New evidence in heart failure (HF) has prompted the American College of Cardiology (ACC), the American Heart Association (AHA) and the Heart Failure Society of America (HFSA) to release a focused update to the 2013 guideline for the management of HF.

“For clinical practice guidelines to be truly useful, new evidence that changes clinical practice should be rapidly incorporated in the guidelines and disseminated to the practice community," Dr. Clyde W. Yancy, chair of the writing group, said in a news release.

"These updates were deemed necessary as new evidence in all of the areas addressed, derived from clinical trials, has emerged since the 2013 Heart Failure Guidelines and now merits inclusion,” he noted.

The update includes revisions to the sections on biomarkers, including recommendations for the prevention, diagnosis, and prognosis or added risk stratification of HF; updates on HF with preserved ejection fraction (EF); new data on comorbidities including sleep apnea, anemia and hypertension; and new insights regarding the prevention of HF, the societies say.

Revisions to the biomarkers section highlighted in the news release include:

For prevention: A recommendation to use natriuretic peptide biomarker–based screening for individuals at risk of developing HF, followed by team–based care that includes a cardiovascular specialist to optimize guideline–directed medical therapy and prevent the development of left ventricular dysfunction or new–onset HF. (Class IIa)

For diagnosis: A recommendation to measure natriuretic peptide biomarkers in patients presenting with dyspnea, to support a diagnosis or exclusion of HF. (Class I)

For prognosis or added risk stratification: 1) Measure B–type natriuretic peptide or N–terminal pro–B–type natriuretic peptide to establish a prognosis or disease severity in chronic HF (Class I); 2) Measure baseline natriuretic peptide biomarkers and/or cardiac troponin on admission to the hospital to establish a prognosis in acutely decompensated HF (Class I); 3) Measure predischarge natriuretic peptide level during a HF hospitalization, to establish a post–discharge prognosis (Class IIa); 4) Measure other clinically available tests, such as biomarkers of myocardial injury or fibrosis, in patients with chronic HF for additive risk stratification (Class IIb).

Revisions to the section on Stage C HF with preserved EF include a recommendation for:

Use of aldosterone antagonists in appropriately selected HF patients with preserved EF (at least 45%, elevated B–type natriuretic peptide or HF admission within 1 year, estimated glomerular filtration rate > 30 and creatinine < 2.5 mg/dL, potassium < 5.0 mEq /L), to decrease hospitalizations (Class IIb).

Routine use of nitrates or phosphodiesterase–5 inhibitors to increase quality of life or outcomes in HF patients with preserved EF, as there is no benefit (Class III).

This guideline update extends the prior guideline update released May 20, 2016 focusing on new drug therapy for HF, specifically the use of an angiotensin receptor–neprilysin inhibitor (valsartan/sacubitril) and a sinoatrial node modulator (ivabradine).(http://bit.ly/2fJL5Jv)

Further revisions were also made for patients with sleep apnea, anemia, and hypertension.

Both updates represent a new model in the generation of HF clinical practice guidelines that now includes input from the ACC, AHA and the HFSA.

The update appeared online April 28 in Circulation.