A closer look at the new heart failure guidelines

Aug 26, 2023

A closer look at the new heart failure guidelines

A new set of recommendations aimed at helping doctors prevent and manage heart failure expand the focus on people at risk or showing early signs of the condition. Find out what you need to know about the new guidelines on House Calls: Real Docs, Real Talk.

House Calls: Real Docs, Real Talk episodes feature conversations with American Heart Association staff and medical experts on topics important to heart attack and stroke patients or anyone looking to live a longer, healthier life.

0:00 Introduction
3:30 How will the new heart failure guidelines improve patient care?
5:00 What are the stages of heart failure?
6:42 What is the difference between reduced ejection fraction and preserved ejection fraction?
7:53 What types of medications could be prescribed for a heart failure patient with reduced ejection fraction?
9:25 What role can caregivers play in the management of heart failure?
11:35 Is there a medication for heart failure patients with preserved ejection fraction?
12:27 What is the role of a specialty care team for someone with advanced heart failure?
13:12 What are the recommendations for heart failure prevention?

Content

1.729 -> (upbeat music)

27.09 -> - Hello, and welcome to House Calls: Real Docs, Real Talk.

30.06 -> I'm your host, Marcedes Fuller.

31.93 -> Today we're going to take a deep dive

34.24 -> into the new heart failure guidelines

36.93 -> that the American Heart Association just released.

40.26 -> These new guidelines wIll have a profound impact

43.97 -> on the healthcare landscape.

45.88 -> So let's get started.

47.49 -> With me this morning is Dr. Biykem Bozkurt.

50.92 -> She is the Professor of Medicine

52.83 -> at Baylor College of Medicine in Houston.

55.85 -> Welcome Dr. Bozkurt,

57.12 -> it's great to have you this morning.

58.81 -> - Thank you.

59.643 -> It's a great pleasure for me to be here.

62.07 -> - Absolutely. Let's get started

64.37 -> with some health in the headlines.

67.771 -> (upbeat music)

75.076 -> Good health is always newsworthy

76.8 -> so each week we select one current headline

79.8 -> that ties back to the topic at hand,

81.93 -> we bring it back to our table

83.63 -> and we ask our expert to respond.

86.42 -> This week's entry comes to us from CNN

88.63 -> and the headline reads, "New heart failure guidelines

91.81 -> add another type of meds to treatment recommendations."

96.38 -> Dr. Bozkurt, what's the new medication

99.26 -> and how does it all fit in?

102.3 -> - Thank you.

103.3 -> It's exciting that we now have

105.66 -> four classes of medications, which now includes

109.5 -> sodium-glucose co-transporter 2 (SGLT2) inhibitors.

116.14 -> These medications prevent reabsorption of glucose

119.43 -> as well as sodium in the kidneys.

121.96 -> They were initially used by diabetologists

124.96 -> for glucose lowering in patients with diabetes.

128.73 -> But we now have found out that they are quite beneficial

132.34 -> in heart failure, regardless of diabetes,

134.84 -> even in patients without hyperglycemia or diabetes.

139.17 -> They have beneficial effects in heart and the kidney,

143.26 -> and now they're part of the armamentarium

145.99 -> for standard therapy of heart failure.

149.09 -> So SGLT2 inhibitors along with beta blockers,

154 -> mineralocorticoid receptor antagonists,

156.77 -> and renin-angiotensin inhibitors,

158.86 -> which include ARNI, ACE-inhibitors or ARB

163.23 -> are now indicated as first line therapy for patients

167.63 -> with heart failure with reduced ejection fraction.

170.64 -> They reduce cardiovascular mortality

173.52 -> and heart failure hospitalization,

175.68 -> and should be prescribed in all patients with heart failure

178.82 -> with reduced ejection fraction.

181.41 -> - Sounds like so much great advancement that's happening.

184.87 -> I get excited when I hear about medical advancement.

187.23 -> So thank you so much for highlighting that for us.

190.84 -> Let's get into our main segment and we call this segment,

193.97 -> You Ask, We Answer.

196.822 -> (logo whooshing)

203.92 -> Doctor, there are so many questions that are coming in.

206.57 -> People are eager to hear about the updated guidelines.

209.69 -> So let's jump in.

211.34 -> Our first question, it comes to us from Malia in Chicago

215.49 -> and this is what Malia wants to know.

217.58 -> How will the new heart failure guidelines

220.15 -> improve patient care?

223.15 -> - The guidelines provide clear recommendations

226.35 -> for evidence-based therapies and management

229.56 -> that result in improvement in clinical outcomes.

