View source for Congestive heart failure treatment of patients with current or prior symptoms of heart failure (Stage C)

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{{Congestive heart failure}}
{{CMG}}; {{AE}} {{MS}},{{MehdiP}}, [[User:Edzelco|Edzel Lorraine Co, D.M.D., M.D.]] [Mailto:efco@alum.up.edu.ph] 

==Overview==
Several measures <ref name="pmid19324966">{{cite journal |author=Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW |title=2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation |journal=[[Circulation]] |volume=119 |issue=14 |pages=e391–479 |year=2009 |month=April |pmid=19324966 |doi=10.1161/CIRCULATIONAHA.109.192065 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=19324966 |accessdate=2011-04-07}}</ref> have been listed for patients in Stage A or B as previously mentioned and the Class 1 recommendations for those patients are also appropriate for patients with current or previous symptoms of HF. The effectiveness of [[diuretics]] and safety of their usage is an important aspect of the treatment that should be closely monitored along with daily measurement of weight and moderate sodium restriction. Physical activity is highly recommended, although heavy labor or sports shouldn’t be a part of it.  A reduction in physical activity promotes physical deconditioning, and an increase of weight which may be associated with more strain on the failing heart.<ref name="pmid7860930">{{cite journal |author=McKelvie RS, Teo KK, McCartney N, Humen D, Montague T, Yusuf S |title=Effects of exercise training in patients with congestive heart failure: a critical review |journal=[[Journal of the American College of Cardiology]] |volume=25 |issue=3 |pages=789–96 |year=1995 |month=March |pmid=7860930 |doi=10.1016/0735-1097(94)00428-S |url=http://linkinghub.elsevier.com/retrieve/pii/0735-1097(94)00428-S |accessdate=2011-04-07}}</ref> Patients with chronic conditions such as [[HF]] are also recommended to be immunized with [[influenza]] and [[pneumococcal]] [[vaccines]] in order to reduce the risk of [[respiratory infection]].

==Drugs that should be Avoided or Used with Caution in Patients with HF==
'''Pharmacological therapy''' should be closely monitored and several classes of drugs should be avoided in case of HF:

*[[Calcium Channel blockers]]: There is no direct role of these drugs in the management of HF, due to negative and possible deleterious effect in patients with HF due to systolic dysfunction<ref name="pmid3552317">{{cite journal |author=Packer M, Kessler PD, Lee WH |title=Calcium-channel blockade in the management of severe chronic congestive heart failure: a bridge too far |journal=[[Circulation]] |volume=75 |issue=6 Pt 2 |pages=V56–64 |year=1987 |month=June |pmid=3552317 |doi= |url= |accessdate=2011-04-07}}</ref>. Vasoelective Calcium Channel blockers as [[amlodipine]] and [[ felodipine]] have not been linked to adverse effect in HF treatment, but there is no evidence of efficacy for these drugs in the management of HF.<ref name="pmid15215801">{{cite journal |author=Reed SD, Friedman JY, Velazquez EJ, Gnanasakthy A, Califf RM, Schulman KA |title=Multinational economic evaluation of valsartan in patients with chronic heart failure: results from the Valsartan Heart Failure Trial (Val-HeFT) |journal=[[American Heart Journal]] |volume=148 |issue=1 |pages=122–8 |year=2004 |month=July |pmid=15215801 |doi=10.1016/j.ahj.2003.12.040 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002870304001000 |accessdate=2011-04-07}}</ref> However, [[amlodipine]] and [[felodipine]] appear to be safe for the treatment of concomitant disease in HF patients, such as [[angina]] or [[hypertension]].

*[[Antiarrhythmic agents]]: Negative inotropic effect exerted by most [[antiarrhythmic]] drugs can precipitate HF in patients with reduced LV function.  The reduction in LV function can also reduce the elimination of these drugs leading to further drug toxicity. Other antiarrhythmic drugs can induce some proarrhythmic effect, especially class 1 agents and class 3 agents [[Ibutilide]] and [[sotalol]];<ref name="pmid10486417">{{cite journal |author=Torp-Pedersen C, Møller M, Bloch-Thomsen PE, Køber L, Sandøe E, Egstrup K, Agner E, Carlsen J, Videbaek J, Marchant B, Camm AJ |title=Dofetilide in patients with congestive heart failure and left ventricular dysfunction. Danish Investigations of Arrhythmia and Mortality on Dofetilide Study Group |journal=[[The New England Journal of Medicine]] |volume=341 |issue=12 |pages=857–65 |year=1999 |month=September |pmid=10486417 |doi=10.1056/NEJM199909163411201 |url=http://dx.doi.org/10.1056/NEJM199909163411201 |accessdate=2011-04-07}}</ref> the same class 3 agents in addition to [[dofetilide]] can induce [[torsades to pointes]].
[[Amiodarone]] is considered the safest of the antiarrhythmic drugs because of its minimal proarrhythmic effect and is generally the preferred drug for treating arrhythmias in HF patients.

