Practical considerations during treatment of heart failure with reduced ejection fraction - Selections from the expert consensus decision pathway of the American College of Cardiology

Abstract

The American College of Cardiology Solution Set Oversight Committee issued an expert consensus document pathway in March, 2024 to aid the clinical decision-making of physicians participating in the care of heart failure patients with reduced ejection fraction. The document describes the practical details of initiation, titration and switching guideline directed medical therapy, as well as the most common contraindications and precautions of medical treatment. The recommendation discusses the clinical scenarios in case of which echocardiography, biomarkers such as natriuretic peptides, or filling pressure measurements could be indicated. These examinations help guide modification of medical therapy or – in case of patients remaining symptomatic despite optimal guideline directed medical therapy – help evaluate the need of and appropriateness for advanced heart failure therapies. Triggers for patient referral to a heart failure specialist are collected, as well as 10 steps to improve patient adherence. Some special patient groups with heart failure and reduced ejection fraction (such as African Americans, elderly or frailty patients) and their specific needs are detailed, as well as financial and social barriers to medical treatment and optimal care. Common comorbidities, palliative care and the complexity of care coordination are dealt with. Our summary of this concise decision pathway aims to present useful information to any expert or staff member involved in heart failure patient care.

Keywords

• heart failure with election fraction (hfref)
• guideline directed medical treatment (gdmt)