How to diagnose heart failure with preserved ejection fraction: the HFA–PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

European Heart Journal, Год журнала: 2019, Номер 40(40), С. 3297 - 3317

Опубликована: Авг. 27, 2019

Abstract Making a firm diagnosis of chronic heart failure with preserved ejection fraction (HFpEF) remains challenge. We recommend new stepwise diagnostic process, the ‘HFA–PEFF algorithm’. Step 1 (P=Pre-test assessment) is typically performed in ambulatory setting and includes assessment for HF symptoms signs, typical clinical demographics (obesity, hypertension, diabetes mellitus, elderly, atrial fibrillation), laboratory tests, electrocardiogram, echocardiography. In absence overt non-cardiac causes breathlessness, HFpEF can be suspected if there normal left ventricular fraction, no significant valve disease or cardiac ischaemia, at least one risk factor. Elevated natriuretic peptides support, but levels do not exclude HFpEF. The second step (E: Echocardiography Natriuretic Peptide Score) requires comprehensive echocardiography by cardiologist. Measures include mitral annular early diastolic velocity (e′), (LV) filling pressure estimated using E/e′, volume index, LV mass relative wall thickness, tricuspid regurgitation velocity, global longitudinal systolic strain, serum peptide levels. Major (2 points) Minor (1 point) criteria were defined from these measures. A score ≥5 points implies definite HFpEF; ≤1 point makes unlikely. An intermediate (2–4 uncertainty, which case 3 (F1: Functional testing) recommended echocardiographic invasive haemodynamic exercise stress tests. 4 (F2: Final aetiology) to establish possible specific cause alternative explanations. Further research needed better classification

Язык: Английский

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Epidemiology of heart failure with preserved ejection fraction

Nature Reviews Cardiology, Год журнала: 2017, Номер 14(10), С. 591 - 602

Опубликована: Май 11, 2017

Язык: Английский

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A Simple, Evidence-Based Approach to Help Guide Diagnosis of Heart Failure With Preserved Ejection Fraction

Circulation, Год журнала: 2018, Номер 138(9), С. 861 - 870

Опубликована: Май 23, 2018

Diagnosis of heart failure with preserved ejection fraction (HFpEF) is challenging in euvolemic patients dyspnea, and no evidence-based criteria are available. We sought to develop then validate noninvasive diagnostic that could be used estimate the likelihood HFpEF present among unexplained dyspnea guide further testing.

Язык: Английский

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Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity

New England Journal of Medicine, Год журнала: 2023, Номер 389(12), С. 1069 - 1084

Опубликована: Авг. 25, 2023

BackgroundHeart failure with preserved ejection fraction is increasing in prevalence and associated a high symptom burden functional impairment, especially persons obesity. No therapies have been approved to target obesity-related heart fraction.MethodsWe randomly assigned 529 patients who had body-mass index (the weight kilograms divided by the square of height meters) 30 or higher receive once-weekly semaglutide (2.4 mg) placebo for 52 weeks. The dual primary end points were change from baseline Kansas City Cardiomyopathy Questionnaire clinical summary score (KCCQ-CSS; scores range 0 100, indicating fewer symptoms physical limitations) body weight. Confirmatory secondary included 6-minute walk distance; hierarchical composite point that death, events, differences KCCQ-CSS C-reactive protein (CRP) level.Download PDF Research Summary.ResultsThe mean was 16.6 8.7 (estimated difference, 7.8 points; 95% confidence interval [CI], 4.8 10.9; P<0.001), percentage −13.3% −2.6% −10.7 CI, −11.9 −9.4; P<0.001). distance 21.5 m 1.2 20.3 m; 8.6 32.1; In analysis point, produced more wins than (win ratio, 1.72; 1.37 2.15; CRP level –43.5% –7.3% treatment 0.61; 0.51 0.72; Serious adverse events reported 35 participants (13.3%) group 71 (26.7%) group.ConclusionsIn obesity, led larger reductions limitations, greater improvements exercise function, loss placebo. (Funded Novo Nordisk; STEP-HFpEF ClinicalTrials.gov number, NCT04788511.) Quick Take Semaglutide Heart Failure Obesity 2m 5s

Язык: Английский

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Evaluation and management of heart failure with preserved ejection fraction

Nature Reviews Cardiology, Год журнала: 2020, Номер 17(9), С. 559 - 573

Опубликована: Март 30, 2020

Язык: Английский

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Cardiopulmonary Exercise Testing

Journal of the American College of Cardiology, Год журнала: 2017, Номер 70(13), С. 1618 - 1636

Опубликована: Сен. 1, 2017

Язык: Английский

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National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Guidelines for the Prevention, Detection, and Management of Heart Failure in Australia 2018

