Show 2 more https://web.pathway.md/diseases/rectslm30dGoeF3RH 15/28 6/24/23, 12:32 PM Heart failure Pathway As per ESC 2021 guidelines, do not administer routine inotropic agents because of safety concerns unless the patient has symptomatic hypotension and evidence of hypoperfusion. D Show 2 more Intravenous nitrates: As per ACEP 2022 guidelines, consider administering high-dose nitroglycerin in patients with acute HF syndrome and elevated BP. C As per ACC 2022 guidelines, consider administering IV nitroglycerin or nitroprusside as an adjuvant to diuretic therapy to relieve dyspnea in patients admitted with decompensated HF, in the absence of systemic hypotension. C As per ESC 2021 guidelines, consider administering IV vasodilators as initial therapy to improve symptoms and reduce congestion in patients with acute HF and systolic BP > 110 mmHg. C Opioids: do not use routine opioids unless in selected patients with severe/intractable pain or anxiety. D Management of cardiogenic shock (general principles): Consider managing patients with cardiogenic shock by a multidisciplinary team experienced in shock. C Consider placing a pulmonary artery line to define hemodynamic subsets and appropriate management strategies in patients presenting with cardiogenic shock. C Management of cardiogenic shock, inotropes and vasopressors: As per HFSA/ACC/AHA 2022 guidelines, administer IV inotropic support to maintain systemic perfusion and preserve end-organ performance in patients with cardiogenic shock. B As per ESC 2021 guidelines, consider administering a vasopressor, preferably norepinephrine, to increase BP and vital organ perfusion in patients with cardiogenic shock. C Management of cardiogenic shock, mechanical circulatory support: As per HFSA/ACC/AHA 2022 guidelines: Consider triaging patients not rapidly responding to initial shock measures to centers providing temporary mechanical circulatory support to optimize management. C Consider initiating temporary mechanical circulatory support in patients with cardiogenic shock when end-organ function cannot be maintained by pharmacologic means to support cardiac function. C As per ESC 2021 guidelines, consider initiating short-term mechanical circulatory support in patients with cardiogenic shock as a bridge to recovery, bridge to decision, bridge to bridge or to treat the cause of cardiogenic shock or long-term mechanical circulatory support or transplantation. C Management of cardiogenic shock (intra-aortic balloon pump): Consider performing intra-aortic balloon pump therapy in patients with cardiogenic shock as a bridge to recovery, bridge to decision, bridge to bridge including the treatment of cardiogenic shock (mechanical complication of acute myocardial infarction) or long-term mechanical circulatory support or transplantation. C https://web.pathway.md/diseases/rectslm30dGoeF3RH 16/28 6/24/23, 12:32 PM Heart failure Pathway Do not perform intra-aortic balloon pump therapy routinely in patients with post-myocardial infarction cardiogenic shock. D Management of cardiogenic shock (coronary revascularization): transfer suitable patients with STEMI developing cardiogenic shock or acute severe HF, irrespective of the time delay from myocardial infarction onset, immediately to a PCI-capable hospital for coronary angiography. B Show 6 more 7. Nonpharmacologic interventions Lifestyle modifications: As per AHA 2017 guidelines, control or avoid other conditions likely to lead or contribute to HF, including obesity, diabetes mellitus, tobacco use, and known cardiotoxic agents. B As per AACE 2016 guidelines, do not offer weight loss for the expressed purpose of preventing cardiovascular events or to extend life in patients with congestive HF, although evidence suggests that weight loss can improve myocardial function and congestive HF symptomatology in the short term. D Self-management programs: Offer self-management strategies in patients with HF to reduce the risk of HF hospitalization and mortality. A Offer either home-based and/or clinic-based programs to improve outcomes and to reduce the risk of HF hospitalization and mortality. A Exercise: As per ACC 2022 guidelines, advise participating in exercise training or practicing regular physical