HF trial". J Card Fail. 11 (9): 647–56. doi:10.1016/j.cardfail.2005.06.433. PMID 16360958.
  9. ↑ Delea TE, Vera-Llonch M, Richner RE, Fowler MB, Oster G (1999). "Cost effectiveness of carvedilol for heart failure". Am J Cardiol. 83 (6): 890–6. doi:10.1016/s0002-9149(98)01066-2. PMID 10190405.
  10. ↑ Gregory D, Udelson JE, Konstam MA (2001). "Economic impact of beta blockade in heart failure". Am J Med. 110 Suppl 7A: 74S–80S. doi:10.1016/s0002-9343(98)00387-8. PMID 11334781.
  11. ↑ Vera-Llonch M, Menzin J, Richner RE, Oster G (2001). "Cost-effectiveness results from the US Carvedilol Heart Failure Trials Program". Ann Pharmacother. 35 (7–8): 846–51. doi:10.1345/aph.10114. PMID 11485131.
  12. ↑ 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).
  13. ↑ 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
  14. ↑ 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

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