2013 ACCF/AHA Guideline for the Management of Heart Failure COPYRIGHT
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1 2013 ACCF/AHA Guideline for the Management of Heart Failure by Clyde W. Yancy, Mariell Jessup, Biykem Bozkurt, Javed Butler, Donald E. Casey, Mark H. Drazner, Gregg C. Fonarow, Stephen A. Geraci, Tamara Horwich, James L. Januzzi, Maryl R. Johnson, Edward K. Kasper, Wayne C. Levy, Frederick A. Masoudi, Patrick E. McBride, John J.V. McMurray, Judith E. Mitchell, Pamela N. Peterson, Barbara Riegel, Flora Sam, Lynne W. Stevenson, W.H. Wilson Tang, Emily J. Tsai, and Bruce L. Wilkoff Circulation Volume 128(16):e240-e327 October 15, 2013
2 Applying Classification of Recommendation and Level of Evidence.
3 Recommendations for Biomarkers in HF.
4 From: BNP-Guided vs Symptom-Guided Heart Failure Therapy: The Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) Randomized Trial JAMA. 2009;301(4): doi: /jama Figure Legend: BNP indicates brain natriuretic peptide; LVEF, left ventricular ejection fraction. Date of download: 5/27/2014 Copyright 2014 American Medical Association. All rights reserved.
5 From: BNP-Guided vs Symptom-Guided Heart Failure Therapy: The Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) Randomized Trial JAMA. 2009;301(4): doi: /jama Figure Legend: BNP indicates brain natriuretic peptide. Error bars indicate standard error of the mean. P <.001 for the differences between the treatment groups for both age groups. Date of download: 5/27/2014 Copyright 2014 American Medical Association. All rights reserved.
6 From: BNP-Guided vs Symptom-Guided Heart Failure Therapy: The Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) Randomized Trial JAMA. 2009;301(4): doi: /jama Figure Legend: A, Symptoms expressed as NYHA class. B, N-terminal BNP levels. Boxes indicate interquartile range; horizontal lines, median; error bars, 10th and 90th percentiles. The improvements by both treatment strategies were significant in both age groups (all P <.001). There were no significant differences between the 2 treatment groups by age for symptoms (P =.11 for <75 years vs P =.38 for 75 years) or by N-terminal BNP level (P =.06 vs P =.30). Date of download: 5/27/2014 Copyright 2014 American Medical Association. All rights reserved.
7 From: BNP-Guided vs Symptom-Guided Heart Failure Therapy: The Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) Randomized Trial JAMA. 2009;301(4): doi: /jama Figure Legend: Relationship between New York Heart Association (NYHA) class and N-terminal BNP levels at visits from baseline to month 12 of all patients showing higher N-terminal BNP levels with higher NYHA class (Spearman r = 0.36, P<.001) and a trend to lower N-terminal BNP levels within each NYHA class from baseline to month 12 (NYHA I: Spearman r = 0.34, P =.001; NYHA II: Spearman r = 0.21, P<.001; NYHA III: Spearman r = 0.15, P<.001; NYHA IV: Spearman r = 0.04, P =.69). Date of download: 5/27/2014 Copyright 2014 American Medical Association. All rights reserved.
8 From: BNP-Guided vs Symptom-Guided Heart Failure Therapy: The Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) Randomized Trial JAMA. 2009;301(4): doi: /jama Figure Legend: NT-BNP indicates N-terminal brain natriuretic peptide; CI, confidence interval; HF, heart failure; HR, hazard ratio. Date of download: 5/27/2014 Copyright 2014 American Medical Association. All rights reserved.
9 From: BNP-Guided vs Symptom-Guided Heart Failure Therapy: The Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) Randomized Trial JAMA. 2009;301(4): doi: /jama Figure Legend: The differences between treatment groups were observed only in younger but not older patients. NT-BNP indicates N-terminal brain natriuretic peptide; CI, confidence interval; HF, heart failure; HR, hazard ratio. Date of download: 5/27/2014 Copyright 2014 American Medical Association. All rights reserved.