*[[Nonsteroidal anti-inflammatory drugs]] (NSAID):<ref name="pmid9605782">{{cite journal |author=Heerdink ER, Leufkens HG, Herings RM, Ottervanger JP, Stricker BH, Bakker A |title=NSAIDs associated with increased risk of congestive heart failure in elderly patients taking diuretics |journal=[[Archives of Internal Medicine]] |volume=158 |issue=10 |pages=1108–12 |year=1998 |month=May |pmid=9605782 |doi= |url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=9605782 |accessdate=2011-04-08}}</ref> The administration of non-selective [[NSAIDs]] in HF patients is linked with an increased risk of HF exacerbation, increased renal dysfunction, and abnormal responses to [[ACEIs]] and [[diuretics]]. [[COX-2]] selective inhibitors have not been fully investigated, but observational studies indicate that they may be linked with an increased rate of HF exacerbation and increased mortality.

[[Aspirin]] benefits and risks are not well established in patients with HF and Vascular disease (including[[CAD]]). The potential interaction between [[ACEIs]] and [[beta blockers]] is of great importance. Although no data has proven that aspirin causes more frequent HF exacerbations and interactions with those drugs, health care providers should be aware of the possibility of such risks, but no recommendation for or against aspirin therapy in patients with heart failure can be made before further data are available. 

*[[Oral Hypoglycemic agents]]:<ref name="pmid1444694">{{cite journal |author=Gan SC, Barr J, Arieff AI, Pearl RG |title=Biguanide-associated lactic acidosis. Case report and review of the literature |journal=[[Archives of Internal Medicine]] |volume=152 |issue=11 |pages=2333–6 |year=1992 |month=November |pmid=1444694 |doi= |url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=1444694 |accessdate=2011-04-08}}</ref> two oral hypoglycemic agents, [[metformin]] and [[thiazolidinediones]] are considered to be risky in patients with HF.
[[Metformin]] - one of the most common side effects of metformin is [[lactic acidosis]], which can be fatal in patients with HF.

[[Thiazolidinediones]] -<ref name="pmid15699279">{{cite journal |author=Masoudi FA, Inzucchi SE, Wang Y, Havranek EP, Foody JM, Krumholz HM |title=Thiazolidinediones, metformin, and outcomes in older patients with diabetes and heart failure: an observational study |journal=[[Circulation]] |volume=111 |issue=5 |pages=583–90 |year=2005 |month=February |pmid=15699279 |doi=10.1161/01.CIR.0000154542.13412.B1 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15699279 |accessdate=2011-04-08}}</ref> the biggest risk of using Thiazolidinediones is fluid retention which may cause severe worsening of patients with HF.

*[[Antidepressants]]: [[Depression]] is a common finding between patients suffering from HF that is usually related to high mortality rate and bad prognosis of those patients.<ref name="pmid17249635">{{cite journal |author=Swenson JR, Doucette S, Fergusson D |title=Adverse cardiovascular events in antidepressant trials involving high-risk patients: a systematic review of randomized trials |journal=[[Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie]] |volume=51 |issue=14 |pages=923–9 |year=2006 |month=December |pmid=17249635 |doi= |url= |accessdate=2011-04-08}}</ref> Limited data are available on the safety and the risks associated with the usage of antidepressants in patients with heart failure. Health care providers should be aware of major cardiovascular events (as [[HF]], [[MI]], [[Stroke]], [[cardiovascular death]] ) that is associated with [[Tricyclic antidepressants]] (TCAs) and [[Selective serotonin reuptake inhibitors]] (SSRIs).

*[[Phosphodiesterase inhibitors]] '''PDE''' – The [[PDE-3 inhibitors]] as<ref name="pmid16549646">{{cite journal |author=Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B |title=ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation |journal=[[Circulation]] |volume=113 |issue=11 |pages=e463–654 |year=2006 |month=March |pmid=16549646 |doi=10.1161/CIRCULATIONAHA.106.174526 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16549646 |accessdate=2011-04-08}}</ref> [[Cilostazol]] and PDE-4 as <ref name="pmid11159509">{{cite journal |author=Storen EC, Tefferi A |title=Long-term use of anagrelide in young patients with essential thrombocythemia |journal=[[Blood]] |volume=97 |issue=4 |pages=863–6 |year=2001 |month=February |pmid=11159509 |doi= |url=http://www.bloodjournal.org/cgi/pmidlookup?view=long&pmid=11159509 |accessdate=2011-04-08}}</ref> [[Anagrelide]] should be avoided in patients with HF, because of an increase risk of [[high-output heart failure]] and fluid retention that is associated with those drugs.<ref name="pmid1731512">{{cite journal |author= |title=Anagrelide, a therapy for thrombocythemic states: experience in 577 patients. Anagrelide Study Group |journal=[[The American Journal of Medicine]] |volume=92 |issue=1 |pages=69–76 |year=1992 |month=January |pmid=1731512 |doi= |url= |accessdate=2011-04-08}}</ref>

