2013 ACCF/AHA Guideline for the Management of Heart Failure

Yancy, Clyde W.; Jessup, Mariell; Bozkurt, Biykem; Butler, Javed; Casey, Donald E.; Drazner, Mark H.; Fonarow, Gregg C.; Geraci, Stephen A.; Horwich, Tamara B.; Januzzi, James L.; Johnson, Maryl R.; Kasper, Edward K.; Levy, Wayne C.; Masoudi, Frederick A.; McBride, Patrick E.; McMurray, John J.V.; Mitchell, Judith E.; Peterson, Pamela N.; Riegel, Bárbara; Sam, Flora; Stevenson, Lynne Warner; Tang, W.H. Wilson; Tsai, Emily J.; Wilkoff, Bruce L.

doi:10.1161/cir.0b013e31829e8776

Cited by 2,105 publications

(1,687 citation statements)

References 1,002 publications

Supporting

Mentioning

1,566

Contrasting

Unclassified

106

Order By: Relevance

“…Its process will be guided by the following advised measures: Drug prescription as well as the rate of titration of each patient will be made by the cardiologist at the beginning of the process and an HF nurse will be responsible for implementing the titration process.To consider possible biweekly increases3 To consider alternating increases of different drugs (American Heart association Heart Failure 2013 CPGs27). …”

Section: Methodsmentioning

confidence: 99%

Design of a multicentre randomized controlled trial to assess the safety and efficacy of dose titration by specialized nurses in patients with heart failure. ETIFIC study protocol

et al. 2017

View full text Add to dashboard Cite

AimsHeart failure (HF) is associated with many hospital admissions and relatively high mortality, rates decreasing with administration of beta‐blockers (BBs), angiotensin‐converting‐enzyme inhibitors, angiotensin II receptor blockers, and mineralocorticoid receptor antagonists. The effect is dose dependent, suboptimal doses being common in clinical practice. The 2012 European guidelines recommend close monitoring and dose titration by HF nurses. Our main aim is to compare BB doses achieved by patients after 4 months in intervention (HF nurse‐managed) and control (cardiologist‐managed) groups. Secondary aims include comparing doses of the other aforementioned drugs achieved after 4 months, adverse events, and outcomes at 6 months in the two groups.MethodsWe have designed a multicentre (20 hospitals) non‐inferiority randomized controlled trial, including patients with new‐onset HF, left ventricular ejection fraction ≤40%, and New York Heart Association class II–III, with no contraindications to BBs. We will also conduct qualitative analysis to explore potential barriers to and facilitators of dose titration by HF nurses. In the intervention group, HF nurses will implement titration as prescribed by cardiologists, following a protocol. In controls, cardiologists will both prescribe and titrate doses. The study variables are doses of each of the drugs after 4 months relative to the target dose (%), New York Heart Association class, left ventricular ejection fraction, N‐terminal pro B‐type natriuretic peptide levels, 6 min walk distance, comorbidities, renal function, readmissions, mortality, quality of life, and psychosocial characteristics.ConclusionsThe trial seeks to assess whether titration by HF nurses of drugs recommended in practice guidelines is safe and not inferior to direct management by cardiologists. The results could have an impact on clinical practice.

show abstract

Section: Methodsmentioning

confidence: 99%

Design of a multicentre randomized controlled trial to assess the safety and efficacy of dose titration by specialized nurses in patients with heart failure. ETIFIC study protocol

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Use of b‐type natriuretic peptide (BNP) and the physiologically inert cleaved fragment, N‐terminal‐pro‐b‐type natriuretic peptide (NT‐proBNP), are guideline recommended by for the evaluation of dyspnea 2, 3. BNP and/or NT‐proBNP levels correlate with HF diagnosis, severity, and mortality 4, 5.…”

Section: Introductionmentioning

confidence: 99%

“…Thus, the prognostic utility of NT‐proBNP may differ between obese and nonobese patients, though this has not been well characterized in patients with acute HF. Given that the diagnostic and prognostic utility of NT‐proBNP may be strongest in the setting of acute decompensated HF,3 we examined the effect modification of body mass index (BMI) on the prognostic value of NT‐proBNP levels during acute HF exacerbation in patients enrolled in the ASCEND‐HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) randomized, clinical trial.…”

Section: Introductionmentioning

confidence: 99%

Interaction of Body Mass Index on the Association Between N‐Terminal‐Pro‐b‐Type Natriuretic Peptide and Morbidity and Mortality in Patients With Acute Heart Failure: Findings From ASCEND‐HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure)