activity to improve functional status, exercise performance and quality of life in patients with HF able to participate. A As per ESC 2021 guidelines, advise exercising in all patients able in order to improve exercise capacity, quality of life and reduce HF hospitalization. A Cardiac rehabilitation: As per ACC 2022 guidelines, consider offering participation in cardiac rehabilitation programs to improve functional capacity, exercise tolerance and health-related quality of life in patients with HF. C As per ESC 2021 guidelines, consider offering a supervised, exercise-based, cardiac rehabilitation program in patients with more severe disease, frailty or with comorbidities. C Fluid and sodium restriction: Advise avoiding excessive sodium intake to reduce congestive symptoms in patients with stage C HF. B Insufficient evidence to recommend fluid restriction to reduce congestive symptoms in patients with advanced HF and hyponatremia. I https://web.pathway.md/diseases/rectslm30dGoeF3RH 17/28 6/24/23, 12:32 PM Heart failure Pathway Landmark trials: SODIUM-HF In adult patients with chronic HF receiving optimally tolerated medical treatment, reduced sodium intake was not superior to usual sodium intake with respect to a composite of admission to hospital for cardiovascular causes, emergency department visit for cardiovascular causes, or death from all causes at 12 months. Justin A Ezekowitz et al. Lancet. 2022 Apr 9. Nutritional supplements: Consider offering omega-3 PUFA supplementation as adjunctive therapy to reduce mortality and cardiovascular hospitalizations in patients with HF and NYHA class II-IV symptoms. C Do not offer vitamins, nutritional supplements or hormonal therapy in patients with HF with reduced ejection fraction other than to correct specific deficiencies. D 8. Therapeutic procedures Cardiac resynchronization therapy: As per ACC 2022 guidelines, perform cardiac resynchronization therapy to reduce total mortality and hospitalizations and improve symptoms and quality of life in patients with LV ejection fraction 35%, sinus rhythm, LBBB with a QRS duration 150 ms and NYHA class II, III or ambulatory IV symptoms on guideline-directed medical therapy. B Show 10 more As per ESC 2021 guidelines, perform cardiac resynchronization therapy to improve symptoms and reduce morbidity and mortality in symptomatic patients with HF in sinus rhythm with a QRS duration 150 ms and LBBB QRS morphology and with LV ejection fraction 35% despite optimal medical therapy. A Show 6 more Implantable cardioverter-defibrillator: As per ACC 2022 guidelines, perform placement of an ICD for primary prevention of sudden cardiac death to reduce total mortality in patients with non-ischemic dilated cardiomyopathy or ischemic heart disease at least 40 days post-myocardial infarction with LV ejection fraction 35% and NYHA class II-III symptoms on chronic guideline-directed medical therapy having a reasonable expectation of meaningful survival for > 1 year. A Show 4 more As per ESC 2021 guidelines, perform placement of an ICD to reduce the risk of sudden death and all-cause mortality in patients recovered from a ventricular arrhythmia causing hemodynamic instability and expected to survive for > 1 year with good functional status, in the absence of reversible causes or unless the ventricular arrhythmia has occurred < 48 hours after a myocardial infarction. A Show 6 more As per AHA 2018 guidelines: https://web.pathway.md/diseases/rectslm30dGoeF3RH 18/28 6/24/23, 12:32 PM Heart failure Pathway Consider performing placement of an ICD in patients with ventricular arrhythmias and HF with reduced ejection fraction awaiting heart transplantation and otherwise not qualifying for an ICD (such as NYHA class IV and/or use of inotropes) with a plan to discharge home. C Consider performing placement of an ICD in patients with a LV assist device and sustained ventricular arrhythmia. C Mechanical circulatory support: As per ACC 2022 guidelines, initiate mechanical circulatory support in carefully selected patients with stage D HF and reduced LV ejection fraction if definitive management is planned or cardiac recovery is anticipated. B As per JCS 2022 guidelines, consider performing placement of an implantable LV assist