[[PDE-5 inhibitors]] such as [[sildenafil]], [[vardenafil]], and [[tadalafil]], are widely used in the management of [[erectile dysfunction]] in men. The use of those agents with any form of [[nitrate]] therapy is contraindicated because of severe [[hypotensive]] effect that can be life threatening.<ref name="pmid17785618">{{cite journal |author=Lewis GD, Shah R, Shahzad K, Camuso JM, Pappagianopoulos PP, Hung J, Tawakol A, Gerszten RE, Systrom DM, Bloch KD, Semigran MJ |title=Sildenafil improves exercise capacity and quality of life in patients with systolic heart failure and secondary pulmonary hypertension |journal=[[Circulation]] |volume=116 |issue=14 |pages=1555–62 |year=2007 |month=October |pmid=17785618 |doi=10.1161/CIRCULATIONAHA.107.716373 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=17785618 |accessdate=2011-04-08}}</ref> In a trial where sildenafil and placebo were randomly assigned to 34 HF patients, no significant difference of symptomatic [[hypotension]] was observed, but HF patients with borderline low blood pressure and/or low volume status are in risk of severe [[hypotension]] and should avoid any [[PDE-5 inhibitors]] use.

*[[Chemotherapy]] – Cardiotoxic chemotherapeutic agents as [[Cyclophosphamide]], [[Trastuzumab]], [[Bevacizumab]] and [[Anthracyclines]], should be avoided in HF patients <ref name="pmid11248153">{{cite journal |author=Slamon DJ, Leyland-Jones B, Shak S, Fuchs H, Paton V, Bajamonde A, Fleming T, Eiermann W, Wolter J, Pegram M, Baselga J, Norton L |title=Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2 |journal=[[The New England Journal of Medicine]] |volume=344 |issue=11 |pages=783–92 |year=2001 |month=March |pmid=11248153 |doi=10.1056/NEJM200103153441101 |url=http://dx.doi.org/10.1056/NEJM200103153441101 |accessdate=2011-04-08}}</ref>

*[[Tumor Necrosis Factor]] alpha inhibitors '''TNF-alpha''': New onset or worsening of pre-existing heart failure have been linked to TNF-alpha inhibitors.<ref name="pmid12796126">{{cite journal |author=Chung ES, Packer M, Lo KH, Fasanmade AA, Willerson JT |title=Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-alpha, in patients with moderate-to-severe heart failure: results of the anti-TNF Therapy Against Congestive Heart Failure (ATTACH) trial |journal=[[Circulation]] |volume=107 |issue=25 |pages=3133–40 |year=2003 |month=July |pmid=12796126 |doi=10.1161/01.CIR.0000077913.60364.D2 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=12796126 |accessdate=2011-04-08}}</ref> [[Infliximab]] has been specifically contraindicated in doses over 5mg/kg in patients with heart failure.

*[[Antihistamines]]:<ref name="pmid14594906">{{cite journal |author=Yap YG, Camm AJ |title=Drug induced QT prolongation and torsades de pointes |journal=[[Heart (British Cardiac Society)]] |volume=89 |issue=11 |pages=1363–72 |year=2003 |month=November |pmid=14594906 |pmc=1767957 |doi= |url=http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=14594906 |accessdate=2011-04-08}}</ref> some second generation antihistamines as [[terfenadine]] and [[astemizole]] have been reported to cause [[long QT syndrome]] and should not be used in HF patients.

Serum potassium should be closely monitored in HF patients, in order of preventing either [[hypokalemia]] or [[hyperkalemia]], which could greatly affect cardiac excitability and conduction, leading to [[sudden cardiac death]].<ref name="pmid2871753">{{cite journal |author=Packer M, Gottlieb SS, Kessler PD |title=Hormone-electrolyte interactions in the pathogenesis of lethal cardiac arrhythmias in patients with congestive heart failure. Basis of a new physiologic approach to control of arrhythmia |journal=[[The American Journal of Medicine]] |volume=80 |issue=4A |pages=23–9 |year=1986 |month=April |pmid=2871753 |doi= |url= |accessdate=2011-04-10}}</ref>
Serum [[potassium]] should be maintained between 4.0 to 5.0 mEq per liter range, because low potassium level may affect [[digitalis]] and antiarrhythmic drugs treatment, while high potassium level can prevent the use of treatments known to prolong life.<ref name="pmid2871753">{{cite journal |author=Packer M, Gottlieb SS, Kessler PD |title=Hormone-electrolyte interactions in the pathogenesis of lethal cardiac arrhythmias in patients with congestive heart failure. Basis of a new physiologic approach to control of arrhythmia |journal=[[The American Journal of Medicine]] |volume=80 |issue=4A |pages=23–9 |year=1986 |month=April |pmid=2871753 |doi= |url= |accessdate=2011-04-10}}</ref>

