The new heart failure (HF) guidelines released this week by three North American societies had a lot of catching up to do given the significant, even paradigm-shifting, additions to available treatment options in the last few years.
The landscape now includes both new and repurposed drug therapies that benefit almost without regard to ejection fraction (EF), and evidence-based urgency to engage patients early on with at least four core medication classes, so-called quadruple therapy.
The guideline document offers a roadmap for navigating those key issues and many others and uses some creative tactics. They include the introduction of generalist-friendly labels for the traditional but obscurely named four stages of HF severity that, it is hoped, will have wider reach and expand the use of effective therapies.
It introduces additional disease-staging terminology that characterizes the syndrome as a continuum:
"At risk for HF" for stage A, applied to asymptomatic patients with risk factors such as diabetes or hypertension but no known cardiac changes
"Pre-HF" for stage B, which adds cardiac structural changes or elevated natriuretic peptides, still in the absence of symptoms
"Symptomatic HF" for stage C, that is, structural disease with current or previous symptoms
"Advanced HF" for stage D, characterized by severe debilitating symptoms or repeated hospitalizations even with guideline-directed medical therapy (GDMT)