device to improve prognosis and quality of life in patients with stage D HF with reduced ejection fraction ineligible for heart transplantation. C As per ESC 2021 guidelines, ensure that patients eligible for long-term mechanical circulatory support have good compliance, appropriate capacity for device handling, and psychosocial support. B Show 2 more Percutaneous coronary intervention: As per ESC 2021 guidelines, consider performing coronary revascularization to relieve persistent symptoms of angina (or an angina-equivalent) in patients with HF with reduced ejection fraction, chronic coronary syndrome and coronary anatomy suitable for revascularization, despite optimal medical therapy including anti-anginal drugs. C Show 2 more As per ACC 2017 guidelines: Perform coronary artery revascularization via CABG surgery or percutaneous intervention in patients with HF and angina despite medical therapy with a suitable coronary anatomy, especially for a left main stenosis (> 50%) or left main equivalent disease. B Consider performing coronary artery revascularization in patients with coronary artery disease if symptoms (angina) or demonstrable myocardial ischemia is judged to be having an adverse effect on symptomatic HFpEF despite guideline-directed medical therapy. C Renal replacement therapy: As per ESC 2021 guidelines: Consider performing RRT in patients with refractory volume overload and end-stage kidney failure. C Consider performing ultrafiltration in patients with refractory volume overload unresponsive to diuretic treatment. C As per ACC 2017 guidelines: Consider performing ultrafiltration in patients with obvious volume overload to alleviate congestive symptoms and restore fluid balance. C Consider performing ultrafiltration in patients with refractory congestion not responding to medical therapy. C https://web.pathway.md/diseases/rectslm30dGoeF3RH 19/28 6/24/23, 12:32 PM Heart failure Pathway 9. Surgical interventions Coronary artery bypass graft: As per ACC 2022 guidelines, consider performing surgical revascularization in conjunction with guideline-directed medical therapy to improve symptoms, cardiovascular hospitalizations and long-term all-cause mortality in selected patients with HF, reduced ejection fraction ( 35%) and suitable coronary anatomy. B As per ESC 2021 guidelines, consider performing CABG as the first-choice revascularization strategy in patients suitable for surgery. especially in patients with diabetes and multivessel disease. C Show 3 more LV aneurysmectomy: consider performing LV reconstructive surgery or LV aneurysmectomy in carefully selected patients with HF with reduced ejection fraction for specific indications, including intractable HF and ventricular arrhythmias. C Aortic valve surgery: As per ESC 2021 guidelines: Perform aortic valve intervention, TAVI or SAVR, to reduce mortality and improve symptoms in patients with HF and severe high gradient aortic stenosis. B Choose between TAVI and SAVR by the heart team according to individual patient preference and features, including age, surgical risk, clinical, anatomical and procedural aspects, weighing the risks and benefits of each approach. B As per AHA 2017 guidelines: Consider performing SAVR in patients with critical aortic stenosis and a predicted surgical mortality of 10%. C Consider performing TAVR after careful candidate consideration in patients with critical aortic stenosis deemed inoperable. C Mitral valve surgery: As per ESC 2021 guidelines, consider performing percutaneous edge-to-edge mitral valve repair in carefully selected patients with secondary MR ineligible for surgery, not requiring coronary revascularization, being symptomatic despite optimal medical therapy, and fulfilling criteria for reducing HF hospitalizations. C Show 2 more As per AHA 2017 guidelines, consider performing transcatheter mitral valve repair or mitral valve surgery for functional mitral insufficiency only after careful candidate selection and with a background of guideline-directed medical therapy. C Heart transplantation: As per ACC 2022 guidelines: Offer cardiac transplantation to improve survival and quality of life in selected patients with advanced HF despite guideline-directed medical therapy. B