Interpretation of 2022 AHA/ACC/HFSA guideline for the management of heart failure : New concepts of heart failure and cardiac surgery concerns_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MENG Yanhai ^1,2 , ZHANG Yanbo ¹ , LIU Ping ¹ , LU Zhengyang ³ , ZHU Changsheng ³ ,  WANG Shuiyun ³

1. Surgery Intensive Care Unit, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;
2. Surgery Intensive Care Unit, Fuwai Yunnan Cardiovascular Hospital, Kunming, 650021, P. R. China;
3. Adult Surgery Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;

Corresponding author：

WANG Shuiyun, Email: wsymd@sina.com

Keywords：

Heart failure; stage of heart failure; value statements; guideline; interpretation

DOI：

10.7507/1007-4848.202204031

Video：

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The "2022 AHA/ACC/HFSA guideline for the management of heart failure" replaces the "2013 ACCF/AHA guideline for the management of heart failure" and the "2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure". The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose and manage patients with heart failure. Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to manage patients with heart failure, with the intent to improve quality of care and align with patients’ interests. New recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses. This article summarized and interpreted the new concept of heart failure in 2022 guidelines, especially the new evidence and suggestions related to cardiac surgery.

Citation： MENG Yanhai, ZHANG Yanbo, LIU Ping, LU Zhengyang, ZHU Changsheng, WANG Shuiyun. Interpretation of 2022 AHA/ACC/HFSA guideline for the management of heart failure : New concepts of heart failure and cardiac surgery concerns. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(6): 676-683. doi: 10.7507/1007-4848.202204031 Copy

1.	Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2022: 101063C-101161C.
2.	Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2013, 128(16): e240-e327.
3.	Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation, 2017, 136(6): e137-e161.
4.	中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018. 中华心力衰竭和心肌病杂志(中英文), 2018, 2(4): 196-225.
5.	Rywik TM. [Summary of the article: Zannad F, McMurray JJV, Krum H et al. ; for the EMPHASIS-HF Study Group. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med, 2011; 364: 11-21]. Kardiol Pol, 2011, 69(6): 631-632.
6.	McMurray JJV, Solomon SD, Inzucchi SE. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med, 2019, 381(21): 1995-2008.
7.	Packer M, Januzzi JL, Ferreira JP, et al. Concentration-dependent clinical and prognostic importance of high-sensitivity cardiac troponin T in heart failure and a reduced ejection fraction and the influence of empagliflozin: The EMPEROR-Reduced trial. Eur J Heart Fail, 2021, 23(9): 1529-1538.
8.	Armstrong PW, Pieske B, Anstrom KJ, et al. Vericiguat in patients with heart failure and reduced ejection fraction. N Engl J Med, 2020, 382(20): 1883-1893.
9.	Velazquez EJ, Lee KL, Jones RH, et al. Coronary-artery bypass surgery in patients with ischemic cardiomyopathy. N Engl J Med, 2016, 374(16): 1511-1520.
10.	Velazquez EJ, Lee KL, Deja MA, et al. Coronary-artery bypass surgery in patients with left ventricular dysfunction. N Engl J Med, 2011, 364(17): 1607-1616.
11.	Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e72-e227.
12.	潘文志, 龙愉良, 周达新, 等. 经导管二尖瓣缘对缘修复(TEER)的过去、现在和未来. 中国胸心血管外科临床杂志, 2021, 28(12): 1409-1414.
13.	Obadia JF, Messika-Zeitoun D, Leurent G, et al. Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med, 2018, 379(24): 2297-2306.
14.	潘文志, 金沁纯, 周达新. 房性功能性二尖瓣反流的定义及经导管缘对缘修复术对其治疗的可行性. 华西医学, 2021, 36(9): 1172-1176.
15.	Clavel MA, Magne J, Pibarot P. Low-gradient aortic stenosis. Eur Heart J, 2016, 37(34): 2645-2657.
16.	Spitzer E, Van Mieghem NM, Pibarot P, et al. Rationale and design of the transcatheter aortic valve replacement to unload the left ventricle in patients with advanced heart failure (TAVR UNLOAD) trial. Am Heart J, 2016, 182: 80-88.
17.	Bozkurt B, Coats AJ, Tsutsui H, et al. Universal definition and classification of heart failure: A report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure. J Card Fail, 2021, pub ahead of print.
18.	Wang J, Zhou W, Yin X. Improvement of hyponatremia is associated with lower mortality risk in patients with acute decompensated heart failure: A meta-analysis of cohort studies. Heart Fail Rev, 2019, 24(2): 209-217.
19.	肖小菊, 黎励文. 《心力衰竭的通用定义和分类》解读. 中国胸心血管外科临床杂志, 2021, 28(10): 1140-1144.

1. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2022: 101063C-101161C.
2. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2013, 128(16): e240-e327.
3. Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation, 2017, 136(6): e137-e161.
4. 中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018. 中华心力衰竭和心肌病杂志(中英文), 2018, 2(4): 196-225.
5. Rywik TM. [Summary of the article: Zannad F, McMurray JJV, Krum H et al. ; for the EMPHASIS-HF Study Group. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med, 2011; 364: 11-21]. Kardiol Pol, 2011, 69(6): 631-632.
6. McMurray JJV, Solomon SD, Inzucchi SE. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med, 2019, 381(21): 1995-2008.
7. Packer M, Januzzi JL, Ferreira JP, et al. Concentration-dependent clinical and prognostic importance of high-sensitivity cardiac troponin T in heart failure and a reduced ejection fraction and the influence of empagliflozin: The EMPEROR-Reduced trial. Eur J Heart Fail, 2021, 23(9): 1529-1538.
8. Armstrong PW, Pieske B, Anstrom KJ, et al. Vericiguat in patients with heart failure and reduced ejection fraction. N Engl J Med, 2020, 382(20): 1883-1893.
9. Velazquez EJ, Lee KL, Jones RH, et al. Coronary-artery bypass surgery in patients with ischemic cardiomyopathy. N Engl J Med, 2016, 374(16): 1511-1520.
10. Velazquez EJ, Lee KL, Deja MA, et al. Coronary-artery bypass surgery in patients with left ventricular dysfunction. N Engl J Med, 2011, 364(17): 1607-1616.
11. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e72-e227.
12. 潘文志, 龙愉良, 周达新, 等. 经导管二尖瓣缘对缘修复(TEER)的过去、现在和未来. 中国胸心血管外科临床杂志, 2021, 28(12): 1409-1414.
13. Obadia JF, Messika-Zeitoun D, Leurent G, et al. Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med, 2018, 379(24): 2297-2306.
14. 潘文志, 金沁纯, 周达新. 房性功能性二尖瓣反流的定义及经导管缘对缘修复术对其治疗的可行性. 华西医学, 2021, 36(9): 1172-1176.
15. Clavel MA, Magne J, Pibarot P. Low-gradient aortic stenosis. Eur Heart J, 2016, 37(34): 2645-2657.
16. Spitzer E, Van Mieghem NM, Pibarot P, et al. Rationale and design of the transcatheter aortic valve replacement to unload the left ventricle in patients with advanced heart failure (TAVR UNLOAD) trial. Am Heart J, 2016, 182: 80-88.
17. Bozkurt B, Coats AJ, Tsutsui H, et al. Universal definition and classification of heart failure: A report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure. J Card Fail, 2021, pub ahead of print.
18. Wang J, Zhou W, Yin X. Improvement of hyponatremia is associated with lower mortality risk in patients with acute decompensated heart failure: A meta-analysis of cohort studies. Heart Fail Rev, 2019, 24(2): 209-217.
19. 肖小菊, 黎励文. 《心力衰竭的通用定义和分类》解读. 中国胸心血管外科临床杂志, 2021, 28(10): 1140-1144.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Interpretation of 2022 AHA/ACC/HFSA guideline for the management of heart failure : New concepts of heart failure and cardiac surgery concerns

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