2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary

<p><em><strong>Take-Home Message No. 1</strong></em></p> <p>Guideline-directed medical therapy (GDMT) for HF with reduced ejection fraction (HFrEF) now includes 4 medication classes 1) renin-angiotensin system inhibition with angiotensin receptor-neprilysin inhibitors (ARNi), angiotensin-converting enzyme inhibitors (ACEi), or angiotensin (II) receptor blockers (ARB) alone; 2) beta blockers; 3) mineralocorticoid receptor antagonists (MRAs); and 4) the new group, SGLT2i</p> <p><em><strong>Take-Home Message No. 2</strong></em></p> <p>Mildly reduced LVEF has new medication recommendations, including use of SGLT2i. Weaker recommendations (COR 2b) are made for ARNi, ACEi, ARB, MRA and beta blockers in this population.</p> <p><em><strong>Take-Home Message No. 3</strong></em></p> <p>Preserved LVEF has new medication recommendations, including use of SGLT2i. New recommendations for HF with preserved EF (HFpEF) are made for SGLT2i (COR 2a), while weaker recommendation for MRAs (COR 2b), and ARNi (COR 2b).</p> <p>Several previous recommendations have been renewed, including treatment of hypertension (COR 1), treatment of AF (COR 2a), use of ARB (COR 2b), and avoidance of routine use of nitrates or phosphodiesterase-5 inhibitors (COR 3: No Benefit).</p> <p><em><strong>Take-Home Message No. 4</strong></em></p> <p>Improved LVEF is used to refer to those with previous HFrEF who now have an LVEF &gt;40%. These patients should continue their HFrEF treatment.</p> <p><em><strong>Take-Home Message No. 5</strong></em></p> <p>Value statements have been created for many treatments. In accordance with ACC/AHA methodology.High-value therapies include ARNi, ACEi, ARB, beta blocker, MRA, implantable cardioverter-defibrillator, and cardiac resynchronization therapy. Intermediate-value therapies include SGLT2i and cardiac transplantation. The only therapy identified as low value was tafamidis for cardiac amyloidosis. The value of mechanical circulatory support and pulmonary pressure monitoring was considered uncertain.</p> <p><em><strong>Ta