232.56 -> These recommendations when implemented they save lives,

236.76 -> they prevent progression of heart failure,

238.93 -> they prevent heart failure hospitalizations.

242.26 -> Thus there is an urgency and necessity

244.83 -> to optimize therapies,

246.91 -> even in patients who may appear stable.

249.74 -> When patients have active heart failure,

251.95 -> outcomes are as bad as cancer.

254.1 -> Therefore there is a need to optimize these therapies

257.39 -> to prevent future adverse outcomes.

259.6 -> And we have recommendations

262.39 -> for different types of heart failure,

264.3 -> including those with heart failure

265.93 -> with reduced ejection fraction,

268 -> as well as mildly reduced ejection fraction

270.52 -> and preserved ejection fraction,

272.48 -> as well as we have specific recommendations

275.15 -> to prevent heart failure

277.3 -> in addition to treatment of heart failure.

279.89 -> Thus we want to alert patients as well as all clinicians,

284.29 -> it's more important than ever

286.85 -> for the guideline directed therapies to be implemented

290.67 -> and optimizing all heart failure patients.

294.98 -> - And doctor, while we're speaking

296.23 -> on the the stages of heart failure,

299.66 -> there's a question that came in from Sasha,

301.79 -> and she wants to know what are the stages of heart failure.

306.05 -> - Thank you for that question.

307.68 -> The stages include patients at risk for heart failure,

312.76 -> pre-heart failure, heart failure and advanced heart failure.

317.58 -> Patients at risk for heart failure

319.24 -> are those who do not have symptoms and/or signs

323.331 -> but are at future risk for heart failure.

326.76 -> Pre-heart failure is when patients

328.89 -> do not have symptoms or signs,

331.39 -> but may have abnormal cardiac function or structure

335.05 -> or abnormal cardiac biomarkers.

338.2 -> Heart failure is when the patients have symptoms or signs

342.83 -> attributable to abnormal cardiac function or structure.

347 -> Advanced heart failure is when patients have

349.15 -> advanced symptoms requiring repeated hospitalizations,

353.31 -> referral to advanced care,

355.52 -> and may need higher levels of care.

358.24 -> We have specific recommendations for each stage

361.16 -> including for patients at risk,

363.79 -> as well as pre-heart failure

365.27 -> to prevent future development of heart failure

367.96 -> in addition to specific recommendations for heart failure

371.95 -> and advanced heart failure.

373.72 -> Our aim is to reverse the trajectory

377.06 -> and prevent development and progression.

379.83 -> And it's exciting that we do have

382.64 -> effective, useful strategies to detect,

386.44 -> prevent and treat heart failure.

388.81 -> And this, armamentarium actually will empower

392.03 -> the clinicians to diagnose heart failure in a timely manner

396.55 -> and prevent before it gets quite advanced.

400.97 -> - Very good.

401.89 -> Doctor, we have another question that's coming in

404.06 -> and the question is from Chelsea in Arkansas

406.89 -> and this is what she wants to know.

408.4 -> What is the difference between reduced ejection fraction

412.2 -> and preserved ejection fraction?

416.09 -> - Ejection fraction is a measurement

418.78 -> of how well the pump can squeeze

421.33 -> and eject blood that fills the the heart chamber.

425.23 -> An injection fraction higher than 50% is considered normal.

431.172 -> One below 40% is considered reduced.

434.9 -> So ejection fraction between 41 and 49%

438.54 -> is now considered mildly reduced.

441.56 -> When heart failure symptoms and/or signs occur in a patient

445.05 -> with ejection fraction exceeding that of 50%,

448.65 -> we call that heart failure with preserved ejection fraction.

452.67 -> When heart failure occurs in a patient

454.82 -> with ejection fraction less than 40%,

458.06 -> we call that heart failure with reduced ejection fraction.

462.02 -> When heart failure occurs in a patient

463.85 -> with ejection fraction between 41 and 49%,

467.86 -> we call that heart failure

469.71 -> with mildly reduced ejection fraction.

472.41 -> - Here's a question from Hunter.

473.81 -> What are the types of medications that could be prescribed

476.92 -> for a heart failure patient with reduced ejection fraction?

482.27 -> - Guideline directed medical therapy

484.77 -> for symptomatic heart failure patients

487.1 -> with reduced ejection fraction now includes

490.37 -> quadruple classes of medications

493.77 -> which include the SGLT2 inhibitors, beta blockers,

499.05 -> mineralocorticoid receptor antagonist,

501.22 -> and RAAS inhibition with ARNI

503.497 -> in NYHA class II-to-III heart failure

506.82 -> or ACE-inhibitors or ARB in NYHA class II-to-IV

510.5 -> heart failure patients.