https://web.pathway.md/diseases/rectslm30dGoeF3RH 20/28 6/24/23, 12:32 PM Heart failure Pathway Recognize that cardiac transplantation provides intermediate economic value in patients with advanced (stage D) HF despite guideline-directed medical therapy. B As per ESC 2021 guidelines, offer heart transplantation in patients with advanced HF refractory to medical/device therapy and not having absolute contraindications. B 10. Specific circumstances Pregnant patients: provide patient-centered counseling regarding contraception and the risks of cardiovascular deterioration during pregnancy in patients with a history of HF or cardiomyopathy including previous peripartum cardiomyopathy. B Show 2 more Patients with cardiac amyloidosis (evaluation): screen for serum and urine monoclonal light chains with serum and urine immunofixation electrophoresis and sFLC in patients with a clinical suspicion for cardiac amyloidosis. B Show 2 more Patients with cardiac amyloidosis, management: As per HFSA/ACC/AHA 2022 guidelines, initiate transthyretin tetramer stabilizer therapy (tafamidis) to reduce cardiovascular morbidity and mortality in selected patients with wild-type or variant transthyretin cardiac amyloidosis and NYHA class I-III HF symptoms. B Show 2 more Landmark trials: ATTR-ACT In patients with transthyretin amyloid cardiomyopathy, tafamidis, as compared to placebo, reduced all-cause mortality (29.5% vs. 42.9%; HR 0.70, 95% CI 0.51-0.96) and reduced the rate of cardiovascular-related hospitalizations (0.48 per year vs. 0.70 per year; RR 0.68, 95% CI 0.56-0.81). Tafamidis also reduced the decline in distance for the 6 minute walk test (p < 0.001) and reduced the rate of decline in KCCQ-OS score (p < 0.001). The incidence and types of adverse events were similar in the two groups. Maurer MS et al. N Engl J Med. 2018 Sep 13. As per ESC 2021 guidelines: Initiate tafamidis to reduce symptoms, cardiovascular hospitalization and mortality in patients with genetic testing proven hereditary transthyretin cardiac amyloidosis and NYHA class I or II symptoms. B Initiate tafamidis to reduce symptoms, cardiovascular hospitalization and mortality in patients with wild-type transthyretin cardiac amyloidosis and NYHA class I or II symptoms. B Patients with cancer therapy-related HF: As per ACC 2022 guidelines, consider obtaining pre-therapy evaluation of cardiac function to establish baseline cardiac function and guide the choice of cancer therapy in patients with https://web.pathway.md/diseases/rectslm30dGoeF3RH 21/28 6/24/23, 12:32 PM Heart failure Pathway cardiovascular risk factors or known cardiac disease being considered for potentially cardiotoxic anticancer therapies. C Show 5 more As per ESC 2021 guidelines, obtain cardiovascular evaluation in patients with cancer at increased risk for cardiotoxicity defined by a history or risk factors of CVD, previous cardiotoxicity or exposure to cardiotoxic agents before scheduled anticancer therapy, preferably by a cardiologist with experience/interest in cardio-oncology. B Show 2 more Patients with pulmonary hypertension: consider obtaining additional testing with exercise or fluid challenge to uncover post-capillary pulmonary hypertension in patients with pulmonary hypertension at right heart catheterization, a borderline pulmonary arterial wedge pressure (13-15 mmHg), and features of HFpEF. C Show 3 more 11. Patient education General counseling: As per AHA 2022 guidelines, provide specific education and support to facilitate self-care in a multidisciplinary manner in patients with HF. B As per JCS 2022 guidelines, encourage and educate patients to measure their BP at home and to record it as a daily self-management goal. B Genetic counseling: Consider referring selected patients with non-ischemic cardiomyopathy for genetic counseling and testing to identify conditions likely to guide treatment in patients and family members. C Offer genetic screening and counseling in first-degree relatives of selected patients with genetic or inherited cardiomyopathies to detect cardiac disease and prompt consideration of treatments to decrease HF progression and sudden death. B 12. Preventative measures Primary prevention: As per ACC 2022 guidelines, advise following a