New ACC/AHA Guidelines for Heart Failure Released

Improving clinic and hospital adherence with evidence-based guidelines for HF is key to reducing avoidable hospitalization and rehospitalization in the US. On April 15th, The American College of Cardiology and the American Heart Association announced the release of updated guidelines for the diagnosis and management of heart failure.

The new document is a revision of HF guidelines released in 2005. Key updates in this document include:

- An entirely new section on managing patients who are hospitalized with acute heart failure, including how to establish the cause of heart failure; the types of assessments to perform throughout the hospitalization; and how to help patients successfully transition to home care, including a new medication regimen and an action plan for detecting signs of trouble and seeking medical attention right away

- Strengthened recommendations on two medications, hydralazine and isosorbide dinitrate, which relieve pressure on the heart by relaxing blood vessels and are particularly effective in African Americans

- Streamlined information on the use of implantable cardioverter-defibrillators (ICDs)—which prevent sudden cardiac death—and cardiac resynchronization devices—which improve symptoms and outcomes in some patients with heart failure by helping the two sides of the heart to beat in a more coordinated fashion

- Clarification of treatment goals in patients with both heart failure and atrial fibrillation, a common heart rhythm disorder

Today, heart failure is the number one cause of hospitalization for patients 65 and older. In 2005, Medicare beneficiaries with heart failure accounted for 37 percent of all Medicare spending and nearly 50 percent of all hospital inpatient costs. Frequently, poorly performing hospitals lack a systematic process for evaluating each patient via accepted guidelines. Additionally, many clinic and hospital teams and professionals are not well-prepared for improvement--particularly the delivery of evidence-based self-management support or health coaching interventions. Consequently patients end up rehospitalized because they are discharged without medications known to prevent recurrent heart attacks, confused about how to take their medications, or uncertain about which warning signs to watch for, or what to do when they appear. Many struggle with difficult, but essential lifestyle changes.

Since 2000, the American Heart Association's Get With the Guidelines (GWTG) program has been used to improve hospital performance and reduce health care disparities related to heart disease. Get with the Guidelines is chaired by Gregg Fonarow, associate chief of cardiology at the University of California Los Angeles Medical Center. Dr. Fonarow has also co-chaired ImproveHF, the largest outpatient HF performance improvement program to date, as well as the follow-up SCA Prevention program. HealthSciences Institute designed and facilitated performance improvement work sessions and tools for the cardiology clinics participating in ImproveHF. Additionally, Dr. Blake Andersen, HealthSciences Institute's President and CEO, co-facilitates a series of national performance improvement work sessions with Dr. Fonarow for US cardiology practices and hospitals through the national SCA Prevention program. Both programs are sponsored by Medtronic. The new HF guidelines are available free online in the Journal of the American College of Cardiology.  

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