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Category: Heart Failure

ACCF/AHA Guideline for the Management of Heart Failure Updated in Light of New Treatment Options

An update to the 2013 ACCF/AHA Guideline for the Management of Heart Failure was recently released to reflect the addition of two new pharmacotherapeutic options in the treatment of heart failure: valsartan/sacubitril, an angiotensin receptor-neprilysin inhibitor (ARNI) and ivabradine, a sinoatrial node modulator. The update clarifies that patients with chronic symptomatic HF with reduced ejection fraction should be given a regimen consisting of an ACE inhibitor or ARB or ARNI along with a beta blocker and an aldosterone antagonist. ARNIs should replace ACE inhibitors or ARBs when stable patients with mild-to-moderate HF on those therapies have an adequate blood pressure and are otherwise tolerating standard therapies well. According to Clyde W. Yancy, MD, MSc, MACC, who chaired the writing committee, “Not every patient is a good candidate for every drug; these guidelines can help physicians decide who best fits which treatment. This document details the benefits and risks of these new therapies so that patients at high risk can be directed towards alternative therapies.”

American College of Cardiology. Societies release focused update for HF management. May 20, 2016.

2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: an Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol. 2016; doi:10.1016/j.jacc.2016.05.011.

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Proposed Quality Measure Will Ensure African Americans with Heart Failure Receive the Standard of Care

A new quality measure has been submitted for consideration by the National Minority Quality Forum (NMQF) to the National Quality Forum (NQF), that if approved, will help ensure that African Americans living with heart failure (HF) will not die prematurely because they are not receiving the standard of care. Public comment began on July 23 and members of the general public are encouraged to support the proposal and comment by August 12 via the NQF’s webpage.

This past March, Dr. Keith C. Ferdinand spoke on the prevalence and severity of HF in African Americans at the Best of the CMHC Regional Conference Series.

“The harsh reality is that African Americans suffer from earlier onset and more prevalent and severe heart failure, with higher readmissions,” Dr. Ferdinand said. “These real and unfortunate disparities demand the appropriate application of evidence-based, guideline-supported pharmacotherapy in blacks. Clinicians, public health leaders, and policymakers cannot overlook this necessary responsibility to ensure the best therapy for all patients where indicated.” Plan on attending the 10th Annual CMHC Boston, October 21-24, 2015 to hear more perspective on the topic.

The new quality measure is fully supported by the Association of Black Cardiologists as well as ACC/AHA guidelines and emphasizes the importance of adherence to the current standard of care for African Americans with HF. More than 550,000 African Americans are living with HF, of whom more than 150,000 should be prescribed fixed-dose hydralazine and isosorbide dinitrate, a drug regimen proven to reduce mortality in African Americans by 43% and first-time hospitalizations for HF by 33%.

Few, however, are actually receiving this regimen. According to Dr. Gary Puckrein, CEO of the NMQF and the proposed measure’s steward, “Astonishingly, only a very small portion, about 7%, of African Americans who are clinically eligible for the therapy are getting it.”

View Dr. Keith Ferdinand’s One-Minute Clinician video interview for more insight.

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