10 From: BNP-Guided vs Symptom-Guided Heart Failure Therapy: The Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) Randomized Trial JAMA. 2009;301(4): doi: /jama Figure Legend: Subgroup analysis between the age groups was prespecified. Values for body mass index (BMI, calculated as weight in kilograms divided by height in meters squared), N-terminal BNP, and creatinine were subdivided by median values. The size of the data markers represents the number of patients in each group. BNP indicates brain natriuretic peptide; CI, confidence interval; HF, heart failure; HR, hazard ratio. a P <.05 for interaction. b P <.10 for interaction. Date of download: 5/27/2014 Copyright 2014 American Medical Association. All rights reserved.
11 From: B-Type Natriuretic Peptide Guided Heart Failure Therapy: A Meta-analysis Arch Intern Med. 2010;170(6): doi: /archinternmed Figure Legend: Quality of Reporting of Meta-analyses (QUOROM) flow diagram. ANP indicates atrial natriuretic; BNP, B-type natriuretic peptide; CNP, C-type natriuretic peptide; HF, heart failure; RCT, randomized controlled trial. Date of download: 5/27/2014 Copyright 2014 American Medical Association. All rights reserved.
12 From: B-Type Natriuretic Peptide Guided Heart Failure Therapy: A Meta-analysis Arch Intern Med. 2010;170(6): doi: /archinternmed Figure Legend: All-cause mortality meta-analysis of individual trials. Fixed-effects model (χ 2 = 3.75; P =.59). CI indicates confidence interval. Date of download: 5/27/2014 Copyright 2014 American Medical Association. All rights reserved.
13 From: B-Type Natriuretic Peptide Guided Heart Failure Therapy: A Meta-analysis Arch Intern Med. 2010;170(6): doi: /archinternmed Figure Legend: Funnel plot of individual trials (filled circles) contributing to all-cause mortality meta-analysis. RR indicates relative risk. Date of download: 5/27/2014 Copyright 2014 American Medical Association. All rights reserved.
14 From: B-Type Natriuretic Peptide Guided Heart Failure Therapy: A Meta-analysis Arch Intern Med. 2010;170(6): doi: /archinternmed Figure Legend: Fixed-effects models. A, All-cause hospitalization meta-analysis of individual trials (χ 2 = 0.78; P =.68); B, survival free of any hospitalization meta-analysis of individual trials (χ 2 = 0.00; P =.98). CI indicates confidence interval. The size of squares reflects weighting for each study. The diamonds indicate the overall results, with the middle being the RR and the outer tips reflecting the 95% CIs around the result. Date of download: 5/27/2014 Copyright 2014 American Medical Association. All rights reserved.
15 From: B-Type Natriuretic Peptide Guided Heart Failure Therapy: A Meta-analysis Arch Intern Med. 2010;170(6): doi: /archinternmed Figure Legend: Patients having medical treatment adjustment. A, Percentage of patients having doses of medication increased; B, percentage change of patients reaching target dose. ACE indicates angiotensin-converting enzyme; BNP, B-type natriuretic peptide. Date of download: 5/27/2014 Copyright 2014 American Medical Association. All rights reserved.
16 Recommendations for Noninvasive Cardiac Imaging.
17 Recommendations for Invasive Evaluation.
18 Recommendations for Treatment of Stage B HF.
19 Stage C HFrEF: evidence-based, guideline-directed medical therapy.
20 Recommendations for Pharmacological Therapy for Management of Stage C HFrEF.
21 Recommendations for Treatment of HFpEF.
22 Recommendations for Device Therapy for Management of Stage C HF.
23 Indications for CRT therapy algorithm.
24 Recommendations for Inotropic Support, MCS, and Cardiac Transplantation.
25 Stages in the development of HF and recommended therapy by stage.
26 Classification of patients presenting with acutely decompensated heart failure.
27 Recommendations for Therapies in the Hospitalized HF Patient.
28 Recommendations for Hospital Discharge.
29 Pharmacological management of patients with newly discovered AF. AF indicates atrial fibrillation; and HF, heart failure.
30 Pharmacological management of patients with recurrent paroxysmal AF. AF indicates atrial fibrillation.
31 Recommendations for Surgical/Percutaneous/Transcatheter Interventional Treatments of HF.
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