147 - Key Recommendations from the 2022 AHA/ACC/HFSA Heart Failure Guidelines

HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast

Sean P. Kane, PharmD, BCPS

Health & Fitness, Medications, Rosalindfranklin, Rfums, Pharmacy, Pharmd, Pharmacist, Medicine, Drugs

5 • 644 Ratings

🗓️ 3 May 2022

⏱️ 48 minutes

🔗️ Recording | iTunes | RSS

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Summary

In this episode, we review new updates and key concepts from the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. This guideline is newly published (April 2022) and is a full update of the 2013 guidelines and the 2017 focused update for heart failure.

Key Concepts

Heart failure is classified as HFrEF (heart failure with reduced ejection fraction <= 40%), HFimpEF (with improved ejection fraction – was <=40% but is now > 40%), HFmrEF (ejection fraction 41% to 49% with increased LV filling pressures), and HFpEF (preserved ejection fraction >= 50% with increased LV filling pressures). Most drug therapy recommendations are similar for HFrEF, HFimpEF, and HFmrEF whereas HFpEF therapies are different.
The 2022 AHA/ACC/HFSA heart failure guidelines now recommend SGLT2 inhibitors, such as dapagliflozin and empagliflozin, in patients with HFrEF, HFmrEF, and HFpEF.
The 2022 AHA/ACC/HFSA heart failure guidelines continue to prefer ARNi, such as sacubitril/valsartan (Entresto), over ACE inhibitors and ARBs in patients with HFrEF. Based on the PARAGON-HF trial, ARNi is also recommended in those with HFpEF albeit with a weak recommendation.
Avoiding excessive dietary sodium is reasonable to reduce congestive symptoms in patients with heart failure; however, guidelines do not recommend a specific maximum intake nor does data support clinical outcome benefit with dietary sodium restriction.

References

Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines [published online ahead of print, 2022 Apr 1]. Circulation. 2022;101161CIR0000000000001063. doi:10.1161/CIR.0000000000001063. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
Ezekowitz JA, Colin-Ramirez E, Ross H, et al. Reduction of dietary sodium to less than 100 mmol in heart failure (SODIUM-HF): an international, open-label, randomised, controlled trial. Lancet. 2022;399(10333):1391-1400. doi:10.1016/S0140-6736(22)00369-5

Transcript

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0:00.0	Welcome to Helix Talk, an educational podcast for healthcare students and providers covering real-life clinical pearls, professional pharmacy topics, and drug therapy discussions.
0:11.0	This podcast is provided by pharmacists and faculty members at Rosal Franklin University College of Pharmacy.
0:17.0	This podcast contains general information for educational purposes only. This is not professional
0:22.4	advice and should not be used in lieu of obtaining advice from a qualified health care provider.
0:27.1	And now on to the show. Welcome to Helix Talk episode 147. I'm your co-host Dr. Kane.
0:35.5	And I'm Dr. Vattal. And the title of today's episode is key recommendations from the 2022 AHA, ACC, HFSA, Heart Failure Guidelines.
0:45.5	So clearly we're talking about these brand new guidelines that have been recently posted.
0:50.0	And we're going to go through some of the most important clinical pearls and what you need to know from those guidelines.
0:55.8	And I believe Dr. Kane, there was a full update of heart failure guidelines back in 2013.
1:02.3	And then a focus update came out in 2017.
1:06.0	But as we know, there has been mounting evidence for particularly SGGLT2 inhibitors that needed to be included
1:13.4	and the guidelines needed to be updated. So here we are with the 2022 full guideline update that
1:20.0	was released in April. So it's fresh off the press actually. Exactly. And I just want to highlight
1:25.9	this is a full guideline update. So they literally went
1:28.9	A to Z in terms of all of the recommendations. This is not just a tweak or a minor update. And they actually
1:35.1	said in the document that moving forward, their plan is to update sections or what they call
1:40.5	chunks of the guideline as new evidence comes out as opposed to what they have
1:44.9	been doing which are those kind of focused updates followed by their full updates so they are planning
1:50.0	to change how they release the updates but this particular 2022 guideline is the full shabang a to z
1:56.9	and for the listeners if you want to go through all 100-something pages of the guidelines,
2:01.0	they're linked in our show notes, helixtalk.com.
2:04.1	And then again, this is episode 147.
	...

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