The expert consensus decision pathway recommends tailored therapy decisions based on clinical trajectory.
Summary: The American College of Cardiology has released updated guidance for managing hospitalized heart failure patients. This Expert Consensus Decision Pathway (ECDP) provides a framework for tailoring therapy based on clinical trajectory, incorporating the latest evidence and aligning with the 2022 ACC/AHA Heart Failure Guideline. The update emphasizes optimizing treatment during hospital stays to improve both short-term and long-term outcomes, addressing the high mortality and readmission rates associated with heart failure. The ECDP also includes new strategies for patient management, medication, and follow-up care.
Key takeaways:
- The updated guidance focuses on tailoring heart failure therapy to individual patient trajectories, emphasizing the importance of personalized care.
- There’s a renewed emphasis on establishing all four pillars of guideline-directed medical therapy for heart failure with reduced ejection fraction (HFrEF) during hospitalization.
- The ECDP addresses various aspects of care, including management strategies for different clinical trajectories, updated diuresis strategies, incorporation of telehealth for follow-up, and consideration of long-term disease trajectory, including palliative care when appropriate.
The American College of Cardiology has issued updated guidance on managing patients hospitalized for heart failure 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.
Heart Failure in Hospitalized Patients
Inpatient admissions for heart failure are associated with high mortality—20% to 30% risk of death within one year—and readmissions and subsequent health events are common. Heart failure symptoms often improve quickly during heart failure hospitalization, but episodes of worsening Heart failure can mark a fundamental change in the heart failure 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,” says Steven Hollenberg, MD, FACC, ECDP, writing committee chair and director of Cardiac Intensive Care at the Emory Heart & Vascular Center, in a release. “The updated ECDP places increased emphasis on establishing all four pillars of guideline-directed medical therapy for HFrEF (heart failure with reduced ejection fraction) 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 consensus update is published in JACC, the flagship journal of the American College of Cardiology.
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