Heart Lung and Circulation, Год журнала: 2018, Номер 27(10), С. 1123 - 1208

Опубликована: Авг. 1, 2018

Tabled 1RecommendationGRADE strength of recommendationQuality evidencePrevention heart failure—non-pharmacologicalSmoking cessation is recommended to decrease the risk cardiovascular events and developing failure.StrongFORLowAvoiding excess alcohol recommended, failure.StrongFORVery lowWeight reduction in patients who are overweight or obese, failure.StrongFORLowRegular physical activity failure.StrongFORLowPrevention failure—pharmacologicalBlood pressure (BP) lowering lipid according published guidelines failure.StrongFORHighAngiotensin converting enzyme (ACE) inhibitors should be considered with disease failure.StrongFORModerateSodium-glucose cotransporter 2 (SGLT2) type diabetes mellitus associated insufficient glycaemic control despite metformin, hospitalisation for failure.StrongFORHighACE left ventricular (LV) systolic dysfunction failure.StrongFORHighBeta blockers LV failure.StrongFORLowDiagnosisA 12-lead electrocardiogram (ECG) either a suspected diagnosis new failure, assess cardiac rhythm, QRS duration, presence underlying conditions such as myocardial ischaemia hypertrophy.StrongFORLowA chest X-ray detect signs pulmonary congestion identify alternative non-cardiac causes patient’s symptoms.StrongFORVery lowPlasma B-type natriuretic peptide (BNP) N-terminal proBNP (NT proBNP) levels when uncertain.StrongFORHighA transthoracic echocardiogram improve diagnostic accuracy, structure function (including measurement ejection fraction [LVEF]), assist classification therefore guide management.StrongFORLowInvasive coronary angiography failure refractory angina, resuscitated arrest, sustained arrhythmias, evidence ischaemic on other investigations, an intermediate-to-high pretest probability artery disease, determine need revascularisation.StrongFORLowEither computed tomography (CT) magnetic resonance imaging (CMR) late gadolinium enhancement (LGE) may have low-to-intermediate distinguish non-ischaemic dysfunction.WeakFORLowNon-invasive functional testing—stress echocardiography, single-photon emission CT scan (SPECT), positron (PET) CMR LGE—may established assessment viability revascularisation.WeakFORVery lowCMR LGE increased wall thickness that remains unexplained following clinical evaluation, including ECG inflammatory infiltrative cardiomyopathies.StrongFORLowEither PET bone scintigraphy cardiomyopathies.WeakFORLowBNP NT prognostic stratification.WeakFORHighGenetic testing dilated cardiomyopathy (DCM) conduction stratification management regarding use implantable cardioverter defibrillators.WeakFORLowTransthoracic echocardiography reduced (HFrEF) 3–6 months after start optimal medical therapy, if there has been change status, appropriateness treatments, device therapy (implantable defibrillator [ICD] resynchronisation [CRT], both).WeakFORLowAcute failureInvestigation precipitating factors all presenting acute failure. Acute syndrome (ACS), hypertensive crisis, arrhythmia, mechanical catastrophe (e.g., ruptured interventricular septum, mitral papillary muscle free wall, valvular regurgitation), embolism confirmed excluded, managed immediately.StrongFORLowMonitoring peripheral arterial oxygen saturation lowOxygen below 94%.StrongFORVery lowNon-invasive ventilation remain hypoxaemic tachypnoeic symptoms reduce requirement intubation.StrongFORHighIntravenous loop diuretics congestion, fluid overload.StrongFORLowIntravenous vasodilators blood more than 90 mm Hg, relieve congestion.WeakFORLowIntravenous inotropic hypoperfusion (usually accompanied by BP <90 Hg) treatment, end-organ function.WeakFORVery lowIntravenous avoided without treatment.StrongAGAINSTLowPharmacological chronic failureACE inhibitorsAn ACE inhibitor HFrEF moderate severe LVEF (LVEF less equal 40%) unless contraindicated not tolerated mortality hospitalisation.StrongFORHighACE mild 41–49%) hospitalisation.WeakFORLowBeta blockersA beta blockera tolerated, once stabilised no minimal examination hospitalisation.aSpecifically, bisoprolol, carvedilol, metoprolol (controlled release extended release) nebivololStrongFORHighBeta nebivololWeakFORLowMineralocorticoid receptor antagonists (MRAs) An MRA failure.StrongFORHighMineralocorticoid (MRAs)An failure.WeakFORLowDiureticsA diuretic symptoms, manage congestion.StrongFORVery lowAngiotensin (ARBs)An ARB combined endpoint failure.StrongFORModerateARBsAn conisdered failure.WeakFORLowAngiotensin neprilysin (ARNI)An ARNI replacement (with at least 36-hour washout window) 40% receiving maximally target doses (or ARB) blocker (unless contraindicated), MRA, hospitalisation.StrongFORHighConcomitant ARNIs these medications administered within 36hours each other, because angioedema.StrongAGAINSTVery lowIvabradineIvabradine 35% sinus rate 70 beats per minute (bpm) above, failure.StrongFORHighHydralazine plus nitratesHydralazine nitrates mortality.WeakFORLowHydralazine black African descent failure.WeakFORModerateDigoxinDigoxin rhythm (New York Heart Association [NYHA] Class 3–4) failure.WeakFORLowNutraceuticalsN-3 Polyunsaturated fatty acids hospitalisation.WeakFORLowNon-pharmacological managementModels care evidence-based practiceReferral multidisciplinary program high-risk features, rehospitalisation.StrongFORHighIn areas where access face-to-face disease-management discharge limited, followed up telemonitoring telephone support program.StrongFORModerateNurse-led medication titration achieved maximum inhibitors, ARBs, ARNIs, MRAs, hospitalisation.StrongFORHighSelf-managementEducating their carers about self-management mortality. It commence soon diagnosis, patient-centred, appropriate level health literacy, culturally appropriate, revised throughout person’s life.StrongFORHighExerciseRegular performance intensity (i.e. breathe faster but hold conversation) continuous exercise stable particularly those LVEF, functioning quality life, hospitalisation.StrongFORHighDevices, surgery percutaneous proceduresCardiac therapyCRT duration 150 ms symptoms.StrongFORHighCRT 130–149 symptoms.StrongFORModerateCRT AF, 130 morbidity mortality, provided this approaches maximise