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ACC AHA Heart Failure Guidelines 2022 Update

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2 Overview Top 10 Take-Home Messages: 1. Guideline-directed medical therapy (GDMT) for heart failure (HF) with reduced ejection fraction (HFrEF) now includes 4 medication classes which include sodium-glucose cotransporter-2 inhibitors (SGLT2i). 2. SGLT2 inhibitors have a 2a recommendation in heart failure with mildly reduced ejection fraction (HFmrEF). Weaker recommendations (2b) are made for ARNi, ACEi, ARB, MRA and beta blockers in this population. 3. New recommendations for HFpEF are made for SGLT2 inhibitors (2a), MRAs (2b) and ARNi (2b). Several prior recommendations have been renewed including treatment of hypertension (1), treatment of atrial fibrillation (2a), use of ARBs (2b) avoidance of routine use of nitrates or phosphodiesterase-5 inhibitors (3-no benefit). 4. Improved LVEF is used to refer to those patients with a previous HFrEF who now have an LVEF >40%. These patients should continue their HFrEF treatment. 5. Value statements were created for select recommendations where high-quality cost-effectiveness studies of the intervention have been published. 6. Amyloid heart disease has new recommendations for treatment including screening for serum and urine monoclonal light chains, bone scintigraphy, genetic sequencing, tetramer stabilizer therapy, and anticoagulation. 7. Evidence supporting increased filling pressures is important for the diagnosis of HF if the LVEF is >40%. Evidence for increased filling pressures can be obtained from non-invasive (e.g., natriuretic peptide, diastolic function on imaging) or invasive testing (e.g., hemodynamic measurement). 8. Patients with advanced HF who wish to prolong survival should be referred to a team specializing in HF. A heart failure specialty team reviews HF management, assesses suitability for advanced HF therapies and uses palliative care including palliative inotropes where consistent with the patient's goals of care. 9. Primary prevention is important for those at risk for HF (Stage A) or pre-HF (Stage B). Stages of HF were revised to emphasize the new terminologies of "at risk" for HF for Stage A and Pre-HF for Stage B. 10. Recommendations are provided for select patients with HF and iron deficiency, anemia, hypertension, sleep disorders, diabetes type 2, atrial fibrillation, coronary artery disease and malignancy.

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