HealthDay News — Guidelines have been developed to help optimize treatment of heart failure with reduced ejection fraction (HFrEF), according to an Expert Consensus Decision Pathway published online in the Journal of the American College of Cardiology.

Noting that there are currently many treatment options for patients with HFrEF, Clyde W. Yancy, MD, from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues developed guidelines to assist clinicians, emphasizing the best principles for initiating and titrating guideline-directed medical therapy for HFrEF.

The researchers discussed 10 pivotal issues in HFrEF that were unresolved in other recently published guideline statements. These include how to initiate, add, or switch therapy to new evidence-based treatments and how to achieve optimal therapy given multiple HF drug options. In addition, the guidelines address when to refer to a specialist; how to address the challenges associated with care coordination; improving adherence; and needs for specific patient cohorts, including frail and older adults. Other issues addressed are managing the cost of care, managing the increasing complexity of HF, managing common comorbidities, and integrating palliative and hospice care.

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“There has been a challenge with implementation of guidelines across the board,” Yancy said in a statement. “This document is a major step toward deploying aspects of implementation science as a means to improve adherence to evidence-based guideline-directed therapy.”

Several authors disclosed financial ties to the pharmaceutical and medical device industries.


Yancy CW, Januzzi JL Jr., Allen LA, et al; for the Heart Failure Pathway Writing Committee. 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction [published online December 13, 2017]. J Am Coll Cardiol. doi:10.1016/j.jacc.2017.11.025