biventricular capture (ideally 92% capture).WeakFORVery lowCRT 50% high-grade atrioventricular (AV) block requiring pacing, failure.WeakFORModerateCRT pre-existing right pacing develop 35%, failure.WeakFORLowCRT ms, lack efficacy possible harm.StrongAGAINSTModerateImplantable defibrillatorsAn ICD secondary prevention indication tachycardia haemodynamic compromise syncope mortality.StrongFORHighAn primary 1 month infarction 30% mortality.StrongFORModerateAn mortality.WeakFORLowPressure monitoringImplantable monitoring previously hospitalised preserved persistent (NYHA class III) care, systems place ensure daily upload weekly review data.WeakFORLowSurgical proceduresCoronary bypass graft (CABG) they surgically correctable relief angina symptoms) long-term mortality.StrongFORModerateMitral valve (MV) repair time elective CABG regurgitation association symptoms.WeakFORLowSurgical MV complicating symptomatic guideline-directed symptoms.WeakFORLowPercutaneous high surgical aortic (SAVR) stenosis absence major comorbidities frailty, mortality.StrongFORLowTranscatheter implantation (TAVI) intermediate operative inoperable SAVR, deemed suitable TAVI team mortality.StrongFORModerateReferral specialist centre consideration (VAD) intractable, pacemaker do suffer from comorbidities, mortality.StrongFORModerateImplantation VAD bridge transplant actively listed transplantation become inotrope-dependent progress needing circulatory support.StrongFORLowReferral intractable NYHA III–IV exhausted therapies overt contraindications mortality.StrongFORLowHypertensionDiltiazem, verapamil, moxonidine HFrEF.StrongAGAINSTLowAtrial fibrillationDetermination stroke anticoagulation atrial fibrillation (AF).StrongForHighPharmacological aiming resting 60–100 bpm AF rapid response.StrongForLowCatheter ablation (either paroxysmal persistent) present recurrent failure.StrongForModerateDiabetesThiazolidinediones (glitazones) due will lead worsening failure.WeakAGAINSTModerateSleep disordered breathingAdaptive servoventilation predominant central sleep apnoea all-cause mortality.StrongAGAINSTModerateAnaemiaErythropoietin used routinely treatment anaemia thromboembolic adverse events.StrongAGAINSTModerateIron deficiencyIn optimised iron studies performed and, patient deficient ferritin <100 μg/L, 100–300 μg/L transferrin <20%) intravenous considered, life.StrongFORModerateTreatment recovered fractionUnless reversible cause corrected, neurohormonal (ACE ARBs MRAs) continued restored fraction, recurrence.StrongFORLowPalliative careReferral palliative advanced alleviate end-stage life rehospitalisation. Involvement early trajectory towards end stage failure.StrongFORHighACE, angiotensin enzyme; ACS, syndrome; fibrillation; ARB, blocker; ARNI, inhibitor; AV, atrioventricular; BNP, peptide; BP, pressure; bpm, minute; CABG, graft; CMR, imaging; CRT, therapy; CT, tomography; ECG, electrocardiogram; DCM, cardiomyopathy; GRADE, Grading Recommendations Assessment, Development Evaluation; HFrEF, fraction; ICD, defibrillator; LGE, enhancement; LV, ventriclular; mineralocorticoid antagonist; MV, valve; NT, N-terminal; NYHA, New Association; PET, replacement; SGLT2, sodium-glucose 2; SPECT, scan; TAVI, transcatheter implantation; VAD, device. Open table tab ACE, These seek provide guidance adult Australia based current evidence. They intended replace 2011 update National Foundation Australia/Cardiac Society Zealand (NHFA/CSANZ) Guidelines Prevention, Detection, Management Chronic Failure [[1]National Cardiac (Chronic Expert Writing Panel). prevention, detection Australia, 2011.Google Scholar]. In 2016, NHFA began process 2018 guidelines. A partnership between CSANZ was formed guidelines, organisation. Clinical committees both organisations were approached advice content (scope) development Acting previous expert panel involved earlier editions together internal advisory committees, members working group, expertise. Based determined scope, guideline writing groups cover four topics: drugs, devices, non-pharmacological management. For writer appointed group consensus, basis expertise experience development. The comprised recognised expertise, stakeholder community. met several occasions discuss during process. reference comprising representatives key national relevance provision Australia. roles input into scope questions being submitted literature review, draft recommendations; facilitate implementation Informed consultation, generated form external searches. Questions searches prioritised uniqueness covered recent European reviewed refined CSANZ. proposed Appendix 2. reviewer through open tender May 2017. started second half 2017 completed December summaries signed off relevant summaries. At same time, drafted topics (in agreed scope) sent February 2018, consulted first full public consultation period 21 days conducted April 2018. Feedback received prior finalisation Final approval Boards submission journal publication undertaken June Conflicts interest framework relationship (direct indirect) participating individual any third party topic under process, nature (financial non-financial) potential conflict. All asked declare conflicts declarations updated every 6 meeting. chair writer. summary responses online description governance available website. addition reviews trials systematic reviews, informed international local Evaluation (GRADE) methodology [[2]Grading A, Working Group. GRADE Handbook. Updated October 2013. Available at: http://gdt.guidelinedevelopment.org/app/handbook/handbook.html. Accessed 21/02/18.Google Scholar] formulate recommendations. highlights recommendation against intervention. This considering evidence, balance benefits harms, trade-offs improving survival uncertainty variability values preferences, resource considerations. increasingly developers worldwide. Each final recommendations endorsement whole group. definition consensus 80% agreement ‘Rationale’ section provides brief underpinning Economic implications system discussed ‘Resources considerations’ appropriate. limited base, impact interventions outcomes modest, comments included ‘Practice advice’ sections guideline. While dosing