Supervision of HF patients with close monitoring of treatment and diet is a very important aspect of the follow-up process in those individuals. Body weight and medications should be closely monitored, because any minor change in those parameters can have a significant effect over symptoms and hospitalization of patients with HF.<ref name="pmid7565975">{{cite journal |author=Rich MW, Beckham V, Wittenberg C, Leven CL, Freedland KE, Carney RM |title=A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure |journal=[[The New England Journal of Medicine]] |volume=333 |issue=18 |pages=1190–5 |year=1995 |month=November |pmid=7565975 |doi=10.1056/NEJM199511023331806 |url=http://dx.doi.org/10.1056/NEJM199511023331806 |accessdate=2011-04-10}}</ref> Patient education is a crucial aspect of the management of HF, patient and family surveillance over any new change of symptoms or body weight is important in allowing early detection of those changes and implementing new treatment strategies to reduce further complications.<ref name="pmid10051785">{{cite journal |author=Philbin EF |title=Comprehensive multidisciplinary programs for the management of patients with congestive heart failure |journal=[[Journal of General Internal Medicine]] |volume=14 |issue=2 |pages=130–5 |year=1999 |month=February |pmid=10051785 |doi= |url= |accessdate=2011-04-10}}</ref>

===Pharmacological Therapy of HF===
Improving symptoms, reducing mortality and slowing or reversing myocardial deterioration are the main goals of pharmacological therapy in HF patients. The therapy should be also directed at preventing arrhythmias, embolic events and other exacerbating factors.
Different strategies have been implemented in the treatment of HF, but the ACC/AHA recommendations are based on a combination of 3 types of drugs: a [[Diuretic]], an [[ACEI]] or an [[ARB]], and a [[beta blocker]]<ref name="pmid10072251">{{cite journal |author= |title=Consensus recommendations for the management of chronic heart failure. On behalf of the membership of the advisory council to improve outcomes nationwide in heart failure |journal=[[The American Journal of Cardiology]] |volume=83 |issue=2A |pages=1A–38A |year=1999 |month=January |pmid=10072251 |doi= |url= |accessdate=2011-04-12}}</ref>. A review of data from several trials, provide clear evidence supporting the central role of these drugs in HF patient Therapy. The Diuretics play an important role in controlling fluid retention and achieving a [[euvolemic]] state. On the other hand, [[ACEI]] and a [[beta blocker]] should be started and maintained in patients who can tolerate them because of their major effect in controlling symptoms and reducing mortality. [[Digoxin]] can be added to this regime as a fourth agent to reduce symptoms, reduce recurrent hospitalization, control great and rhythm, and enhance exercise tolerance.

===Diuretics===
Different classes of [[diuretics]] have been implicated in the treatment of [[CHF]]. [[Loop Diuretics]] such as [[furosemide]], [[bumetanide]] and [[torsemide]], act on the inhibition of sodium and chloride reabsorption in the [[loop of Henle]], whereas [[thiazide diuretics]], [[metolazone]], and [[potassium sparing diuretics]] as [[spironolactone]] act on the distal portion of the [[renal tubule]].
<ref name="pmid9691107">{{cite journal |author=Brater DC |title=Diuretic therapy |journal=[[The New England Journal of Medicine]] |volume=339 |issue=6 |pages=387–95 |year=1998 |month=August |pmid=9691107 |doi=10.1056/NEJM199808063390607 |url=http://www.nejm.org/doi/abs/10.1056/NEJM199808063390607?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed |accessdate=2011-04-12}}</ref>[[Loop diuretics]] increase sodium secretion up to 25 % of the filtered load of sodium, enhance free [[water clearance]] and maintain their efficacy unless severe [[renal impairment]] is present.<ref name="pmid8074594">{{cite journal |author=Cody RJ, Kubo SH, Pickworth KK |title=Diuretic treatment for the sodium retention of congestive heart failure |journal=[[Archives of Internal Medicine]] |volume=154 |issue=17 |pages=1905–14 |year=1994 |month=September |pmid=8074594 |doi= |url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=8074594 |accessdate=2011-04-12}}</ref>[[Thiazide]] diuretics in contrast, increase the [[fractional excretion of sodium]] to a maximum of 10% of the filtered load, decrease [[free water clearance]] and lose their efficacy in patients with [[impaired renal function]]. For such reasons, [[loop diuretics]] are much preferred, unless [[hypertension]] with mild fluid retention is present in HF patients, where [[thiazide]] diuretics may have a better [[antihypertensive]] effect in this case.

