2022 Update: Heart Failure Management Guidelines

Three of the major heart health organizations have released new guidelines for managing heart failure (HF). The guidelines come from the American Heart Association, American College of Cardiology, and Heart Failure Society of America.

HF is a chronic illness that arises from heart damage. It affects how well the heart pumps blood through the body. It has many causes, including high blood pressure, diabetes, and smoking. Some common symptoms of heart damage are:^1-3

• Trouble breathing
• Swelling
• Increased heart rate

What are the heart failure management guidelines?

These guidelines help doctors work to prevent, diagnose, and treat HF. The 2022 guidelines replace the guidelines put in place in 2013. They also replace an update to the 2013 guidelines that was released in 2017.⁴

The guidelines are made by looking at current HF research. Researchers and doctors looked at how well treatments work. They also looked at trends in HF in the most up-to-date research. Doctors use these guidelines to figure out what level of HF you have. The guidelines also give advice on how to best treat you at this level.⁴

Changing how we categorize HF

The new guidelines have changed the levels of HF. The 2013 and 2017 versions of the guidelines grouped levels of HF based on your symptoms. The advice for each level focused on treating heart damage. The levels were:^4,5

• A: you do not have any symptoms of HF or signs of heart damage, but are at risk
• B: you do not have any symptoms of HF but do have heart damage
• C: you have both symptoms of HF and heart damage
• D: you have very severe heart damage and symptoms

The 2022 guidelines change these levels to be more focused on how HF develops. The older guidelines were concerned with preventing death for people with HF. The 2022 guidelines look at your risk for HF and how to keep it from getting worse.

The first level (A) is now called "at-risk." It includes people who have risk factors like high blood pressure or diabetes. The guidelines give more advice on lifestyle changes to lower risks. This will help doctors to try and prevent HF.⁴

The second level (B) is now called "pre-heart failure." It includes people who do not have symptoms but show signs of heart damage. At this level, the guidelines focus on stopping HF. By checking for heart damage early on, doctors can work to prevent further damage.⁴

One of the ways that heart damage can be detected is through blood tests. Brain natriuretic peptide (BNP) is a protein made by the heart. If the level of BNP in your blood is high, that can be a sign of heart damage.⁶

Heart damage is also found by checking ejection fraction (EF). EF measures how much blood is pumped out of the heart. If your EF is low, that can be another sign of heart damage. EF can be measured many ways, including magnetic resonance imaging (MRI).⁷

More drug options for treating HF

Another major change to the guidelines was adding new drug types for treatment. Before, there were 3 major drug types that were used to treat HF:⁴

• ACE (angiotensin-converting enzyme) or ARN (angiotensin receptor-neprilysin) inhibitors
• Mineralocorticoid antagonists
• Beta blockers

Now doctors can also use SGLT2 inhibitors. SGLT2 inhibitors originally were used to help people with diabetes. But these drugs have also been found to help reduce risk of death for people with HF.⁴

The 2022 guidelines were changed to focus more on working to prevent HF. Updates to the way HF is categorized help with this. They also give more options for helping people with HF. Lifestyle changes and different types of medicine are some of these options. You should talk to your doctor if you have questions or concerns about HF.

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