Updated heart failure guidelines focus on key research findings, clinical advances

Mar 29 2009

Updated guidelines on the diagnosis and management of heart failure will help physicians incorporate the latest research findings into the treatment of patients with this complex and disabling disease.

The guidelines update was a joint effort of the American College of Cardiology (ACC) and the American Heart Association (AHA), and was accomplished in collaboration with the International Society for Heart and Lung Transplantation. The new document, a focused revision of guidelines released in 2005, publishes online today in the Journal of the American College of Cardiology (JACC) and Circulation: Journal of the American Heart Association.

"Heart failure is the number one reason patients over the age of 65 are hospitalized, and is responsible for a huge portion of the costs associated with cardiovascular disease," said Mariell Jessup, M.D., chair of the guidelines writing group and a professor of medicine at the University of Pennsylvania School of Medicine in Philadelphia. "We want to be sure the guidelines are current and timely, and reflect the latest data on the management of this important condition."

In heart failure, the heart does not do an adequate job circulating blood throughout the body. In one type of heart failure, the heart is enlarged and weak. It is therefore unable to squeeze enough blood out into the blood vessels with each beat. In another form of heart failure, the walls of the heart become stiff so that the heart is unable to relax and fill with enough blood between beats. In either case, fluid backs up into the lungs and the rest of the body, causing shortness of breath, swelling of the limbs and other symptoms.

Some 5.7 million Americans have heart failure, a condition that accounts for more than 1.1 million hospitalizations each year. One in five people die within a year of being diagnosed with heart failure. In 2009, it is estimated that total costs associated with heart failure will reach $37.2 billion.

The new document includes several key updates, including the following:

• An entirely new section on managing patients who are hospitalized with acute heart failure, including how to establish the cause of heart failure; the types of assessments to perform throughout the hospitalization; and how to help patients successfully transition to home care, including a new medication regimen and an action plan for detecting signs of trouble and seeking medical attention right away
• Strengthened recommendations on two medications, hydralazine and isosorbide dinitrate, which relieve pressure on the heart by relaxing blood vessels and are particularly effective in African Americans
• Streamlined information on the use of implantable cardioverter-defibrillators (ICDs)—which prevent sudden cardiac death—and cardiac resynchronization devices—which improve symptoms and outcomes in some patients with heart failure by helping the two sides of the heart to beat in a more coordinated fashion
• Clarification of treatment goals in patients with both heart failure and atrial fibrillation, a common heart rhythm disorder

"These guidelines strive to reflect the most recent information coming out of clinical trials on heart failure," said Dr. Jessup, who is also director of the Heart Failure and Transplant Program of the University of Pennsylvania Health System in Philadelphia. "They also bring a new focus to patients hospitalized with heart failure. We look forward to continued research developments, so that the next update will be even more useful for guiding physicians."