2019 ACC Expert Consensus Decision Pathway on Risk Assessment, Management, and Clinical Trajectory of Patients Hospitalized With Heart Failure

Hollenberg, Steven M.; Stevenson, Lynne Warner; Ahmad, Tariq; Amin, Vaibhav J.; Bozkurt, Biykem; Butler, Javed; Davis, Leslie L.; Drazner, Mark H.; Kirkpatrick, James N.; Peterson, Pamela N.; Reed, Brent N.; Roy, Christopher L.; Storrow, Alan B.

doi:10.1016/j.jacc.2019.08.001

Cited by 254 publications

(275 citation statements)

References 189 publications

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“…Clinicians will rely on history, physical exam, ECG and biomarkers, and recent cardiac imaging tests if available. Underlying cardiac history including CAD, cardiomyopathy, heart failure, and arrhythmia should be sought, and frequent contributors to decompensation should be eliminated ( 20 ). As discussed in the following text, the additional use of cardiac imaging may be helpful in the evaluation of cardiac complications from COVID-19.…”

Section: Clinical Presentationsmentioning

confidence: 99%

Multimodality Imaging in Evaluation of Cardiovascular Complications in Patients With COVID-19

Rudski

Januzzi

Rigolin

et al. 2020

Journal of the American College of Cardiology

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Standard evaluation and management of the patient with suspected or proven cardiovascular complications of coronavirus disease-2019 (COVID-19), the disease caused by severe acute respiratory syndrome relatedcoronavirus-2 (SARS-CoV-2), is challenging. Routine history, physical examination, laboratory testing, electrocardiography, and plain x-ray imaging may often suffice for such patients, but given overlap between COVID-19 and typical cardiovascular diagnoses such as heart failure and acute myocardial infarction, need frequently arises for advanced imaging techniques to assist in differential diagnosis and management. This document provides guidance in several common scenarios among patients with confirmed or suspected COVID-19 infection and possible cardiovascular involvement, including chest discomfort with electrocardiographic changes, acute hemodynamic instability, newly recognized left ventricular dysfunction, as well as imaging during the subacute/chronic phase of COVID-19. For each, the authors consider the role of biomarker testing to guide imaging decision-making, provide differential diagnostic considerations, and offer general suggestions regarding application of various advanced imaging techniques.

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Section: Clinical Presentationsmentioning

confidence: 99%

Multimodality Imaging in Evaluation of Cardiovascular Complications in Patients With COVID-19

Rudski

Januzzi

Rigolin

et al. 2020

Journal of the American College of Cardiology

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“…The aforementioned guidelines made no recommen-dation regarding ARNI for patients hospitalized with decompensated HF. Following publication of the PIO-NEER-HF trial in 2019, the expert consensus document from ESC [59] and expert consensus decision pathway from the American College of Cardiology [60] stated that the initiation of sacubitril/valsartan instead of ACEIs or ARBs may be considered for patients admitted for decompensated HF. Although the Korean Food and Drug Administration label has not included the use of sacubitril/valsartan in acute HF patients to date, the Korean Society of Heart Failure recently revised the guideline to consider sacubitril/valsartan as an initial treatment for patients hospitalized with acute decompensated HF (class IIb, level of evidence B).…”

Section: Acute Heart Failurementioning

confidence: 99%

Angiotensin receptor-neprilysin inhibitor for the treatment of heart failure: a review of recent evidence

Choi

Shin

2020

Korean J Intern Med

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Heart failure (HF) is a growing health concern in aging societies worldwide. Sacubitril/valsartan is changing the real-world treatment in the whole spectrum of HF. The beginning was the PARADIGM-HF trial published in 2014, which demonstrated the beneficial effects of inhibiting natriuretic peptide breakdown in combination with hindering the renin-angiotensin system in HF patients with a reduced ejection fraction. Subsequent large-scale randomized trials have evaluated angiotensin receptor-neprilysin inhibitor in HF patients with acute decompensation or with preserved ejection fraction. The post hoc analyses are being conducted as well. This review summarizes the recent evidence of sacubitril/ valsartan regarding patient-centered outcomes, based on randomized controlled trials and their associated studies.

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“…Doing so takes advantage of an important opportunity to reduce the risk of readmission and even reverse the disease process. 18 Uptitration of GDMT in patients with heart failure with reduced ejection fraction is associated with a decreased risk of mortality, while discontinuation is associated with an increased risk of mortality. 19 However, recent registry data indicate that intensity of GDMT is just as likely to be decreased as increased during the hospitalization.…”

Section: During Hospitalizationmentioning

confidence: 99%

The Role of Process Improvements in Reducing Heart Failure Readmissions

Dong¹

2020

JCOM

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Objective: To review selected process-of-care interventions that can be applied both during the hospitalization and during the transitional care period to help address the persistent challenge of heart failure readmissions. Methods: Review of the literature. Results: Process-of-care interventions that can be implemented to reduce readmissions of heart failure patients include: accurately identifying heart failure patients; providing disease education; titrating guideline-directed medical therapy; ensuring discharge readiness; arranging close discharge follow-up; identifying and addressing social barriers; following up by telephone; using home health; and addressing comorbidities. Importantly, the heart failure hospitalization is an opportunity to set up outpatient success, and setting up feedback loops can aid in postdischarge monitoring. Conclusion: We encourage teams to consider local capabilities when selecting processes to improve; begin by improving something small to build capacity and team morale, and continually iterate and reexamine processes, as health care systems are continually evolving.

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2019 ACC Expert Consensus Decision Pathway on Risk Assessment, Management, and Clinical Trajectory of Patients Hospitalized With Heart Failure

Cited by 254 publications

References 189 publications

Multimodality Imaging in Evaluation of Cardiovascular Complications in Patients With COVID-19

Multimodality Imaging in Evaluation of Cardiovascular Complications in Patients With COVID-19

Angiotensin receptor-neprilysin inhibitor for the treatment of heart failure: a review of recent evidence

The Role of Process Improvements in Reducing Heart Failure Readmissions

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