Ten Principles for Successful Treatment of HF With Reduced EF: New ACC Decision Pathway

A new decision pathway, one loaded with “practical tips, tables, and figures” for the successful and speedy treatment of patients who have heart failure (HF) with reduced ejection fraction (EF), is now available from experts at the American College of Cardiology.

The consensus report, chaired by Clyde Yancy, MD (Northwestern University Feinberg School of Medicine, Chicago, IL), highlights pivotal issues in HF with reduced EF, including when to start, add, or change therapy to new evidence-based, guideline-directed treatments and how to optimize treatment given the multitude of available medications and clinical assessment tools.

Regarding guideline-directed medical therapy, the document provides information on how to use angiotensin receptor neprilysin inhibitor (ARNI) therapy, which is a combination of a sacubitril and valsartan (Entresto; Novartis), and ivabradine (Corlanor; Amgen). Both agents were approved by the US Food and Drug Administration in 2015. 

In addition, the experts highlight when to refer a patient to a heart failure specialist, how to coordinate clinical care, how to improve adherence to medical therapy, and how to manage the increasing complexity of treatment, including in patients with common comorbidities. Cost of therapy, unique patient populations, and transitioning to palliative and hospice care are also covered in the new consensus document. 

“The treatment of HF with reduced EF can feel overwhelming, and many opportunities to improve patient outcomes are being missed,” according to the writing committee. “Hopefully, this expert consensus decision pathway may streamline care to realize best possible patient outcomes in HF.”

The report was published online December 22, 2017, ahead of print in the Journal of the American College of Cardiology and is intended to complement the 2017 ACC/AHA/HFSA focused update of the 2013 ACC/AHA guideline for the management of heart failure.