Different short-studies demonstrated the efficacy of [[diuretics]] in improving various symptoms of HF, reducing [[jugular venous pressure]], [[pulmonary congestion]], [[peripheral edema]] and body weight, all within days of initiation of therapy.<ref name="pmid7997385">{{cite journal |author=Patterson JH, Adams KF, Applefeld MM, Corder CN, Masse BR |title=Oral torsemide in patients with chronic congestive heart failure: effects on body weight, edema, and electrolyte excretion. Torsemide Investigators Group |journal=[[Pharmacotherapy]] |volume=14 |issue=5 |pages=514–21 |year=1994 |pmid=7997385 |doi= |url= |accessdate=2011-04-14}}</ref> No long term studies have been conducted so far to reveal the effects of [[diuretic]] therapy on morbidity and mortality, but an improvement in [[cardiac function]] and exercise tolerance in patients with HF have been demonstrated in intermediate-term trials.<ref name="pmid2888942">{{cite journal |author=Richardson A, Bayliss J, Scriven AJ, Parameshwar J, Poole-Wilson PA, Sutton GC |title=Double-blind comparison of captopril alone against frusemide plus amiloride in mild heart failure |journal=[[Lancet]] |volume=2 |issue=8561 |pages=709–11 |year=1987 |month=September |pmid=2888942 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(87)91074-9 |accessdate=2011-04-14}}</ref>

[[Diuretics]] produce great symptomatic benefits,<ref name="pmid6352079">{{cite journal |author=Packer M, Medina N, Yushak M, Meller J |title=Hemodynamic patterns of response during long-term captopril therapy for severe chronic heart failure |journal=[[Circulation]] |volume=68 |issue=4 |pages=803–12 |year=1983 |month=October |pmid=6352079 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=6352079 |accessdate=2011-04-14}}</ref> much more rapidly than any other drugs for HF, they can adequately control the fluid retention of HF, relieving [[pulmonary edema]] and [[peripheral edema]] within hours or days. However, [[Diuretics]] should not be used alone in controlling Stage C HF.  They should be combined with an [[ACEI]] and a [[beta blocker]] to avoid further clinical deterioration and maintain the HF symptoms under control.<ref name="pmid2888942">{{cite journal |author=Richardson A, Bayliss J, Scriven AJ, Parameshwar J, Poole-Wilson PA, Sutton GC |title=Double-blind comparison of captopril alone against frusemide plus amiloride in mild heart failure |journal=[[Lancet]] |volume=2 |issue=8561 |pages=709–11 |year=1987 |month=September |pmid=2888942 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(87)91074-9 |accessdate=2011-04-14}}</ref>

Appropriate dose of [[diuretics]] should used in treatment of HF,<ref name="pmid7954539">{{cite journal |author=Risler T, Schwab A, Kramer B, Braun N, Erley C |title=Comparative pharmacokinetics and pharmacodynamics of loop diuretics in renal failure |journal=[[Cardiology]] |volume=84 Suppl 2 |issue= |pages=155–61 |year=1994 |pmid=7954539 |doi= |url= |accessdate=2011-04-14}}</ref> because low doses will cause fluid retention, which can lead to a reduced response to [[ACEI]]s and [[ARB]]s and an increase risk of decompensation with the use of [[beta blockers]], while excessive [[diuretics]] will lead to volume contraction which can increase the risk of [[hypotension]] and [[renal insufficiency]] with [[ACEI]]s, [[ARB]]s and beta [[blockers]].<ref name="pmid7039281">{{cite journal |author=Cody RJ, Franklin KW, Laragh JH |title=Postural hypotension during tilt with chronic captopril and diuretic therapy of severe congestive heart failure |journal=[[American Heart Journal]] |volume=103 |issue=4 Pt 1 |pages=480–4 |year=1982 |month=April |pmid=7039281 |doi= |url= |accessdate=2011-04-14}}</ref>

[[Loop diuretics]] are usually the first [[diuretics]] to be used to control pulmonary and/or [[peripheral edema]]. [[Furosemide]] is the most commonly used, but some patients may respond favorably to other agents in this category (as [[torsemide]] and [[Bumetanide]]) because of superior absorption and longer time of action.<ref name="pmid3970471">{{cite journal |author=Vasko MR, Cartwright DB, Knochel JP, Nixon JV, Brater DC |title=Furosemide absorption altered in decompensated congestive heart failure |journal=[[Annals of Internal Medicine]] |volume=102 |issue=3 |pages=314–8 |year=1985 |month=March |pmid=3970471 |doi= |url= |accessdate=2011-04-14}}</ref>

The starting dosage is usually 20 to 40 mg of [[furosemide]] or its equivalent, but the exact dosing should always be monitored according to diuresis and other clinical symptoms, since the ultimate goal is to eliminate the evidence of fluid retention such as [[jugular venous pressure]] elevation and [[peripheral edema]].  Outpatients with HF are usually started with low dose until urine increases and weigh decreases by 0.5 to 1.0 kg daily.  Diuretic therapy should be also combined with moderate dietary sodium restriction.
Unstable or severe disease, should be controlled with [[intravenous diuretics]]( [[bolus]] or [[continuous infusion]]) and [[thiazide]] diuretics can be added for a synergistic effect.<ref name="pmid8800113">{{cite journal |author=Dormans TP, van Meyel JJ, Gerlag PG, Tan Y, Russel FG, Smits P |title=Diuretic efficacy of high dose furosemide in severe heart failure: bolus injection versus continuous infusion |journal=[[Journal of the American College of Cardiology]] |volume=28 |issue=2 |pages=376–82 |year=1996 |month=August |pmid=8800113 |doi=10.1016/0735-1097(96)00161-1 |url=http://linkinghub.elsevier.com/retrieve/pii/0735-1097(96)00161-1 |accessdate=2011-04-14}}</ref>

