Heart Failure (ACCF Bundle)

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Key Points •  The clinical syndrome of heart failure (HF) may result from disorders of the pericardium, myocardium, endocardium, heart valves, or great vessels or from certain metabolic abnormalities, but most patients with HF have symptoms due to impaired left ventricular (LV) myocardial function. ▶▶ Because some patients present without signs or symptoms of volume overload, the term "heart failure" is preferred over "congestive heart failure." •  HF is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. •  It should be emphasized that HF is not synonymous with either cardiomyopathy or LV dysfunction; these latter terms describe possible structural or functional reasons for the development of HF. •  HF may be associated with a wide spectrum of LV functional abnormalities, which may range from patients with normal LV size and preserved ejection fraction (EF) to those with severe dilatation and/or markedly reduced EF. •  In most patients, abnormalities of systolic and diastolic dysfunction coexist, irrespective of EF. •  The EF is considered important in classification of patients with HF because of differing patient demographics, comorbid conditions, prognosis, and response to therapies and because most clinical trials have selected patients based on EF. ▶▶ EF values are dependent on the imaging technique employed, method of analysis, and operator. Because other techniques may indicate abnormalities in systolic function among patients with a preserved EF, it is preferable to use the terms "preserved EF" (HFpEF) or "reduced EF" (HFrEF) over preserved or reduced "systolic function." •  In view of the advances in medical therapy across the spectrum of cardiovascular diseases, the American College of Cardiology Foundation/ American Heart Association (ACCF/AHA) guideline task force has designated the term "guideline-directed medical therapy" (GDMT) to represent optimal medical therapy—a combination of lifestyle modifications and medications—as defined by their guideline-directed therapies (primarily Class I)(see Figure 1). •  This guideline outlines a comprehensive approach to the management of HF by ACCF/AHA stage of HF development (see algorithmic summary in Figure 3). 1

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