healthy lifestyle habits to reduce future risk of HF in general population, including: regular physical activity maintaining normal weight healthy dietary patterns avoiding smoking. B Show 3 more Landmark trials: STOP-HF https://web.pathway.md/diseases/rectslm30dGoeF3RH 22/28 6/24/23, 12:32 PM Heart failure Pathway In patients with cardiovascular risk factors, screening with BNP was superior to no routine BNP screening with respect to LV dysfunction with or without HF. Ledwidge M et al. JAMA. 2013 Jul 3. As per ESC 2021 guidelines, counsel patients against sedentary habit, obesity, cigarette smoking and alcohol abuse to prevent or delay the onset of HF. B Show 4 more Immunizations: As per ACC 2022 guidelines, consider offering vaccination against respiratory illnesses to reduce mortality in patients with HF. C As per ESC 2021 guidelines, consider offering influenza and pneumococcal vaccinations in patients with HF to prevent HF hospitalizations. C 13. Follow-up and surveillance Telemonitoring: consider offering noninvasive home telemonitoring to reduce the risk of recurrent cardiovascular and HF hospitalizations and cardiovascular death in patients with HF. C Wireless implantable hemodynamic monitoring: As per ACC 2022 guidelines: Insufficient evidence regarding the usefulness of wireless monitoring of pulmonary artery pressure by an implanted hemodynamic monitor to reduce the risk of subsequent HF hospitalizations in selected adult patients with NYHA class III HF and history of a HF hospitalization in the past year or elevated natriuretic peptide levels on maximally tolerated stable doses of guideline-directed medical therapy with optimal device therapy. I Insufficient evidence regarding the usefulness of wireless monitoring of the pulmonary artery pressure by an implanted hemodynamic monitor in patients with NYHA class III HF with a HF hospitalization within the previous year. I As per ESC 2021 guidelines, consider performing placement of a wireless hemodynamic monitoring system for pulmonary artery pressure monitoring to improve clinical outcomes in symptomatic patients with HF. C Discharge from hospital: As per ACEP 2022 guidelines, do not rely on current acute HF syndrome risk stratification tools alone to determine which patients may be discharged directly home from the emergency department. D Show 3 more As per ACC 2022 guidelines, provide patient-centered discharge instructions with a clear plan for transitional care before hospital discharge in patients hospitalized with worsening HF. B As per ESC 2021 guidelines: https://web.pathway.md/diseases/rectslm30dGoeF3RH 23/28 6/24/23, 12:32 PM Heart failure Pathway Obtain careful evaluation in patients hospitalized for HF to exclude persistent signs of congestion before discharge and to optimize oral treatment. B Initiate evidence-based oral medical treatment before discharge. B Follow-up after hospital discharge: As per ACC 2022 guidelines, consider obtaining an early follow-up, generally within 7 days of hospital discharge, to optimize care and reduce re-hospitalization in patients discharged after hospitalization for worsening HF. C As per ESC 2021 guidelines, obtain an early follow-up at 12 weeks after discharge to assess signs of congestion, drug tolerance and start and/or uptitrate evidence-based therapy. B Palliative care: provide palliative and supportive care, including high-quality communication, conveyance of prognosis, clarifying goals of care, shared decision-making, symptom management and caregiver support, to improve quality of life and relieve suffering in all patients with HF. B Show 4 more 14. Quality improvement Performance measures: Use performance measures based on professionally developed clinical practice guidelines with the goal of improving quality of care in patients with HF. B Consider participating in quality improvement programs, including patient registries providing benchmark feedback on nationally endorsed, clinical practice guideline-based quality and performance measures in improving the quality of care for patients with HF. C Likelihood Ratios Pertinent positives The following findings increase the probability of heart failure in adults. 