2017 ACC/AHA/HFSA Focused Update of the 2013 …

1 CLINICAL PRACTICE GUIDELINE: Focused UPDATE2017 ACC/AHA/HFSA Focused Update ofthe2013 ACCF/AHAG uidelineforthe management of Heart FailureA Report of the american College of Cardiology/ american Heart AssociationTask Force on Clinical Practice Guidelines and the Heart Failure Society of AmericaDeveloped in Collaboration with the american Academy of Family Physicians, american College of Chest Physicians, and International Society for Heart and Lung TransplantationWritingGroupMembers*Clyde W. Yancy, MD, MSC, MACC, FAHA, FHFSA,ChairMariell Jessup, MD, FACC, FAHA,Vice ChairBiykem Bozkurt, MD, PHD, FACC, FAHA*yJaved Butler, MD, MBA, MPH, FACC, FAHA*zDonald E. Casey, JR, MD, MPH, MBA, FACCxMonica M.

2 Colvin, MD, FAHAkMark H. Drazner, MD, MSC, FACC, FAHA, FHFSAzGerasimos S. Filippatos, MD*Gregg C. Fonarow, MD, FACC, FAHA, FHFSA*zMichael M. Givertz, MD, FACC, FHFSA*{Steven M. Hollenberg, MD, FACC#JoAnn Lindenfeld, MD, FACC, FAHA, FHFSA*{Frederick A. Masoudi, MD, MSPH, FACC**Patrick E. McBride, MD, MPH, FACCyyPamela N. Peterson, MD, FACC, FAHAzLynne Warner Stevenson, MD, FACC*zCheryl Westlake, PHD, RN, ACNS-BC, FAHA, FHFSA{*Writing group members are required to recuse themselves from voting onsections to which their specific relationships with industry may apply; seeAppendix 1for detailed Task Force on ClinicalPracticeGuidelines Representative.{HFSA Representative.}}}}

3 #CHEST Representative.**ACC/AHA Task Force on Performance Measures document was approved by the american College of Cardiology Clinical Policy Approval Committee, the american Heart association ScienceAdvisory and Coordinating Committee, the american Heart association Executive Committee, and the Heart Failure Society of America ExecutiveCommittee in April american College of Cardiology requests that this document be cited as follows: Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM,Drazner MH, Filippatos GS, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN, Stevenson LW, Westlake ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the american College ofCardiology/ american Heart association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America.

4 J Am Coll ;70:776 article has been copublished inCirculationand theJournal of Cardiac : This document is available on the World Wide Web sites of the american College of Cardiology ( ), the american Heart association ( ), and the Heart Failure Society of America ( ). For copies of this document, please contact the Elsevier ReprintDepartment via fax (212-633-3820) or e-mail Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the expresspermission of the american College of Cardiology. Requests may be completed online via the Elsevier site ( ).JOURNAL OF THE american COLLEGE OF CARDIOLOGYVOL.

5 70, NO. 6, 2017 2017 BY THE american COLLEGE OF CARDIOLOGY FOUNDATION,THE american HEART association , INC., AND THE HEART FAILURE SOCIETY OF AMERICAISSN 0735-1097/$ BY ELSEVIERACC/AHA TaskForce MembersGlenn N. Levine, MD, FACC, FAHA,ChairPatrick T. O Gara, MD, FACC, FAHA,Chair-ElectJonathan L. Halperin, MD, FACC, FAHA,Immediate Past ChairzzSana M. Al-Khatib, MD, MHS, FACC, FAHAKim K. Birtcher, PHARMD, MS, AACCB iykem Bozkurt, MD, PHD, FACC, FAHAR alph G. Brindis, MD, MPH, MACCzzJoaquin E. Cigarroa, MD, FACCL esley H. Curtis, PHD, FAHALee A. Fleisher, MD, FACC, FAHAF ederico Gentile, MD, FACCS amuel Gidding, MD, FAHAMark A. Hlatky, MD, FACCJohn Ikonomidis, MD, PHD, FAHAJos Joglar, MD, FACC, FAHAS usan J.

6 Pressler, PHD, RN, FAHAD uminda N. Wijeysundera, MD, PHDzzFormer Task Force member; current member duringthe writing OF Methodology and Evidence Organization of the Writing Document Review and INITIAL AND SERIAL EVALUATION OF THEHF Biomarkers for Biomarkers for Biomarkers for Prognosis or Added RiskStratification: TREATMENT OF STAGES A TO Stage Pharmacological Treatment for Stage C HFWith Reduced Ejection Renin-Angiotensin System InhibitionWith Angiotensin-Converting EnzymeInhibitor or Angiotensin ReceptorBlocker or ARNI: Ivabradine: Pharmacological Treatment for Stage CHFpEF: IMPORTANT COMORBIDITIES IN Anemia: Hypertension(New Section).

7 Treating Hypertension to Reduce theIncidence of HF: Treating Hypertension in Stage C Treating Hypertension in Stage C Sleep-Disordered Breathing: 1 Author Relationships With Industry and Other Entities(Relevant)..798 APPENDIX 2 Reviewer Relationships With Industry andOther Entities (Comprehensive)..800 APPENDIX 1980, the american College of Cardiology (ACC) andAmerican Heart association (AHA) have translated scien-tific evidence into clinical practice guidelines (guidelines)with recommendations to improve cardiovascular guidelines, which are based on systematic methodsto evaluate and classify evidence, provide a cornerstonefor quality cardiovascular care.

8 The ACC and AHA sponsorthe development and publication of guidelines withoutcommercial support, and members of each organizationvolunteer their time to the writing and review are official policy of the ACC and UsePractice guidelines provide recommendations applicableto patients with or at risk of developing cardiovascularJACC VOL. 70, NO. 6, 2017 Yancyet 8, 2017:776 8032017 ACC/AHA/HFSA Heart Failure Focused Update777disease. The focus is on medical practice in the UnitedStates, but guidelines developed in collaboration withother organizations may have a global impact. Althoughguidelines may be used to inform regulatory or payer de-cisions, their intent is to improve patients quality of careand align with patients interests.

9 Guidelines are intendedto define practices meeting the needs of patients in most,but not all, circumstances and should not replace ImplementationGuideline recommended management is effective onlywhen followed by healthcare providers and to recommendations can be enhanced byshared decision making between healthcare providersand patients, with patient engagement in selecting in-terventions based on individual values, preferences, andassociated conditions and and ModernizationThe ACC/AHA Task Force on Clinical Practice Guidelines(Task Force) continuously reviews, updates, and mod-ifies guideline methodology on the basis of publishedstandards from organizationsincluding the Institute ofMedicine(1,2)and on the basis of internal , the presentation and delivery of guidelines arereevaluated and modified on the basis of evolvingtechnologies and other factors to facilitate optimaldissemination of information at the point of care tohealthcare professionals.

10 Given time constraints of busyhealthcare providers and the need to limit text, thecurrent guideline format delineates that each recom-mendation be supported by limited text (ideally,<250words) and hyperlinks to supportive evidence summarytables. Ongoing efforts to further limit text are under-way. Recognizing the importance of cost-value consid-erations in certain guidelines, when appropriate andfeasible, an analysis of the value of a drug, device, orintervention may be performed in accordance with theACC/AHA methodology(3).To ensure that guideline recommendations remaincurrent, new data are reviewed on an ongoing basis, withfull guideline revisions commissioned in approximately6-year cycles.