Reducing overall volume may decrease [[intracardiac filling pressure]] resulting in a lower [[cardiac output]] via the [[Frank-Starling]] relationship.  This effect is usually a minor effect and does not alter the course of the therapy.  On the other hand, an unexplained increase in [[BUN]] and [[creatinine]] should be closely monitored and suspected as a sign of abnormal tissue perfusion. In this case [[renal function]] and other end organ perfusion should be assessed to avoid any concomitant complications.

===Angiotensin Converting Enzyme Inhibitors===
Patients with moderate to severe HF or asymptomatic left ventricular dysfunction show a great improvement in survival rate with the usage of [[ACE inhibitors]].<ref name="pmid1463530">{{cite journal |author= |title=Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. The SOLVD Investigattors |journal=[[The New England Journal of Medicine]] |volume=327 |issue=10 |pages=685–91 |year=1992 |month=September |pmid=1463530 |doi=10.1056/NEJM199209033271003 |url=http://dx.doi.org/10.1056/NEJM199209033271003 |accessdate=2011-04-22}}</ref> ACE inhibitors enhance the action of [[kinins]] and augment [[kinin]]-mediated [[prostaglandin]] production, so the effect of [[ACEI]]s cannot be solely explained by the suppression of [[Angiotensin II]] production.  Furthermore, it has been proven that ACEIs modify cardiac remodeling more favorably than [[ARB]]s in experimental models of HF.<ref name="pmid11333991">{{cite journal |author=Exner DV, Dries DL, Domanski MJ, Cohn JN |title=Lesser response to angiotensin-converting-enzyme inhibitor therapy in black as compared with white patients with left ventricular dysfunction |journal=[[The New England Journal of Medicine]] |volume=344 |issue=18 |pages=1351–7 |year=2001 |month=May |pmid=11333991 |doi=10.1056/NEJM200105033441802 |url=http://dx.doi.org/10.1056/NEJM200105033441802 |accessdate=2011-04-22}}</ref>  Several studies indicates that [[ACEI]]s can alleviate symptoms,<ref name="pmid10496190">{{cite journal |author=Carson P, Ziesche S, Johnson G, Cohn JN |title=Racial differences in response to therapy for heart failure: analysis of the vasodilator-heart failure trials. Vasodilator-Heart Failure Trial Study Group |journal=[[Journal of Cardiac Failure]] |volume=5 |issue=3 |pages=178–87 |year=1999 |month=September |pmid=10496190 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S1071916499000196 |accessdate=2011-04-22}}</ref> improve clinical status and sense of well being in patients with HF. 

Another important aspect of [[ACEI]]s therapy is the reduction of mortality and hospitalization in such patients.<ref name="pmid7654275">{{cite journal |author=Garg R, Yusuf S |title=Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials |journal=[[JAMA : the Journal of the American Medical Association]] |volume=273 |issue=18 |pages=1450–6 |year=1995 |month=May |pmid=7654275 |doi= |url= |accessdate=2011-04-22}}</ref> These benefits were noticed in patients with mild, moderate or even severe symptoms of HF, with or without [[CAD]].  In general ACEIs should be used together with  a [[beta blocker]] and should not be used without [[diuretics]] in patients with a current or recent history of fluid retention, because of the important role of [[diuretics]] in maintaining sodium balance and preventing the development of peripheral and [[pulmonary edema]].<ref name="pmid2888942">{{cite journal |author=Richardson A, Bayliss J, Scriven AJ, Parameshwar J, Poole-Wilson PA, Sutton GC |title=Double-blind comparison of captopril alone against frusemide plus amiloride in mild heart failure |journal=[[Lancet]] |volume=2 |issue=8561 |pages=709–11 |year=1987 |month=September |pmid=2888942 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(87)91074-9 |accessdate=2011-04-22}}</ref>