Bhatt

Cooper

Ambrosy

et al. 2018

JAHA

Self Cite

View full text Add to dashboard Cite

BackgroundHigher body mass index (BMI) is associated with lower circulating levels of N‐terminal‐pro‐b‐type natriuretic peptide (NT‐proBNP). The Interaction between BMI and NT‐proBNP with respect to clinical outcomes is not well characterized in patients with acute heart failure.Methods and ResultsA total of 686 patients from the biomarker substudy of the ASCEND‐HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated HF ) clinical trial with documented NT‐proBNP levels at baseline were included in the present analysis. Patients were classified by the World Health Organization obesity classification (nonobese: BMI <30 kg/m2, Class I obesity: BMI 30–34.9 kg/m2, Class II obesity BMI 35–39.9 kg/m2, and Class III obesity BMI ≥40 kg/m2). We assessed baseline characteristics and 30‐ and 180‐day outcomes by BMI class and explored the interaction between BMI and NT‐proBNP for these outcomes. Study participants had a median age of 67 years (55, 78) and 71% were female. NT‐proBNP levels were inversely correlated with BMI (P<0.001). Higher NT‐proBNP levels were associated with higher 180‐day mortality (adjusted hazard ratio for each doubling of NT‐proBNP, 1.40; 95% confidence interval, 1.16, 1.71; P<0.001), but not 30‐day outcomes. The effect of NT‐proBNP on 180‐day death was not modified by BMI class (interaction P=0.24).ConclusionsThe prognostic value of NT‐proBNP was not modified by BMI in this acute heart failure population. NT‐proBNP remains a useful prognostic indicator of long‐term mortality in acute heart failure even in the obese patient.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00475852.

show abstract

“…The use of nitrates is strongly recommended by the Canadian Cardiovascular Society,9 and it is a class IIa recommendation by the European Society of Cardiology 10. The American Heart Association recommends nitrates least strongly, as a class IIb recommendation 11. The evidence behind these recommendations is limited and based on small studies or consensus opinion of experts (moderate quality, level of evidence B and C).…”

Section: Introductionmentioning

confidence: 99%

Impact of Nitrate Use on Survival in Acute Heart Failure: A Propensity‐Matched Analysis

Parker

Austin

et al. 2016

JAHA

View full text Add to dashboard Cite

BackgroundThere is limited evidence that the use of nitrates in acute decompensated heart failure early after presentation to a hospital can improve clinical outcomes. We aimed to determine whether early nitrate exposure is associated with improved survival in a large retrospective cohort study.Methods and ResultsWe examined 11 078 acute decompensated heart failure patients who presented to emergency departments in Ontario, Canada, between 2004 and 2007, in the Enhanced Feedback For Effective Cardiac Treatment and the Emergency Heart failure Mortality Risk Grade studies. In propensity‐matched analyses, we examined the effect of nitrate administration in the acute emergency department setting for its impact on death at 7, 30, and 365 days. In propensity‐matched analyses, we found no difference in survival between those who received nitrates in the emergency department and the non‐nitrate comparator group. Hazard ratios for mortality were 0.76 (95% CI; 0.51, 1.12) over 7 days, 0.97 (95% CI; 0.77, 1.21) over 30 days, and 0.91 (95% CI; 0.82, 1.02) over 1 year of follow‐up. There was no significant difference in survival or hospital length of stay between nitrate and non‐nitrate controls in extended follow‐up. There was also no significant effect of nitrates in subgroups stratified by presence of chest pain, troponin elevation, chronic nitrate use, and known coronary artery disease.ConclusionsIn acute decompensated heart failure, use of nitrates acutely in the emergency department setting was not associated with improvement in short‐term or near‐term survival. Our study does not support generalized use of nitrates when the primary goal of therapy is to reduce mortality.

show abstract

2013 ACCF/AHA Guideline for the Management of Heart Failure

Cited by 2,105 publications

References 1,002 publications

Design of a multicentre randomized controlled trial to assess the safety and efficacy of dose titration by specialized nurses in patients with heart failure. ETIFIC study protocol

Design of a multicentre randomized controlled trial to assess the safety and efficacy of dose titration by specialized nurses in patients with heart failure. ETIFIC study protocol

Interaction of Body Mass Index on the Association Between N‐Terminal‐Pro‐b‐Type Natriuretic Peptide and Morbidity and Mortality in Patients With Acute Heart Failure: Findings From ASCEND‐HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure)

Impact of Nitrate Use on Survival in Acute Heart Failure: A Propensity‐Matched Analysis

Contact Info

Product

Resources

About