1 1 1 1 1 Finding LR+ Value History of exertional dyspnea 5 Presence of abdominojugular reflux 4.4 (1.8-10) Presence of myocardial infarction 4.3 Presence of third heart sound 4 history of myocardial infarction, previous diagnosis of heart failure, orthopnea or paroxysmal nocturnal dyspnea, Q-wave or intraventricular conduction delay, or a chest radiograph abnormality (cardiomegaly, pulmonary venous hypertension, or edema) Show 10 more Pertinent negatives The following findings decrease the probability of heart failure in adults. 1 1 1 1 1 https://web.pathway.md/diseases/rectslm30dGoeF3RH 24/28 6/24/23, 12:32 PM Heart failure Pathway Finding LR- Value Absence of any abnormal finding on ECG 0.03 (0.01-0.10) Absence of BNP 37 pg/mL and no clinical finding of HF 0.04 (0.01-0.30) blood B-type natriuretic peptide not increased 0.1 Absence of BNP > 37 pg/mL and no clinical finding of HF* 0.23 (0.06-0.92) history of myocardial infarction, previous diagnosis of heart failure, orthopnea or paroxysmal nocturnal dyspnea, Q-wave or intraventricular conduction delay, or a chest radiograph abnormality (cardiomegaly, pulmonary venous hypertension, or edema) Show 10 more References 1. O'Gara PT, Kushner FG, Ascheim DD et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013 Jan 29;61 4):e78 140. Open 2. Theresa A McDonagh, Marco Metra, Marianna Adamo et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42 36 3599 3726. Open 3. W Timothy Garvey, Jeffrey I Mechanick, Elise M Brett et al. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY COMPREHENSIVE CLINICAL PRACTICE GUIDELINES FOR MEDICAL CARE OF PATIENTS WITH OBESITY. Endocr Pract. 2016 Jul;22 Suppl 3 1 203. Open 4. Paul A Heidenreich, Biykem Bozkurt, David Aguilar et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022 Apr 1;101161CIR0000000000001063. Open 5. Katja Zeppenfeld, Jacob Tfelt-Hansen, Marta de Riva et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022 Aug 26;ehac262. Open 6. Minoru Ono, Osamu Yamaguchi, Tomohito Ohtani et al. JCS/JSCVS/JATS/JSVS 2021 Guideline on Implantable Left Ventricular Assist Device for Patients With Advanced Heart Failure. Circ J. 2022 May 25;86 6 1024 1058. Open 7. Sana M Al-Khatib, William G Stevenson, Michael J Ackerman et al. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2018 Sep 25;138 13):e272-e391. Open 8. Nishimura RA, Otto CM, Bonow RO et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017 Jun 20;135 25):e1159-e1195. Open https://web.pathway.md/diseases/rectslm30dGoeF3RH 25/28 6/24/23, 12:32 PM Heart failure Pathway 9. Marc Humbert, Gabor Kovacs, Marius M Hoeper et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022 Oct 11;43 38 3618 3731. Open 10. Paul K Whelton, Robert M Carey, Wilbert S Aronow et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018 Jun;71 6):e13-e115. Open 11. American College of Emergency Physicians Clinical Policies Subcommittee Writing Committee) on Acute Heart Failure Syndromes. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Heart Failure Syndromes: Approved by ACEP Board of Directors, June 23, 2022. Ann Emerg Med. 2022 Oct;80 4):e31-e59. Open 12. G B John Mancini, Eileen O'Meara, Shelley Zieroth et al. 2022 Canadian Cardiovascular Society Guideline for Use of GLP 1 Receptor Agonists and SGLT2 Inhibitors for Cardiorenal Risk Reduction in Adults. Can J Cardiol. 2022 Aug;38 8 1153 1167. Open 13. Ziaeian B, Fonarow GC, . Epidemiology and aetiology of heart failure. Nat Rev Cardiol. 2016 Jun;13 6 368 78. Open 14. Komanduri S, Jadhao Y, Guduru SS et al. Prevalence and risk factors of heart failure in the USA NHANES 2013 2014 epidemiological follow-up study. J Community Hosp Intern Med Perspect. 2017 Mar 31;7 1 15 20. Open 15. Metra M, Teerlink JR. Heart failure. Lancet. 2017 Oct 28;390 10106 1981 1995. Open 16. Konstam MA, Kiernan MS, Bernstein D et al. Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association. Circulation. 2018 May 15;137 20):e578-e622. Open 17. Yancy CW, Jessup M, Bozkurt B et al. 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. Circulation. 2017 Aug 8;136 6):e137-e161. Open 18. Anker SD, Comin Colet J, Filippatos G et al. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med. 2009 Dec 17;361 25 2436 48. Open 19. Yancy CW, Januzzi JL Jr, Allen LA et al. 