New Guidelines for Treating Heart Failure

March 26 (HealthDay News) -- New guidelines for treatment of heart failure are being issued by the American Heart Association and the American College of Cardiology, with a strong emphasis on management of people hospitalized for the condition and also on the treatment of blacks.

"The most important change is the addition of a new section on hospitalized patients," said Dr. Mariell Jessup, professor of medicine at the University of Pennsylvania and chairwoman of the guidelines writing group. "It's unusual to have a completely new section, but it is increasingly recognized that hospitalization for heart failure contributes substantially to morbidity and mortality and to health-care costs."

About 5.7 million Americans have heart failure, the progressive loss of ability to pump blood, and 1.1 million people are hospitalized because of it each year. Heart failure management will cost the U.S. health-care system more than $37 billion this year, the guidelines group estimated.

Guidelines are assessed periodically to determine whether results of new trials or studies require changes, Jessup said. "We found that enough has happened for the guidelines to be changed," she said. "The most important studies were on hospitalized patients, so we felt there was a gap we had to fill."

The guidelines are being published in the Journal of the American College of Cardiology and in the Heart Association journal Circulation

The new guidelines "outline what has to happen in the initial evaluation, such as measurement of ejection fraction and whether the patient has coronary disease or not," Jessup said. "They describe what should be done each day to assess the patient and the need to think carefully about which drugs should be given and why."

Drug assessment includes "the role of cardioactive drugs including nitroglycerine," Jessup said. "The guidelines also stress the role of evidence-based medicine and also what should be considered in the discharge of a patient from the hospital."

Special consideration is given to blacks, she said, because "heart failure has a different etiology [cause] and tends to occur younger" in blacks than in others. The guidelines stress the use of two drugs, hydralazine and isosorbide dinitrate, in blacks. Both relieve pressure on the heart by relaxing blood vessels.

"A trial showed that using them in a fixed-dose combination produced a remarkable reduction in mortality in African-Americans, and we really wanted to strengthen the recommendations that they should be used in African-Americans," Jessup said.

The drugs are effective, because heart failure in blacks has been shown to be more related to high blood pressure than it is in whites, she said. "Also, African-Americans with heart failure don't seem to have as much coronary disease," or blockage of the heart arteries, Jessup said.

One revised section of the guidelines contains simplified advice on implantable cardioverter defibrillators, which can prevent sudden cardiac death by delivering a shock to restore normal heart rhythm when the heart suddenly beats irregularly. Various guidelines on the use of these devices have been issued, Jessup said, "and we are trying to simplify what we have said about them," Jessup said.

Also revised is the guideline section on treatment of people who have both heart failure and the arrhythmia called atrial fibrillation. There has been a debate about whether it is better to center treatment on relieving heart failure or on restoring normal heart rhythm, Jessup said. Several studies have shown that neither strategy is superior, and so the guidelines say a decision should be based on individual patient characteristics, she said.


SOURCES: Mariell Jessup, M.D., professor of medicine, University of Pennsylvania School of Medicine, Philadelphia; March 26, 2009, Circulation; March 26, 2009, Journal of the American College of Cardiology

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