For the reasons mentioned above, [[ACEI]] therapy should be started in asymptomatic or symptomatic patients with HF.  The beginning therapy should be a low dose ( eg, 2.5 mg of [[enalapril]] twice a day, 6.25 mg of [[captopril]] three time a day or 5 mg of lisinopril once a day).  The dose should be gradually increased in one to two week if the initial therapy is tolerated and try to target a dose of 20 mg of [[enalapril]] twice a day, or 50 mg of [[captopril]] three times a day or up to 40 mg of [[lisinopril]] a day.<ref name="pmid10587334">{{cite journal |author=Packer M, Poole-Wilson PA, Armstrong PW, Cleland JG, Horowitz JD, Massie BM, Rydén L, Thygesen K, Uretsky BF |title=Comparative effects of low and high doses of the angiotensin-converting enzyme inhibitor, lisinopril, on morbidity and mortality in chronic heart failure. ATLAS Study Group |journal=[[Circulation]] |volume=100 |issue=23 |pages=2312–8 |year=1999 |month=December |pmid=10587334 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=10587334 |accessdate=2011-04-22}}</ref> Plasma potassium and renal function should be assessed one to two weeks after starting or changing a dose and periodically thereafter.  Physicians should attempt to target certain doses which have been proved to reduce the risk of cardiovascular events.  If these target doses of ACEIs cannot be used or poorly tolerated than intermediate doses should be implemented. <ref name="pmid11127446">{{cite journal |author=Delahaye F, de Gevigney G |title=Is the optimal dose of angiotensin-converting enzyme inhibitors in patients with congestive heart failure definitely established? |journal=[[Journal of the American College of Cardiology]] |volume=36 |issue=7 |pages=2096–7 |year=2000 |month=December |pmid=11127446 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(00)01026-3 |accessdate=2011-04-22}}</ref>

[[NSAID]]s should be avoided since they may cause an increase in adverse effects of [[ACEI]]s in patients with HF and a decrease in the favorable effect of [[ACEI]]s therapy.<ref name="pmid2888942">{{cite journal |author=Richardson A, Bayliss J, Scriven AJ, Parameshwar J, Poole-Wilson PA, Sutton GC |title=Double-blind comparison of captopril alone against frusemide plus amiloride in mild heart failure |journal=[[Lancet]] |volume=2 |issue=8561 |pages=709–11 |year=1987 |month=September |pmid=2888942 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(87)91074-9 |accessdate=2011-04-22}}</ref> Some evidence suggests that [[aspirin]] may inhibit the acute hemodynamic benefits of [[ACEI]]s.<ref name="pmid8298418">{{cite journal |author= |title=Collaborative overview of randomised trials of antiplatelet therapy--I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists' Collaboration |journal=[[BMJ (Clinical Research Ed.)]] |volume=308 |issue=6921 |pages=81–106 |year=1994 |month=January |pmid=8298418 |pmc=2539220 |doi= |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=8298418 |accessdate=2011-04-22}}</ref>  If the patient has a know history of coronary artery disease([[CAD]]) then use of [[ASA]] along with [[ACEI]]s is recommended.  However, but in patients with no history of [[CAD]], there is no evidence to support the use of [[aspirin]].

===Treatment of HFrEF Stage C and D===

<span style="font-size:85%">'''Abbreviations:'''
'''ACEI:''' angiotensin-converting enzyme inhibitor, '''ARB:''' angiotensin receptor-blocker, '''ARNI:''' angiotensin
receptor-neprilysin inhibitor, '''BP:''' blood pressure, '''bpm:''' beats per minute, '''C/I:''' contraindication, '''COR:''' Class of
Recommendation, '''NT-proBNP:''' creatinine clearance, '''NYHA:''' cardiac resynchronization therapy–device, '''pts:''' diagnosis, '''HF:''' guideline-directed management and therapy, '''CrCl:''' creatinine clearance, '''CRT-D:''' cardiac resynchronization therapy–device, '''Dx:''' diagnosis, '''GDMT:''' guideline-directed management and therapy, '''HF:''' heart failure, '''HFrEF:''' heart failure with reduced ejection fraction, '''ISDN/HYD:''' isosorbide dinitrate hydral-nitrates, '''K+:''' potassium, '''LBBB:''' left bundle-branch block, '''LVAD:''' left ventricular assist device, '''LVEF:''' left ventricular ejection fraction, '''MI:''' myocardial infarction, '''NSR:''' normal sinus rhythm, '''NYHA:''' New York Heart Association
</span>
<br>
[[image:HF.jpg|center|]]

†Hydral-Nitrates green box: The combination of ISDN/HYD with ARNI has not been robustly tested. BP response should be carefully monitored.<br>
§Participation in investigational studies is also appropriate for stage C, NYHA class II and III HF.

== 2022 AHA/ACC/HFSA Heart Failure Guideline/ 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure/2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline,2013 ACC/AHA Guideline, 2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Heart Failure in the Adult (DO NOT EDIT) <ref name="pmid35363500">{{cite journal| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM | display-authors=etal| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2022 | volume= 145 | issue= 18 | pages= e876-e894 | pmid=35363500 | doi=10.1161/CIR.0000000000001062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500  }} </ref><ref name="pmid23747642">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE et al.| title=2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume=  | issue=  | pages=  | pmid=23747642 | doi=10.1016/j.jacc.2013.05.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23747642  }} </ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016.[http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>==

===Non[[pharmacological]] [[Interventions]] (DO NOT EDIT)<ref name="pmid35363500">{{cite journal| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM | display-authors=etal| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2022 | volume= 145 | issue= 18 | pages= e876-e894 | pmid=35363500 | doi=10.1161/CIR.0000000000001062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500  }} </ref><ref name="pmid23747642">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE et al.| title=2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume=  | issue=  | pages=  | pmid=23747642 | doi=10.1016/j.jacc.2013.05.019 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23747642  }} </ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID:[http://pubmed.gov/19324967 19324967]</ref>===