512.16 -> In addition to these core therapies,

515.09 -> diuretics are recommended as needed for patients

518.06 -> with fluid retention to relieve congestion.

521.36 -> Once these first line therapies are optimized

525 -> additional therapies can be considered.

527.78 -> Hydralazine and nitrates are indicated in African-American

531.24 -> or black patients and other therapies such as

534.26 -> Ivabradine can be considered for patients

537.35 -> with elevated heart rate despite optimal doses

540.16 -> of beta blockade, digoxin,

542.76 -> or soluble guanylate cyclase stimulator

545.63 -> may be considered to reduce

547.64 -> heart failure hospitalizations in certain patients.

550.87 -> We also have specific recommendations

553.29 -> for patients with mild reduced EF and do recommend

557.13 -> the continuation of guideline directed therapies

559.97 -> even among those patients who have improvement

563.29 -> in their ejection fraction.

565.06 -> - Here's a question from Beau in Delaware.

567.35 -> What role can caregivers play

569.81 -> in a heart failure patients management of their condition?

575.55 -> - This is a very important question.

577.29 -> Caregivers are critical part of the heart failure journey

583.11 -> and caregivers need to be aware that there are therapies

586.3 -> that can improve symptoms, functional capacity,

590.25 -> quality of life as well as survival

593.89 -> and reduction of hospitalizations for their loved ones,

597.77 -> for their patients that they provide care for.

603.18 -> Caregivers can help patients receive optimized care.

607.69 -> They can help translate that the number of medications

611.27 -> should not be something that the patient should be afraid of

615.41 -> but rather see as an opportunity to beat heart failure.

619.22 -> And caregivers can also help navigate and coordinate

623.1 -> the transitions of care, especially post discharge

626.08 -> or coordination of follow-up appointments.

628.87 -> They can also help implement lifestyle changes,

632.62 -> help patients remain physically active.

635.66 -> Caregivers can also help with identification

638.43 -> of patient goals,

640.26 -> which is central to all our treatment options.

643.03 -> It's a critical concept

645.24 -> that needs to be conveyed to all providers,

648.53 -> including specialists as well as primary care providers.

652.54 -> And caregivers can also help coordinate

655.68 -> the management of comorbidities.

657.81 -> In the new guidelines, we have specific recommendations

660.83 -> for management of diabetes, hypertension,

665.01 -> sleep apnea, iron deficiency, atrial fibrillation,

670 -> cancer therapy related to heart failure

671.82 -> as well as valvular heart disease.

673.8 -> So I think we have many more guideline directed therapies

679.44 -> that is gonna help our patients

682.02 -> in the whole continuum of care,

684.07 -> in the whole heart failure journey.

686.86 -> - Doctor, I'm so excited about these new guidelines

689.27 -> because it seems like it's a wealth of information

691.53 -> that will really help so many patients.

694.11 -> Jenna from Austin wonders,

695.83 -> is there any medication for heart failure patient

699.55 -> with preserved ejection fraction?

702.83 -> - We do have specific recommendations

705.25 -> for patients with heart failure preserved ejection fraction.

708.95 -> SGLT2 inhibitors now have a class 2a recommendation

713.67 -> in patients with heart failure with preserved EF.

716.28 -> They can be beneficial in reducing

718.83 -> heart failure hospitalizations and cardiovascular mortality.

722.59 -> Mineralocorticoid receptor antagonists,

725.51 -> angiotensin receptor blockers and ARNI

728.94 -> have a class 2b recommendation

730.89 -> and maybe considered to decrease hospitalizations.

734.5 -> We also have specific recommendations

737.34 -> for treatment of hypertension,

739.7 -> as well as treatment of atrial fibrillation

742.17 -> and cardiovascular disease in patients

743.97 -> with heart failure with preserved ejection fraction.

746.47 -> - Barbara wants to know what role can a specialty care team

750.56 -> serve for a patient with advanced heart failure?

754.37 -> - Patients with advanced heart failure

756.21 -> who wish to prolong survival should be referred

759.32 -> to a team specializing in heart failure.

762.073 -> A heart failure specialty team

763.93 -> reviews the heart failure management,

766.97 -> assesses suitability for advanced heart failure therapies

770.75 -> such as mechanical circuitry support,

773.52 -> palliative care, cardiac transplantation and others.

