2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America

Characteristics and Treatments of Patients Enrolled in the CHAMP‐HF Registry Compared With Patients Enrolled in the PARADIGM‐HF Trial

“…Current heart failure (HF) guidelines recommend the use of an angiotensin receptor neprilysin inhibitor in a broad population of patients with chronic HF with reduced ejection fraction (HFrEF) 1. The guidelines recommend an angiotensin receptor neprilysin inhibitor, an angiotensin‐converting enzyme inhibitor (ACEI), or an angiotensin receptor blocker (ARB) to reduce morbidity and mortality in all eligible patients with stage C chronic HFrEF.…”

Prognostic Significance of Baseline Serum Sodium in Heart Failure With Preserved Ejection Fraction

“…Epidemiologic studies estimate that the prevalence of heart failure with preserved ejection fraction (HFpEF), previously termed diastolic heart failure (HF), is 1.1% to 5.5% of the general population,1, 2 and ranges from 40% to 71% among HF patients 1, 3, 4. Over the past 3 decades, while the prevalence of HF with reduced ejection fraction (EF) or systolic HF has remained stable, HFpEF has increased commensurately with the aging of the population at a rate of 1% per year 3.…”

“…A major gap in treatment of HFpEF is that no evidence‐based therapy has yet been identified for HFpEF in spite of multiple clinical trials testing the efficacy of angiotensin‐converting enzyme inhibitors,7 angiotensin receptor blockers,8 β‐blockers,9 digoxin,10 and spironolactone 11. The major limiting factors in previously reported clinical trials and prospective observational studies include lack of uniformity in accurately defining the HFpEF cohort, and failure in distinguishing HFpEF from HF with intermediate EF and HF with recovered EF, as advocated in the clinical guidelines of the European Society of Cardiology and the American College of Cardiology Foundation/American Heart Association 4. HFpEF is extremely difficult to curate in a large national database given its lack of consistency in identifying and reporting by healthcare providers and the difficulty of extracting all known left ventricular ejection fraction (LVEF) values to ensure accurate diagnosis.…”

Mineralocorticoid Receptor Antagonists in High‐Risk Heart Failure Patients With Diabetes Mellitus and/or Chronic Kidney Disease

“…Although spironolactone appeared to reduce cardiovascular mortality and HFHs (Heart Failure Hospitalizations) in the Americas region in TOPCAT, the overall results including patients from Russia and the Republic of Georgia, who have been found not to have had the mortality rate we expect in patients with HFpEF and in whom there is evidence that many patients randomized to spironolactone and claiming to have taken it did not take it,15 were not significant. Until further strategies are identified that clearly reduce cardiovascular mortality and hospitalizations for heart failure in patients with HFmrEF and HFpEF, one should consider the use of spironolactone in these patients as suggested by the class II indication in current US guidelines 2. Further information in regard to the efficacy and safety of spironolactone in patients with midrange left ventricular function and HFpEF should be forthcoming from the prospectively randomized open label SPIRRIT‐HFpEF (Spironolactone Initiation Registry Randomized Interventional Trial in Heart Failure with Preserved Ejection Fraction) (n=3200) in which the primary outcome is cardiovascular mortality 16.…”

“…Their use in patients with midrange and preserved left ventricular function (HFpEF) remains controversial. Despite designation as a class 1 indication in current US2 and European3 guidelines for patients with HFrEF, their use remains suboptimal in comparison to β‐adrenergic blocking agents, angiotensin‐converting enzyme inhibitors, or angiotensin receptor blocking agents 4. The relative underuse of MRAs in guideline‐eligible patients with HFrEF5 has in large part been attributed to the fear of inducing hyperkalemia and/or renal insufficiency (RI), especially in patients with diabetes mellitus (DM) and/or chronic kidney disease 6.…”