The ACC has released an updated Expert Consensus Decision Pathway providing guidance and recommendations on streamlining clinical care to achieve optimal outcomes for patients with heart failure with reduced ejection fraction (HFrEF). The document, published Jan. 11 in the Journal of the American College of Cardiology, is an update to the 2017 ACC Expert Consensus Decision Pathway For Optimization of Heart Failure Treatment.

Led by Chair Thomas M. Maddox, MD, MSc, FACC, and Vice Chair James L. Januzzi, Jr., MD, FACC, the Pathway aims to address 10 "pivotal" issues that remain unresolved in clinical guidelines related to how to implement guideline-directed medical therapy; how to address specific challenges like referral, care coordination, specific patient cohorts, etc.; and how to manage areas of increasing complexity, comorbidities and palliative care.

According to Maddox, Januzzi, et al., new therapies for HFrEF have emerged that expand the armamentarium for the treatment of patients with HFrEF since the original Pathway was published in 2017. As a result, the updated Pathway incorporates two new recommendations for patients with HFrEF, including the up-front use of sacubitril/valsartan without an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker pre-treatment. The second recommendation is for the use of a sodium-glucose cotransporter-2 inhibitor for care of patients with HFrEF, with or without diabetes.

The authors emphasize that the checklists and algorithms provided in this Pathway should be applied only in the context of the most recent update to the ACC/American Heart Association guidelines for management of adults with chronic heart failure and, in this case, patients with HFrEF. They add that no guideline, pathway or algorithm should ever supersede clinical judgment.

"Clinicians are often faced with the complexity of clinical care," the authors write. "This article helps to reduce the complex decisions into a stepwise, guided format for achieving optimal heart failure management."

Clinical Topics: Geriatric Cardiology, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Valvular Heart Disease, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Echocardiography/Ultrasound, Mitral Regurgitation

Keywords: Patient Compliance, Biomarkers, Delivery of Health Care, Integrated, Delivery of Health Care, Organization and Administration, Comorbidity, Heart Failure, Drug Therapy, Costs and Cost Analysis, Echocardiography, Geriatrics, Frail Elderly, Guideline, Therapeutics, Hemodynamics, Hospices, Diagnostic Imaging, Mitral Valve Insufficiency, Pharmacology, Palliative Care, Referral and Consultation

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