NHC/ SHA 2023 Focused update of the 2019 guidelines for the management of heart failure

Abstract

Background The burden of cardiovascular diseases is undeniable in local populations, who have high mortality rates and a young age of disease onset. A systematic review of emerging evidence and update of the Saudi Heart Association (SHA) 2019 heart failure (HF) guidelines was therefore undertaken. Methodology A panel of expert cardiologists reviewed recommendations of the 2019 guidelines following the Saudi Heart Association methodology for guideline recommendations. When needed, the panel provided updated and new recommendations endorsed by the national heart council that are appropriate for clinical practice and local resources in Saudi Arabia. Recommendations and conclusion The focused update describes the appropriate use of clinical assessment as well as invasive and non-invasive modalities for the classification and diagnosis of HF. The prevention of HF was emphasized by expanding on both primary and secondary prevention approaches. Pharmacological treatment of HF was supplemented with recommendations on newer therapies, such as SGLT-2 inhibitors. Recommendations were also provided on the management of patients with cardiovascular and non-cardiovascular co-morbidities, with a focus on cardio-oncology and pregnancy. Updated clinical algorithms were included in support of HF management in both the acute and chronic settings. The implementation of this focused update on HF management in clinical practice is expected to lead to improved patient outcomes by providing evidence-based comprehensive guidance for practitioners in Saudi Arabia.

A Case-Based Implementation of Heart Failure Therapies, A Consensus Pathway by The Saudi Heart Failure Working Group

“…The addition of Vericiguat, an sGC stimulant, is recommended for patients with worsening HF with the maximum tolerated medical therapy [ 4 , 5 ]. The variegate can be considered an additional therapy in patients hospitalized with HF or outpatients with New York Heart Association (NYHA) Class II-IV [ 2 , 49 , 50 ] ( Fig. 8 ).…”

“…Cardiac resynchronization therapy (CRT) has been shown to reduce mortality and morbidity in HF [ 2 ]. The CRT is indicated in symptomatic HFrEF with LVEF <35%, with left bundle branch block and QRS duration of >150 ms after optimizing medical therapy [ 2 ].…”

“…The HF patients will progress to advanced stage D when they need to be evaluated for a heart transplant or durable left ventricle assist device. The following are the criteria that should prompt the referral for advanced HF therapies: NYHA III with recurrent emergency department visit >1 in 6 months, or recurrent hospital admission for HF, an escalating dose of diuretics, intolerant to medical therapy, inotrope dependent and refractory ventricular arrhythmia [ 2 , 4 , 5 ].…”

“…In clinical practice, a gap remains in implementing recommendations for optimizing GDMT for heart failure with reduced ejection fraction (HFrEF), defined as HF with an ejection fraction ≤40% [ 1 , 2 ]. This is due to multiple factors such as a variable patient profile, co-morbidities, difficulty of timely patient follow-up, and the increasing complexity of the treatment regimen [ 3 ].…”

“…The most recent HFrEF guidelines extend class I recommendations for four categories of HFrEF therapies [ 2 , 4 , 5 ]. These include the reninangiotensin-aldosterone system inhibitors (RAASi), beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter 2 inhibitors (SGLT-2i) [ 4 , 5 ].…”