<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, say that you don't know. Please don't share false information. <</SYS>>What are the take away of document 2022 AHA/ACC/HFSA Guideline for
the Management of Heart Failure ? [/INST] 1. Guideline-directed medical therapy (GDMT) for heart
failure (HF) with reduced ejection fraction (HFrEF)
now includes 4 medication classes that
include sodium-glucose cotransporter-2 inhibitors
(SGLT2i).
2. SGLT2i have a Class of Recommendation 2a in HF with
mildly reduced ejection fraction (HFmrEF). Weaker
recommendations (Class of Recommendation 2b)
are made for ARNi, ACEi, ARB, MRA, and beta blockers
in this population.
3. New recommendations for HFpEF are made for
SGLT2i (Class of Recommendation 2a), MRAs (Class of
Recommendation 2b), and ARNi (Class of Recommendation 2b). Several prior recommendations have
been renewed including treatment of hypertension
(Class of Recommendation 1), treatment of atrial
fibrillation (Class of Recommendation 2a), use of ARBs
(Class of Recommendation 2b), and avoidance of
routine use of nitrates or phosphodiesterase-5 inhibitors (Class of Recommendation 3: No Benefit).
4. Improved LVEF is used to refer to those patients with
previous HFrEF who now have an LVEF >40%. These
patients should continue their HFrEF treatment.
5. Value statements were created for select recommendations where high-quality, cost-effectiveness studies
of the intervention have been published.
6. Amyloid heart disease has new recommendations
for treatment including screening for serum and
urine monoclonal light chains, bone scintigraphy,
genetic sequencing, tetramer stabilizer therapy, and
anticoagulation.
7. Evidence supporting increased filling pressures is
important for the diagnosis of HF if the LVEF is >40%.
Evidence for increased filling pressures can be obtained from noninvasive (e.g., natriuretic peptide,
diastolic function on imaging) or invasive testing
(e.g., hemodynamic measurement).
8. Patients with advanced HF who wish to prolong survival should be referred to a team specializing in HF. A
HF specialty team reviews HF management, assesses
suitability for advanced HF therapies, and uses palliative care including palliative inotropes where consistent with the patient’s goals of care.
9. Primary prevention is important for those at risk for
HF (stage A) or pre-HF (stage B). Stages of HF were
revised to emphasize the new terminologies of “at
risk” for HF for stage A and pre-HF for stage B.
10. Recommendations are provided for select patients
with HF and iron deficiency, anemia, hypertension,
sleep disorders, type 2 diabetes, atrial fibrillation,
coronary artery disease, and malignancy. </s>