Show Menu

ACC/AHA Recommendations for Treating CHF Cheat Sheet by

heart     treatment     failure     healthcare     recommendations     aca-aha     chf     chronic

Introd­uction

The American College of Cardiology (ACC) and the American Heart Associ­ation (AHA) have released updated guidelines on the diagnosis and management of chronic heart failure in adults. guidelines discuss the recomm­ended treatment options for patients based on the 4 stages of heart failure. Patients in Stage A or B are at risk for developing heart failure, whereas those in Stage C or D have documented signs or symptoms of the disease.

The new recomm­end­ations stress the importance of early recogn­ition and treatment of risk factors such as hypert­ension, diabetes, and coronary artery disease in an attempt to prevent or delay the develo­pment of heart failure.

Additi­onally, the updated guideline has officially altered the name of the condition from “conge­stive heart failure” to “heart failure” because many patients with the disease do not present with congestive symptoms.
These guidelines were published in the September 20, 2005 issue of Circul­ation and are currently available on the ACC website at www.ac­c.org

Stage A High risk for developing heart failure

Patients at high-risk for heart failure should be counseled to avoid smoking, illicit drug use, and excessive alcohol consum­ption.
For patients with diabetes, glucose should be contro­lled.
A noninv­asive evaluation of left ventri­cular function should be performed in patients with a strong family history of cardio­myo­pathy or in patients receiving cardio­toxic interv­ent­ions.
Angiotensin converting enzyme inhibitors (ACEIs) (1st choice) or angiot­ensin II receptor blockers (ARBs) (2nd choice) can be useful to prevent heart failure in patients with risk factors

Stage B cardiac structural abnorm­alities

Patients with cardiac structural abnorm­alities or remodeling who have not developed sympto­matic heart failure
Beta-blockers and ACEIs should be used in all patients with a history of myocardial infarction (MI) regardless of ejection fraction or presence of heart failure symptoms.
For patients who have not experi­enced an MI but have a reduced ejection fraction and no symptoms of heart failure, a beta-b­locker and ACEI are recomm­ended.
Treatment with an ARB is recomm­ended for patients who are ACEI intole­rant.
Coronary revasc­ula­riz­ation or valve replac­ement should be recomm­ended for patients with signif­icant disease.
An ACEI or ARB can be beneficial for patients with hypert­ension and left ventri­cular hypert­rophy without any heart failure symptoms.
Placement of an implan­table cardio­ver­ter­-de­fib­ril­lator (ICD) is reasonable for patients with ischemic cardio­myo­pathy who are at least 40 days post-MI, have a left ventri­cular ejection fraction of 30% or less, and are in New York Heart Associ­ation (NYHA) Class I.
Placement of an implan­table ICD is also reasonable for patients with nonisc­hemic cardio­myo­pathy who have a left ventri­cular ejection fraction of 30% or less, and are in NYHA Class I.
 

Heart Failure

Stage C: Curren­t/Prior Symptoms of Heart Failure

Bisoprolol, carved­ilol, or sustained release metoprolol succinate are recomm­ended for all stable patients with current or prior symptoms of heart failure and left ventri­cular ejection fraction.
Treatment with an ARB, specif­ically candes­artan or valsartan, is recomm­ended for patients with current or prior symptoms of heart failure and reduced left ventri­cular ejection fraction who are intolerant of an ACEI.
Exercise training is beneficial as an adjunctive treatment approach in patients with current or prior symptoms of heart failure and reduced left ventri­cular ejection fraction.
ICD therapy should be considered in a variety of heart failure patients to reduce total mortality.
Cardiac resync­hro­niz­ation therapy should be considered in patients with cardiac dysync­hrony (QRS greater than 0.12 ms) who have a left ventri­cular ejection fraction less than or equal to 35%, are in sinus rhythm, and are in NYHA Class III or IV despite medical therapy.
Addition of an aldost­erone antagonist is reasonable in selected patients with moderate to severe symptoms of heart failure and reduced left ventri­cular ejection fraction.
Treatment with an ARB is a reasonable first line option to use as an altern­ative to an ACEI for patients with mild to moderate heart failure and reduced left ventri­cular ejection fraction.
Digitalis can be beneficial to reduce hospit­ali­zations in patients with current or prior symptoms of heart failure and reduced left ventri­cular ejection fraction.
A combin­ation of hydral­azine and a nitrate may be reasonable in patients with current or prior symptoms of heart failure and reduced left ventri­cular ejection fraction who can not tolerate an ACEI or ARB

Stage D: Refractory end-stage Heart Failure

Options for end-of­-life care should be discussed with the patient and their family once severe symptoms of heart failure persist
despite treatment.
Patients with end-stage heart failure and and ICD should receive inform­ation about the option to inactivate defibr­ill­ation.
Consideration of a left ventri­cular assist device as permanent or destin­ation therapy is reasonable in patients with refractory heart failure with an estimated 1-year mortality of over 50% despite medical therapy

Download the ACC/AHA Recommendations for Treating CHF Cheat Sheet

2 Pages
//media.cheatography.com/storage/thumb/davidpol_acc-aha-recommendations-for-treating-chf.750.jpg

PDF (recommended)

Alternative Downloads

Share This Cheat Sheet!

 

Comments

No comments yet. Add yours below!

Add a Comment

Your Comment

Please enter your name.

    Please enter your email address

      Please enter your Comment.

          Related Cheat Sheets

          More Cheat Sheets by Davidpol