Heart failure guidelines revised for the first time in 6 yrs

New heart failure treatment guideline recommends the use of SGLT-2 in treatment

The Korean Society of Heart Failure (KSHF) published “Completely Revised Heart Failure Clinical Practice Guidelines 2022”

Patients with a Cardiac ejection fraction rate of 41-49% were reclassified as “Heart Failure with mildly reduced EF (HFmrEF)”

SGLT-2 inhibitor·ARNI recommended as the first-line standard of care in heart failure with reduced ejection fraction

The clinical practice guidelines for heart failure have been completely revised for the first time in 6 years.

 

The new guideline contains all the latest drugs ranging from SGLT-2 inhibitors that demonstrated an effect in heart failure, angiotensin receptor-neprilysin inhibitors (ARNIs) that are represented by the Entresto, to the recently approved vericiguat.

 

On the 22nd, the Korean Society of Heart Failure (KSHF) held an online press conference to celebrate the publication of the “Completely Revised Heart Failure Clinical Practice Guidelines 2022,” and announced the significance of the revision and the 10 important changes that were made.

 

KSHF presents the “Completely Revised Heart Failure Clinical Practice Guidelines 2022,”

The guideline had been completely revised for the first time in 6 years.

 

The development of the Korean heart failure clinical practice guidelines started in 2016 when the KSHF first published a guideline for chronic heart failure, and then for acute heart failure in 2017.

 

The guidelines underwent two partial updates in 2018 and 2020.

 

Completely Revised Heart Failure Clinical Practice Guidelines 2022” consists of 64 chapters and 300 pages that reflect all the changes that were made over the past 5-6 years as well as the latest Korean and global research results.

 

The major revisions include ▲the Definition and Classification of HF ▲HF diagnosis algorithm ▲Treatment of HF with reduced ejection fraction, ▲Changes in the roles of HF medicines (focusing on ARNI and SGLT2) ▲HF patients with improved ejection fraction ▲Treatment of HFmrEF and HFpEH ▲Treatment of comorbidities in HF patients ▲ Diagnosis and Treatment of cardiac amyloidosis ▲Period for transferring HF patients to tertiary hospitals or HF specialists ▲Treatment of acute HF patients and severe HF.

 

The revision first made a more detailed classification and definition of HF.

 

In the past, patients with an ejection fraction rate of 41-49% were considered to have a similar condition to “heart failure with preserved ejection fraction (HFpEF).” However, with studies reporting that the patient group shows similar drug treatment effects with the “Heart Failure with reduced EF (HFrEF)” group, the KSHF decided to classify the patient group as “Heart Failure with mildly reduced EF (HFmrEF)” The society also presented appropriate treatment methods in line with the newly set HF classification, as new treatments were introduced to treat HFpEF, a field that had high unmet needs with no suitable available treatment.

 

While reflecting the international HF guidelines, such as those that were revised in the US in April 2022 and Europe in 2021, KSHF provided a standardized, optimal HF treatment guideline for Koreans whose recommendations align with the contents necessary and real to Korea.

 

Source : KSHF

In the guidelines, ARNI (angiotensin receptor-neprilysin inhibitors) or angiotensin-converting enzyme inhibitor (angiotensin receptor blocker for intolerant patients), beta blocker, saline corticoid receptor antagonist (aldosterone antagonist), and SGLT-2 inhibitors were recommended (Class I, Level of Evidence) as first-line standard of care in HFrEF.

 

SGLT-2 inhibitors were recommended for administration regardless of the patient’s diabetic status to reduce hospitalization from HF or cardiovascular deaths.

 

In addition, the new guidelines recommended patients continue receiving the standard of care treatment even if the patient’s symptoms improve and EF increases to 40% or higher after standard of care.

 

(Class I, Level of Evidence B).

 

If EF continues to decrease despite standard drug therapy, the guidelines recommend treatments such as ivabradine, vericiguat, or digoxin as second-line treatments Also, diuretics, SGLT2 inhibitors, and ARNIs were recommended as primary treatments for HFmrEF and HFpEF, In the HFmrEF and HFpEF group, diuretics and SGLT2 inhibitors (empagliflozin or dapagliflozin) were recommended as a priority (Class I), and ARNI was then recommended (Class IIa, Level of Evidence B) Hyun-Jae Cho, Director of Clinical Practice Guidelines in KSHF (Professor of Cardiology at SNUH), said, “The revised guidelines contain updated definition and classification of HF that is more detailed than before.

 

The changed treatment methods and drug recommendations are also included in detail.”