American College of Cardiology issues guide for managing in-patient heart failure

The American College of Cardiology has issued updated guidance on managing patients hospitalized for heart failure (HF) to provide a decision-making pathway that tailors therapy to clinical trajectory to better manage disease. The updated Expert Consensus Decision Pathway incorporates the latest evidence to provide guidance for clinicians to use at the point of care in conjunction with the 2022 ACC/AHA Heart Failure Guideline.

Heart failure refers to several conditions that can affect the way the heart works, its structure or both. Over time, heart failure makes it harder for the heart to pump enough blood and oxygen to meet your body’s needs. It affects nearly 6.7 million Americans, and that number continues to increase.

Inpatient admissions for HF are associated with high mortality—20% to 30% risk of death within one year—and readmissions and subsequent health events are common. HF symptoms often improve quickly during HF hospitalization, but episodes of worsening HF can mark a fundamental change in the HF trajectory.

“Clinicians should be assessing and optimizing therapy during a hospital stay to not only provide a good clinical response in the hospital but also to address a patient’s long-term trajectory after discharge,” said Steven Hollenberg, MD, FACC, ECDP writing committee chair and director of Cardiac Intensive Care at the Emory Heart & Vascular Center. “The updated ECDP places increased emphasis on establishing all four pillars of guideline-directed medical therapy (GDMT) for HFrEF in the hospital, when possible, along with ensuring appropriate follow-up to monitor tolerance and continue medication.”

The ECDP specifically addresses management strategies in patients with different short-term

clinical trajectories in the hospital, provides updates on alternative agents and dosing strategies for diuresis, updates communications and follow-up recommendations to incorporate telehealth, and provides additional emphasis on long-term disease trajectory, including care discussions and identification of patients who may need palliative care.

The 2024 ACC Expert Consensus Decision Pathway on Clinical Assessment, Management, and Trajectory of Patients Hospitalized With Heart Failure Focused Update is published in JACC, the flagship journal of the American College of Cardiology.

The American College of Cardiology (ACC) is the global leader in transforming cardiovascular care and improving heart health for all. As the preeminent source of professional medical education for the entire cardiovascular care team since 1949, ACC credentials cardiovascular professionals in over 140 countries who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. Through its world-renowned family of JACC Journals, NCDR registries, ACC Accreditation Services, global network of Member Sections, CardioSmart patient resources and more, the College is committed to ensuring a world where science, knowledge and innovation optimize patient care and outcomes. Learn more at www.ACC.org or follow @ACCinTouch.

The ACC’s JACC Journals rank among the top cardiovascular journals in the world for scientific impact. The flagship journal, the Journal of the American College of Cardiology (JACC) — and specialty journals consisting of JACC: Advances, JACC: Asia, JACC: Basic to Translational Science, JACC: CardioOncology, JACC: Cardiovascular Imaging, JACC: Cardiovascular Interventions, JACC: Case Reports, JACC: Clinical Electrophysiology and JACC: Heart Failure — pride themselves on publishing the top peer-reviewed research on all aspects of cardiovascular disease. Learn more at JACC.org.

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