Язык: Английский

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How to diagnose heart failure with preserved ejection fraction: the HFA–PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

European Journal of Heart Failure, Год журнала: 2020, Номер 22(3), С. 391 - 412

Опубликована: Март 1, 2020

Язык: Английский

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Heart Failure With Preserved Ejection Fraction

JAMA, Год журнала: 2023, Номер 329(10), С. 827 - 827

Опубликована: Март 14, 2023

Heart failure with preserved ejection fraction (HFpEF), defined as HF an EF of 50% or higher at diagnosis, affects approximately 3 million people in the US and up to 32 worldwide. Patients HFpEF are hospitalized 1.4 times per year have annual mortality rate 15%.Risk factors for include older age, hypertension, diabetes, dyslipidemia, obesity. Approximately 65% patients present dyspnea physical examination, chest radiographic, echocardiographic, invasive hemodynamic evidence overt congestion (volume overload) rest. 35% "unexplained" on exertion, meaning they do not clear physical, echocardiographic signs HF. These elevated atrial pressures exercise measured stress testing estimated Doppler echocardiography testing. In unselected presenting unexplained dyspnea, H2FPEF score incorporating clinical (age, obesity, fibrillation status) resting (estimated pulmonary artery systolic pressure left pressure) variables can assist diagnosis (H2FPEF range, 0-9; >5 indicates more than 95% probability HFpEF). Specific causes syndrome normal other should be identified treated, such valvular, infiltrative, pericardial disease. First-line pharmacologic therapy consists sodium-glucose cotransporter type 2 inhibitors, dapagliflozin empagliflozin, which reduced hospitalization cardiovascular death by 20% compared placebo randomized trials. Compared usual care, training diet-induced weight loss produced clinically meaningful increases functional capacity quality life Diuretics (typically loop diuretics, furosemide torsemide) prescribed improve symptoms. Education self-care (eg, adherence medications dietary restrictions, monitoring symptoms vital signs) help avoid decompensation.Approximately HFpEF. exercise, self-care, diuretics needed maintain euvolemia, obesity

Язык: Английский

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Atrial Dysfunction in Patients With Heart Failure With Preserved Ejection Fraction and Atrial Fibrillation

Journal of the American College of Cardiology, Год журнала: 2020, Номер 76(9), С. 1051 - 1064

Опубликована: Авг. 24, 2020

Язык: Английский

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