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol. 2018 Jan 16;71 2 201 230. Open 20. Bozkurt B, . What Is New in Heart Failure Management in 2017? Update on ACC/AHA Heart Failure Guidelines. Curr Cardiol Rep. 2018 Apr 17;20 6 39. Open 21. Atherton JJ, Sindone A, De Pasquale CG et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of heart failure 2018. Med J Aust. 2018 Oct 15;209 8 363 369. Open 22. Simone Frea, Stefano Pidello, Alessandra Volpe et al. Diuretic treatment in high-risk acute decompensation of advanced chronic heart failure-bolus intermittent vs. continuous infusion of furosemide: a randomized controlled trial. Clin Res Cardiol. 2020 Apr;109 4 417 425. Open https://web.pathway.md/diseases/rectslm30dGoeF3RH 26/28 6/24/23, 12:32 PM Heart failure Pathway 23. Eileen O'Meara, Michael McDonald, Michael Chan et al. CCS/CHFS Heart Failure Guidelines: Clinical Trial Update on Functional Mitral Regurgitation, SGLT2 Inhibitors, ARNI in HFpEF, and Tafamidis in Amyloidosis. Can J Cardiol. 2020 Feb;36 2 159 169. Open 24. Ali Ahmed. American College of Cardiology/American Heart Association Chronic Heart Failure Evaluation and Management guidelines: relevance to the geriatric practice. J Am Geriatr Soc. 2003 Jan;51 1 123 6. Open 25. John J V McMurray, Scott D Solomon, Silvio E Inzucchi et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019 Nov 21;381 21 1995 2008. Open 26. Charlene Bredy, Margherita Ministeri, Alexander Kempny et al. New York Heart Association NYHA classification in adults with congenital heart disease: relation to objective measures of exercise and outcome. Eur Heart J Qual Care Clin Outcomes. 2018 Jan 1;4 1 51 58. Open 27. Ian G Stiell, Jeffrey J Perry, Catherine M Clement et al. Prospective and Explicit Clinical Validation of the Ottawa Heart Failure Risk Scale, With and Without Use of Quantitative NT-proBNP. Acad Emerg Med. 2017 Mar;24 3 316 327. Open 28. L Goldman, B Hashimoto, E F Cook et al. Comparative reproducibility and validity of systems for assessing cardiovascular functional class: advantages of a new specific activity scale. Circulation. 1981 Dec;64 6 1227 34. Open 29. Stefan D Anker, Javed Butler, Gerasimos Filippatos et al. Empagliflozin in Heart Failure with a Preserved Ejection Fraction. N Engl J Med. 2021 Oct 14;385 16 1451 1461. Open 30. Barry M Massie, Peter E Carson, John J McMurray et al. Irbesartan in patients with heart failure and preserved ejection fraction. N Engl J Med. 2008 Dec 4;359 23 2456 67. Open 31. Justin A Ezekowitz, Eloisa Colin-Ramirez, Heather Ross et al. Reduction of dietary sodium to less than 100 mmol in heart failure SODIUM HF an international, open-label, randomised, controlled trial. Lancet. 2022 Apr 9;399 10333 1391 1400. Open 32. Justin A Ezekowitz, Eileen O'Meara, Michael A McDonald et al. 2017 Comprehensive Update of the Canadian Cardiovascular Society Guidelines for the Management of Heart Failure. Can J Cardiol. 2017 Nov;33 11 1342 1433. Open 33. Milton Packer, Stefan D Anker, Javed Butler et al. Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. N Engl J Med. 2020 Oct 8;383 15 1413 1424. Open 34. Adriaan A Voors, Christiane E Angermann, John R Teerlink et al. The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: a multinational randomized trial. Nat Med. 2022 Mar;28 3 568 574. Open 35. Scott D Solomon, John J V McMurray, Brian Claggett et al. Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction. N Engl J Med. 2022 Sep 22;387 12 1089 1098. Open 36. Alexandre Mebazaa, Beth Davison, Ovidiu Chioncel et al. Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure STRONG HF a multinational, open-label, randomised, trial. Lancet. 2022 Dec 3;400 10367 1938 1952. Open 37. Frederik H Verbrugge, Venu Menon. Torsemide comparison with furosemide for management of heart failure TRANSFORM HF trial. Eur Heart J Acute Cardiovasc Care. 2022 Dec 27;11 12 931 932. Open https://web.pathway.md/diseases/rectslm30dGoeF3RH 27/28 6/24/23, 12:32 PM Heart failure Pathway 38. Julio N ez, Pau Ll cer, Vicente Bertomeu-Gonz lez et al. Carbohydrate Antigen-125 Guided Therapy in Acute Heart Failure: CHANCE HF A Randomized Study. JACC Heart Fail. 2016 Nov;4 11 833 843. Open https://web.pathway.md/diseases/rectslm30dGoeF3RH 28/28