2017 Update of Guidelines for Heart Failure Management
Since 1980, the American College of Cardiology and the American Heart Association have teamed up to provide guidelines to improve heart health. Guidelines are based on evidence from research studies and updated with the most current recommendations. Recently, the American College of Cardiology, American Heart Association and Heart Failure Society of America released an update to guidelines for heart failure management released in 2013. Heart failure is a lifelong condition affecting about 6 million adults in the U.S. It occurs when the heart can’t pump enough blood to the rest of the body. As a result, fluid can build up in the body, most often in the legs and lungs. Patients with heart failure often feel short of breath and may tire more easily. Since heart failure can worsen over time, it requires watchful care and treatment to improve outcomes and quality of life. The recommendations in this update address the prevention of heart failure, as well as detecting and managing the disease. These key points cover changes to the guidelines that all patients should know.
Prevention and Screening
One of the biggest updates to the guidelines involved using natriuretic peptides as biomarkers to screen for heart failure.
Natriuretic peptides, such as B-type natriuretic peptide (BNP) or NT-proBNP, are hormones that can be found in the blood and, when elevated, may be a sign of heart failure.
Based on the latest evidence, experts conclude that it’s reasonable to use these peptides to screen patients at risk for getting heart failure. Research suggests that early screening can help high-risk patients prevent heart failure, often through early interventions and treatment. Experts also strongly recommend screening patients with shortness of breath, referred to as dyspnea. Shortness of breath is a common symptom of heart failure. Screening for peptide biomarkers is very useful in diagnosing or ruling out heart failure. Additionally, experts recommend similar tests in patients already diagnosed with heart failure. The biomarker can help predict outcomes and assess the level of disease in patients with heart failure.
Managing Heart Failure
Another focus of the update regards medication to treat heart failure. While the recommendations remained the same as those released in a focused update last year, experts more clearly defined which drugs should be used for which patients. For example, experts made the recommendations more clear for patients with symptoms of heart failure and reduced ejection fraction, which is a measure of how much blood your heart pumps to the body. Those patients should replace ACE (angiotensin-converting enzyme) inhibitors or ARBs (angiotensin receptor blockers)—used to lower blood pressure and reduce strain on the heart—with ARNIs (angiotensin receptor–neprilysin inhibitor) to help reduce risk of complications and death. Also, based on new evidence, ARNIs should not be used with an ACE inhibitor or within 36 hours of taking an ACE inhibitor, as it may cause harm.
Finally, experts included sections in the guidelines to address common conditions associated with heart failure. High Blood Pressure Based on the latest findings, experts recommend that patients at high risk for heart failure reduce their blood pressure to at least 130 mmHg/80 mmHg. Blood pressure readings lower than 120 mmHg/80 mmHg are considered to be in a normal range. Experts also recommend using medicine to lower systolic blood pressure (top number in a blood pressure reading) to at least 130 mmHg in patients with heart failure and hypertension. These steps can help improve outcomes and prevent complications linked to high blood pressure. Sleep Apnea Sleep apnea, a common sleep disorder, occurs when someone’s breathing stops or becomes very shallow while sleeping. As sleep apnea is very common among patients with heart failure, experts conclude that sleep assessments are reasonable in heart failure patients who complain of sleep issues. They also explain that a treatment called CPAP (continuous positive airway pressure) therapy is reasonable in patients with sleep apnea, as it can help keep breathing normal during sleep. However, they do not recommend a treatment called adaptive servo-ventilation, which may cause harm in patients with heart failure. Anemia Anemia occurs when the body doesn’t have enough healthy red blood cells, which can be caused by low iron levels. Anemia is common in patients with heart failure and has been associated with poorer outcomes and ability to exercise. Based on the latest evidence, experts conclude that iron replacement delivered directly into a vein (through an IV, or intravenous tube) may be considered to help improve patient outcomes and quality of life.