Comprehensive review of the heart failure management guidelines presented by the American College of Cardiology and the current supporting evidence.

Abstract

Context: Heart failure (HF) is a chronic condition that affects the heart's functional capacity, resulting in symptoms such as fatigue, edema, and dyspnea. It affects millions of adults in the United States and presents challenges in optimizing treatment and coordinating care among clinicians. Additionally, the various classifications for HF and limited research on treatment outcomes in heart failure with midrange ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF) further complicate the pharmacological management of patients with this disease.

Objectives: The objectives of this article are to review the pharmacotherapy guidelines for HF provided by the American College of Cardiology (ACC) and offer an update on the current trials conducted on these agents.

Methods: The paper includes a post hoc analysis of established randomized controlled trials (RCTs), current RCTs, analysis of HF registries, and the guidelines published by the ACC. The gathering of research began in June 2023 and completed in August 2023. PubMed was utilized with the following search items: "treatment for HFrEF" (heart failure with reduced ejection fraction), "treatment for HFmrEF," and "treatment for HFpEF." The screening process was completed by one author. The automation tools utilized were "clinical trials," "randomized control trials," and "five years". Meta-analyses, systematic reviews, and case reports were excluded from the screening process. This review does not include research regarding medical devices, interventional therapies, and lifestyle modifications. Finally, research regarding additional comorbidities, nonpharmacological focused research, and agents not recommended by the ACC are not included in this paper.

Results: The search began with 6,561 records identified from PubMed, with 407 records screened after automation tools were utilized to filter for "clinical trials," "randomized control trials," "one year," and "five years". A total of 22 duplicates were reviewed, 318 were sought for screening after trials from 2019 were removed, and 31 studies were ultimately included in the review. A detailed summary of the most recent recommendations by the ACC are provided. The discussion includes indications, mechanisms of action, side effects, and contraindications for the selected agents. Additionally, recent clinical trials are included to provide evidence on the efficacy of the recommended classes of drugs.

Conclusions: The current guidelines for managing HFrEF have been consistent, but there is limited consensus on treating HFmrEF and HFpEF. Large RCTs have provided compelling evidence supporting the use of the recommended pharmacological agents. However, despite the new effective treatment protocols, slow clinical inertia and underoptimization of HF management persist. Thus, it is crucial to synchronize care among clinicians involved in managing patients with this disease.