776.92 -> So coordination of care with the specialty team

781.15 -> will help appropriate implementation of guideline

784.83 -> directed therapies and tailor the therapies

787.59 -> to patients goals.

789.09 -> - Our last question comes to us from Caroline

791.24 -> and this is what she wonders.

792.67 -> Why is primary prevention important for those at risk?

796.85 -> And what are the recommendations for prevention?

800.39 -> - Primary prevention is critical to prevent heart failure

804.32 -> especially for those patients who are at risk

806.86 -> such as those patients with hypertension, diabetes,

811.5 -> coronary artery disease or obesity.

814.12 -> We do have specific recommendations for these patients

817.58 -> which include optimal control of blood pressure

820.57 -> in patients with hypertension,

823.31 -> SGLT2 inhibitors in patients with diabetes

826.29 -> to prevent cardiovascular disease or heart failure risk,

832 -> optimal management of cardiovascular disease,

836.17 -> multidisciplinary evaluation in patients

838.67 -> with exposure to cardiotoxic agents,

841.94 -> genetic screening and counseling in first degree

844.95 -> of relatives of patients with genetic

846.83 -> or inherited cardiomyopathies.

849.54 -> For patients at risk for development of heart failure,

852.45 -> we also have a class 2a recommendations

855.6 -> for natriuretic peptide-based screening,

857.88 -> a biomarker based screening followed by team-based care

862.24 -> which can be useful to prevent

864.14 -> development of heart failure or cardiac dysfunction

868.52 -> especially among patients at risk for heart failure.

873.54 -> - Dr. Bozkurt, thank you so much

875.75 -> for sharing your expertise on the new guidelines.

878.88 -> Is there anything else that you'd like to add

880.97 -> before leaving us today?

883.84 -> - These new guidelines highlight

887.52 -> very critical recommendations

889.42 -> that are important in heart failure practice.

891.3 -> We're hoping that these new recommendations

894.21 -> will be helpful to clinicians, patients, and caregivers

898.71 -> to help us improve the patient outcomes.

901.62 -> - Thank you so much, doctor.

902.82 -> Well, friends that does it for our show today.

905.11 -> You can find any of our previous episodes

907.46 -> by visiting our YouTube playlist

909.98 -> and please make sure you subscribe

912.04 -> and share it with all your family and friends.

914.54 -> And we want you to stay abreast of all breaking health news.

918.41 -> Until next time, please take care of yourselves

920.9 -> and watch this closing video to refresh your memory

924.73 -> on the warning signs of heart failure.

927.37 -> We'll see you next time.

929.26 -> - [Announcer] Do you know the symptoms of heart failure?

932.09 -> During heart failure,

933.27 -> the heart can't pump blood efficiently enough

935.63 -> to meet the body's needs because either

938.48 -> its pumping ability has weakened

940.92 -> or because the lower left chamber has become thick

944.64 -> and no longer holds enough blood.

947.05 -> Without proper pumping fluid can build up and cause symptoms

951.01 -> that everyone should learn to recognize.

954.01 -> Swelling also known as edema is most often noticed

958.33 -> in the feet, ankles, legs, or abdomen.

962.33 -> Sudden weight gain.

963.84 -> People with heart failure can also track their weight

966.41 -> to help manage any swelling.

968.31 -> Shortness of breath is another important symptom

970.75 -> to discuss with your doctor,

972.26 -> especially if you notice that normal activities

974.76 -> are getting harder to do or that your breathing

977.81 -> is often interrupted by persistent coughing or wheezing.

981.8 -> You should also speak with a healthcare provider

984.1 -> if you lose the ability to sleep

986.03 -> and breathe well while lying down.

989.06 -> Inadequate blood flow can also cause lightheadedness

992.37 -> or fatigue, confusion, depression, or even fainting.

998.57 -> Additional symptoms can sometimes include

1001.31 -> a rapid heart rate, nausea or lack of appetite.

1005.99 -> If you notice these important symptoms

1008.62 -> be sure to seek medical care.

1011.27 -> Know the symptoms so that together

1013.76 -> people who have heart failure can track symptoms

1016.49 -> to help manage it successfully for a longer, healthier life.

1021.257 -> (upbeat music)

1038.02 -> - [Narrator] Learn more about

1038.853 -> House Calls: Real Docs, Real Talk

1041.29 -> and submit your questions at heart.org/housecalls.

Source: https://www.youtube.com/watch?v=httKhQDz1Kk