2013年美国心力衰竭管理指南(心衰指南)-英文

This guideline covers multiple management issues for the adult patient with HF. Although of increasing

importance, HF in children and congenital heart lesions in adults are not specifically addressed in this guideline. The reader is referred to publically available resources to address questions in these areas. However, this

guideline does address HF with preserved ejection fraction (EF) in more detail and similarly revisits hospitalized HF. Additional areas of renewed interest are in stage D HF, palliative care, transition of care, and quality of care for HF. Certain management strategies appropriate for the patient at risk for HF or already affected by HF are also reviewed in numerous relevant clinical practice guidelines and scientific statements published by the ACCF/AHA Task Force on Practice Guidelines, AHA, ACCF Task Force on Appropriate Use Criteria,

European Society of Cardiology, Heart Failure Society of America, and the National Heart, Lung, and Blood Institute. The writing committee saw no need to reiterate the recommendations contained in those guidelines and chose to harmonize recommendations when appropriate and eliminate discrepancies. This is especially the case for device-based therapeutics, where complete alignment between the HF guideline and the device-based therapy guideline was deemed imperative (4). Some recommendations from earlier guidelines have been

updated as warranted by new evidence or a better understanding of earlier evidence, whereas others that were no longer accurate or relevant or which were overlapping were modified; recommendations from previous guidelines that were similar or redundant were eliminated or consolidated when possible.

The present document recommends a combination of lifestyle modifications and medications that constitute GDMT. GDMT is specifically referenced in the recommendations for the treatment of HF (Figure 1; Section

7.3.2). Both for GDMT and other recommended drug treatment regimens, the reader is advised to confirm dosages with product insert material and to evaluate carefully for contraindications and drug-drug interactions. Table 2 is a list of documents deemed pertinent to this effort and is intended for use as a resource; it obviates the need to repeat already extant guideline recommendations. Additional other HF guideline statements are highlighted as well for the purpose of comparison and completeness.

Table 2. Associated Guidelines and Statements

Title

Guidelines

Guidelines for the Management of Adults With Congenital Heart Disease

Guidelines for the Management of Patients With Atrial Fibrillation

Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults

Guideline for Coronary Artery Bypass Graft Surgery

Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities

Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy

Guideline for Percutaneous Coronary Intervention

Secondary Prevention and Risk Reduction Therapy for Patients With

Coronary and Other Atherosclerotic Vascular Disease: 2011 Update

Guideline for the Diagnosis and Management of Patients With Stable

Ischemic Heart Disease

Guideline for the Management of ST-Elevation Myocardial Infarction

Guidelines for the Management of Patients With Unstable Angina/Non–ST-

Organization ACCF/AHA ACCF/AHA/HRS ACCF/AHA ACCF/AHA ACCF/AHA/HRS ACCF/AHA ACCF/AHA/SCAI AHA/ACCF ACCF/AHA/ACP/AATS /PCNA/SCAI/STS ACCF/AHA ACCF/AHA Publication Year (Reference) 2008 (5) 2011 (6-8) 2010 (9) 2011 (10) 2013 (4) 2011 (11) 2011 (12) 2011 (13) 2012 (14) 2013 (15) 2013 (16)