I'm Michelle Kittleson,
I'm a heart failure transplant cardiologist,
at Cedar-Sinai in Los Angeles, California,
and I'm here to talk
about the new 2022 ACC/AHA/HFSA guideline
for the management of heart failure.
(gentle music)
So I'm particularly excited
about four advances in the new guidelines.
Number one, I think it's fantastic that the categorization
of ejection fraction includes the 41 to 49% particularly,
making a special category and distinction for heart failure
with improved ejection fraction,
because it's so important
to follow your patient's trajectories,
and if you achieve success, improvement
and ejection fraction,
don't stop the guideline directed medical therapy
that likely got them there.
Which leads me to my second advance
that I'm very excited about,
which is the fact that the guidelines truly support
and celebrate the importance of quadruple therapy,
the four essential pillars
of guideline directed medical therapy best given
with an angiotensin receptor neprilysin inhibitor,
evidence based beta blocker, mineralocorticoid antagonist
and SGLT2 inhibitor.
The third area I'm very excited
about is cardiac amyloidosis,
which has now been given an entire section
in the new guidelines for diagnosis
and treatment really indicating how important
this has become in the field of cardiology,
with under recognised prevalence
with ease of diagnosis, non-invasively for TTR amyloidosis
and now an FDA approved therapy to improve survival
and reduce heart failure hospitalizations
in patients with amyloidosis.
And finally, I'm so excited
that the new guidelines include value statements
for many therapies, balancing the costs and the benefits.
And in addition, focuses on vulnerable populations
and disparities and strategies to a improve them.
You know, I think a guideline document can be very daunting
over a hundred pages,
almost 200 recommendations, countless tables, figures.
How do you navigate this?
So I have a strategy.
Number one, whenever you see a new guideline document,
read the top 10 take home messages
that tell you what the architects
of the guideline found most important.
Number two, look through the table
of contents get a sense of what's actually in there.
Number three, look at the tables and the figures,
so high yield for diagnostic therapeutic algorithms.
Then the next time you're faced with a patient,
you don't know what to do.
You know that your answer may be in the guidelines,
use the search function, thank goodness
for the search function
and hone in on the area it can help you.
I think if you use the guidelines
as your trusted and reliable resource of how to care
for patients and know to feel comfortable going to them,
you will more easily incorporate them
in your clinical practice.
You know, there's no question
that there exists therapeutic inertia
on the part of clinicians,
on the part of patients, on the part of systems.
But I would say whenever you encounter a patient
with heart failure the most important questions
to ask yourself are if this is heart failure
with improved ejection fraction, make sure
you don't stop guideline directive medical therapy.
If there's a patient with heart failure
with reduced EF are they on the four essential pillars?
And if not, why not?
If this patient has a preserved ejection fraction,
am I missing cardiac amyloidosis?
And with every patient, is there something I can do
as their clinician to assist
with these issues of disparity and improve their lives.