JCS/JHFS 2021 Guideline Focused Update on Diagnosis and Treatment of Acute and Chronic Heart Failure

Abstract

Taking the latest guidelines of Western countries into considerations, we published the revised edition as the guidelines presenting standard treatment of acute and chronic heart failure by incorporating evidence and actual clinical experience in Japan.Grade A Strongly recommended and supported by strong evidence Grade BRecommended with moderately strong supporting evidence Grade C1Recommended despite no strong supporting evidence Grade C2Not recommended because of the absence of strong supporting evidence Grade D Not recommended as evidence indicates that the treatment is ineffective or even harmful (Adapted from MINDS Treatment Guidelines Selection Committee.

Factors Associated With the Improvement of Left Ventricular Systolic Function by Continuous Positive Airway Pressure Therapy in Patients With Heart Failure With Reduced Ejection Fraction and Obstructive Sleep Apnea

“…We enrolled patients who were being followed up at the cardiovascular center in Toranomon Hospital (Tokyo, Japan) between January 1, 2001 and March 1, 2005, if they met the following inclusion criteria: (1) the presence of symptomatic HF with reduced LVEF, which was defined as an LVEF of <50% on echocardiography ( 14 ) within 1 month before the diagnostic sleep study, and with New York Heart Association (NYHA) Class II or above; (2) stable clinical status, defined as the absence of hospital admissions and obtainment of optimal medical therapy for at least 1 month before enrollment in the study; (3) having a diagnosis of moderate-to-severe sleep apnea from a sleep study, which was defined as ≥ 15 apnea or hypopnea events per hour of sleep (i.e., AHI); and (4) good adherence to CPAP (night usage of ≥ 4 h on 70% of the days during CPAP therapy) ( 15 ) during the initial month. The exclusion criteria were as follows: (1) age <20 or > 80 years, (2) the presence of known untreated neoplasms, (3) a history of stroke with neurologic deficit, and (4) a history of severe chronic pulmonary disease.…”

Use of oral hydromorphone in a patient with stage D heart failure

“…3 In recent years, based on accumulated evidence, each guideline recommends palliative and end-of-life care. 1,2,5 In aging societies, especially in Asian countries, the prevalence and mortality of HF have increased, and the need for palliative and end-of-life care for elderly patients with advanced HF is currently recognized. 6,7 According to the results of a nationwide survey in Japan, the majority of institutions recognized the necessity of palliative care for HF patients, and two-thirds of institutions prescribed analgesics and/or sedatives as palliative care, with intravenous morphine being most commonly, and oral opioids were limited.…”

Globe is Still Heterogenous from the Perspective of Heart Failure

“…Furthermore, care transition is more important for patients with severe HF. 7 In many developed countries, in the near future, more patients with severe HF will be expected to stay at home while receiving necessary medical and nursing care, because this could contribute to improving the patient's quality of life and decreasing medical costs. 14 Thus, there is a growing interest on the effective transition of care program and home management in patients with moderate or severe HF.…”

“…Effective discharge interventions include detailed discharge summaries and early prearranged and structured physician and/or HF nurses follow-up. 6,7 In a systematic review by Van Spall et al, 8 nurse home visits and multidisciplinary HF clinics including HF nurses, cardiologists, geriatricians, dietitians, and/or physiotherapist were found to decrease all-cause readmissions compared with usual care. Because patients with HF in the United States are considered to be most vulnerable at hospital discharge, high-intensity transitional care interventions are of high importance during the early postdischarge period.…”