ACC/AHA/HFSA 2022 and ESC 2021 guidelines on heart failure comparison

Abstract

The 2022 American College of Cardiology/American Heart Association/Heart Failure Society of America (ACC/AHA/HFSA) and the 2021 European Society of Cardiology (ESC) both provide evidence‐based guides for the diagnosis and treatment of heart failure (HF). In this review, we aimed to compare recommendations suggested by these guidelines highlighting the differences and latest evidence mentioned in each of the guidelines. While the staging of HF depends on left ventricular ejection fraction, the Universal Definition of HF, suggested in 2021, is described in 2022 ACC/AHA/HFSA guidelines. Both guidelines recommend invasive and non‐invasive tests to diagnose. Despite being identical in the backbone, some differences exist in medical therapy and devices, which can be partially attributed to the recent trials published that are presented in the American guidelines. The recommendation of implantable cardioverter defibrillator for prevention in HF with reduced ejection fraction (HFrEF) patients, made by ACC/AHA/HFSA guidelines, is among the bold differences. It seems that ACC/AHA/HFSA guidelines emphasize the quality of life, cost‐effectiveness, and optimization of care given to patients. On the other hand, the ESC guidelines provide recommendations for certain comorbidities. This comparison can guide clinicians in choosing the proper approach for their own settings and the writing committees in addressing the differences in order to have better consistency in future guidelines.

Expert Review on Contemporary Management of Common Benign Pleural Effusions

“…As preliminary concepts, HF with reduced ejection fraction (HFrEF) is defined as a left ventricular ejection fraction (LVEF) ≤40%; HF with preserved ejection fraction (HFpEF), which represents at least half of the population with HF, implies an LVEF ≥50%, whereas HF with mildly reduced ejection fraction (HFmrEF) refers to an LVEF of 41 to 49%. 34…”

“…As preliminary concepts, HF with reduced ejection fraction (HFrEF) is defined as a left ventricular ejection fraction (LVEF) 40%; HF with preserved ejection fraction (HFpEF), which represents at least half of the population with HF, implies an LVEF 50%, whereas HF with mildly reduced ejection fraction (HFmrEF) refers to an LVEF of 41 to 49%. 34 It is important to recognize that treatment of HF-related PEs does not only involve diuretics. Treatment of stages C (symptomatic HF) and D (advanced HF) HFrEF now entails five medication classes, which may be initiated simultaneously (at low doses) or sequentially 34,35 : (1) loop diuretics (furosemide, torasemide) as needed, (2) angiotensin receptor-neprilysin inhibitors (ARNi; e.g., sacubitril-valsartan) or, if not feasible, angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB), (3) beta blockers (bisoprolol, carvedilol, metoprolol succinate) in clinically stabilized patients, (4) mineralocorticoid receptor antagonists (e.g., spironolactone, eplerenone) if estimated glomerular filtration rate (eGFR) is >30 mL/min/1.73 m 2 and serum potassium is <5.0 mEq/L, and (5) sodium-glucose cotransporter 2 inhibitors (SGLT2i; e.g., dapagliflozin, empagliflozin), irrespective of the presence of type 2 diabetes, provided the patient has an eGFR of at least 30 mL/min/1.73 m 2 for dapagliflozin and at least 20 mL/min/1.73 m 2 for empagliflozin.…”

“…Some further points concerning the optimal medical treatment of HF-related effusions should be noted. 34,35 First, ARNi should not be administered to patients with a history of angioedema or within 36 hours of the last dose of an ACEi. Second, there is an increased risk for genital infections in patients receiving SGLT2i.…”

The impact of implantable cardioverter defibrillator on the prognosis of nonischemic dilated cardiomyopathy patients compared with standard medical treatments

“…Patients with DCM are prone to arrhythmias leading to sudden cardiac death (SCD) in about 30% of cases 3 . Medical treatments such as beta‐blockers are recognized as influential and potential agents which can increase survival and cardiac function of patients with DCM 4,5 . Moreover, they might prevent SCD by reducing the possibility of arrhythmias 6 .…”

“… 3 Medical treatments such as beta‐blockers are recognized as influential and potential agents which can increase survival and cardiac function of patients with DCM. 4 , 5 Moreover, they might prevent SCD by reducing the possibility of arrhythmias. 6 However, according to current guidelines, using implantable cardioverter defibrillators (ICDs) in addition to medical treatments is recommended for selected DCM patients to prevent sudden cardiac arrhythmias.…”