Heart failure

New heart failure guidelines emphasize prevention

Key points to remember

  • Cardiology experts have updated treatment guidelines that help providers who work with patients with heart failure or at risk of the disease.
  • The new guidelines emphasize the importance of preventing heart failure and adding a new class of drugs to the list of treatments for patients who haven’t had many options.
  • The guidelines also emphasize that a multidisciplinary approach is needed to ensure that patients with heart failure effectively manage their disease.

New guidelines have been released to help providers treat patients with heart failure as well as patients at risk of contracting the disease.

The update was a joint effort of experts from the American College of Cardiology (ACC), the American Heart Association (AHA), and the Heart Failure Society of America (HFSA). The guidelines were last updated in 2017.

The new changes emphasize the importance of prevention, add a new class of drugs to treatment options and promote a multidisciplinary care approach for people diagnosed with symptomatic heart failure.

“These new recommendations are timely and incorporate recent developments for the treatment of heart failure,” Jeffrey Teuteberg, MD, associate professor of cardiovascular medicine at Stanford Hospital and Clinics, told Verywell. “They give the community an idea of ​​what’s going on.”

What is heart failure?

Heart failure occurs when a person’s heart is weak and cannot pump blood and oxygen to the rest of the body as well as it should.

According to the Centers for Disease Control and Prevention (CDC), heart failure affects 6.2 million American adults.

Although there is no cure for heart failure, it can be managed with medication, lifestyle changes, and other treatments (like braces or surgery).

Who is at risk for heart failure?

People with certain underlying medical conditions are at higher risk of developing heart failure, including people with:

Other factors like physical inactivity, dietary habits, genetics, and smoking are also linked to cardiovascular diseases, including heart failure.

Heart failure stages

The American Heart Association (AHA) classifies levels of heart failure as follows:

  • Stage A: At risk of heart failure: There are no signs of structural heart disease and muscle damage, and no symptoms or signs of heart muscle damage. The risks of heart failure include diseases such as diabetes, metabolic syndrome or hypertension; heredity; and treatments that can cause heart damage, such as cancer chemotherapy.
  • Stage B: Pre-heart failure: There are evidence of structural heart disease and muscle injury, but there are no symptoms.
  • Stage C: Symptomatic heart failure: There is structural heart disease with symptoms such as shortness of breath, cough, swelling of the arms, legs or abdomen.
  • Stage D: Advanced heart failure: There is structural heart disease with symptoms that interfere with daily activities and usually includes recurrent hospitalizations.

ejection fraction

The updated heart failure guidelines also made changes to the four left ventricular ejection fraction (LVEF) classifications.

The ejection fraction shows how much the left ventricle of the heart can squeeze to pump blood. The metric is used to see how the disease is progressing and whether it is responding to treatment.

Updated levels of ejection fraction (normal range is 50% to 55%) are:

  • HFrEF (reduced ejection fraction): less than or equal to 40%
  • HFimpEF (enhanced ejection fraction): improved from less than 40% to more than 40%
  • HFmrEF (slightly reduced ejection fraction): between 41% and 49%
  • HFpEF (preserved ejection fraction): greater than 50% but with increased filling pressures

Highlights of the new recommendations

There have been a few key updates to the guidelines that will change how providers work with patients who have different stages of heart failure, including medications and treatment goals.


A key feature of the update is that it is aimed at an often overlooked group of patients who show early signs of heart failure with a mildly reduced or preserved ejection fraction.

Experts have recommended that a new class of drugs, along with other preventive measures, be used to reduce complications, hospitalizations and deaths from heart failure in patients with HFmrEF and HFpEF .

Teuteberg said the addition is “a real godsend” because “there are fewer drugs and therapies for people with this category of heart failure.”

The drug class – sodium-glucose transporter protein 2 (SGLT-2) inhibitors – is also recommended as a treatment option for patients with symptomatic and advanced heart failure.

SGLT-2 is primarily used to treat type 2 diabetes because it lowers blood sugar levels and may even improve heart health.

In fact, clinical trials have shown that an SGLT-2 inhibitor can reduce the risk of hospitalization by 30%. This evidence is why experts decided to add the drug to new heart failure management guidelines.

Pre-heart failure

Paying more attention to ‘pre-heart failure’ (stage B) is also an important goal of the new guidelines.

Experts want to shift the focus to emphasize the progressive nature of the disease and hopefully lead to more effective communication between patients and providers.

The main goal of treatment for patients with stage B is to control their blood pressure, lower their cholesterol, and manage their blood sugar to help prevent disease progression.


Ensuring that patients with heart failure, especially those in the later stages of the disease, have a multidisciplinary care team is another key part of the updated recommendations.

For example, many of these patients will benefit from working with cardiac medicine professionals who specialize in advanced heart failure, transplant surgery, implantable heart devices, and palliative care.

While the guidelines explain how to help patients with advanced disease, they also highlight the importance of prevention, whether by identifying at-risk patients earlier or using a new class of drugs to treat patients. in stages A and B.

Much of the prevention of cardiovascular disease can be achieved through lifestyle changes, but patients still need the support of their healthcare providers to make and stick with these changes.

By emphasizing prevention, it is hoped that millions of people at risk of heart failure will be able to stop the progression of the disease and live healthy, symptom-free lives.