ACC shares updated recommendations for managing HFpEF
Rates of heart failure (HF) in the United States are stable or even beginning to decline. When it comes to HF with preserved ejection fraction (HFpEF), however, the numbers are on the rise.
This prompted the American College of Cardiology (ACC) to create an expert consensus decision pathway document focused on the efficient management of HFpEF patients.[1]
The new document represents an update of the ACC's 2023 recommendations, exploring new data to provide an abbreviated, practical guidance for patient management. The format was revised to associate treatment algorithms and tables to match the evolving clinical evidence.
Despite advances in HF therapy, it remains a major consumer of healthcare resources and death worldwide. HFpEF accounts for more than 50% of new cases of HF each year and has outcomes comparable to heart failure with reduced ejection fraction (HFrEF). However, the consensus authors said HFpEF is often underdiagnosed and results in substantial resource utilization.
"Historically, a dearth of effective options have been available to improve quality of life and reduce morbidity in HFpEF. However, the conceptual framework of HFpEF has evolved to a complex, multisystem syndrome driven by visceral adiposity, inflammatory adipokines and metabolic dysfunction, with recognition of distinct phenotypic subgroups," wrote lead author Michelle M. Kittleson, MD, a professor of medicine at Cedars-Sinai, and director of education in heart failure and transplantation at the Smidt Heart Institute, and colleagues.
Remarkable advances in the past decade have yielded novel, effective interventions, according to Kittleson, et al. However, there is an increasing urgency for earlier, accurate diagnoses, so optimal medical therapy can be initiated sooner to better manage new HFpEF cases.
They cite favorable clinical trials, particularly with sodium glucose-cotransporter 2 (SGLT2) inhibitors, nonsteroidal mineralocorticoid receptor antagonists (MRA), and incretin-based therapies. Additionally, these agents show evidence of additional cardiovascular-kidney-metabolic benefits.
"These pivotal advances in HFpEF motivated this update to the 2023 expert consensus decision pathway," the authors wrote.
The document includes a section of sex-specific considerations for HFpEF in women versus men. This includes different biomarkers, such as lower natriuretic peptide levels in women, compared to higher high sensitivity troponin in men. The list of specific risk factors that mainly impact women includes menopause, infertility, preeclampsia, heightened inflammation and microvascular disease.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]