====Self-Care Support in HF====
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]

|-
|bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[Patients]] with [[HF]] should receive [[care]] from multidisciplinary teams to facilitate the implementation of GDMT, address potential barriers to self-care, reduce the risk of subsequent rehospitalization for [[HF]], and improve [[survival]].<ref name="pmid15958358">{{cite journal| author=Holland R, Battersby J, Harvey I, Lenaghan E, Smith J, Hay L| title=Systematic review of multidisciplinary interventions in heart failure. | journal=Heart | year= 2005 | volume= 91 | issue= 7 | pages= 899-906 | pmid=15958358 | doi=10.1136/hrt.2004.048389 | pmc=1769009 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15958358  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=16437805 Review in: Evid Based Nurs. 2006 Jan;9(1):23] </ref><ref name="pmid15312864">{{cite journal| author=McAlister FA, Stewart S, Ferrua S, McMurray JJ| title=Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials. | journal=J Am Coll Cardiol | year= 2004 | volume= 44 | issue= 4 | pages= 810-9 | pmid=15312864 | doi=10.1016/j.jacc.2004.05.055 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15312864  }} </ref><ref name="pmid31351119">{{cite journal| author=Parajuli DR, Kourbelis C, Franzon J, Newman P, Mckinnon RA, Shakib S | display-authors=etal| title=Effectiveness of the Pharmacist-Involved Multidisciplinary Management of Heart Failure to Improve Hospitalizations and Mortality Rates in 4630 Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. | journal=J Card Fail | year= 2019 | volume= 25 | issue= 9 | pages= 744-756 | pmid=31351119 | doi=10.1016/j.cardfail.2019.07.455 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31351119  }} </ref><ref name="pmid30620776">{{cite journal| author=Takeda A, Martin N, Taylor RS, Taylor SJ| title=Disease management interventions for heart failure. | journal=Cochrane Database Syst Rev | year= 2019 | volume= 1 | issue=  | pages= CD002752 | pmid=30620776 | doi=10.1002/14651858.CD002752.pub4 | pmc=6492456 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30620776  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>

|-
|bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' [[Patients]] with [[HF]] should receive education and support to facilitate [[HF]] [[self-care]] in multidisciplinary manner. <ref name="pmid15312864">{{cite journal| author=McAlister FA, Stewart S, Ferrua S, McMurray JJ| title=Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials. | journal=J Am Coll Cardiol | year= 2004 | volume= 44 | issue= 4 | pages= 810-9 | pmid=15312864 | doi=10.1016/j.jacc.2004.05.055 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15312864  }} </ref><ref name="pmid26873943">{{cite journal| author=Jonkman NH, Westland H, Groenwold RH, Ågren S, Atienza F, Blue L | display-authors=etal| title=Do Self-Management Interventions Work in Patients With Heart Failure? An Individual Patient Data Meta-Analysis. | journal=Circulation | year= 2016 | volume= 133 | issue= 12 | pages= 1189-98 | pmid=26873943 | doi=10.1161/CIRCULATIONAHA.115.018006 | pmc=5180429 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26873943  }} </ref><ref name="pmid26517969">{{cite journal| author=Inglis SC, Clark RA, Dierckx R, Prieto-Merino D, Cleland JG| title=Structured telephone support or non-invasive telemonitoring for patients with heart failure. | journal=Cochrane Database Syst Rev | year= 2015 | volume=  | issue= 10 | pages= CD007228 | pmid=26517969 | doi=10.1002/14651858.CD007228.pub3 | pmc=8482064 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26517969  }} </ref><ref name="pmid20687083">{{cite journal| author=Inglis SC, Clark RA, McAlister FA, Ball J, Lewinter C, Cullington D | display-authors=etal| title=Structured telephone support or telemonitoring programmes for patients with chronic heart failure. | journal=Cochrane Database Syst Rev | year= 2010 | volume=  | issue= 8 | pages= CD007228 | pmid=20687083 | doi=10.1002/14651858.CD007228.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20687083  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=21163801 Review in: Evid Based Nurs. 2011 Jan;14(1):27-8] </ref><ref name="pmid17081306">{{cite journal| author=Jovicic A, Holroyd-Leduc JM, Straus SE| title=Effects of self-management intervention on health outcomes of patients with heart failure: a systematic review of randomized controlled trials. | journal=BMC Cardiovasc Disord | year= 2006 | volume= 6 | issue=  | pages= 43 | pmid=17081306 | doi=10.1186/1471-2261-6-43 | pmc=1660572 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17081306  }} </ref><ref name="pmid27317347">{{cite journal| author=Ruppar TM, Cooper PS, Mehr DR, Delgado JM, Dunbar-Jacob JM| title=Medication Adherence Interventions Improve Heart Failure Mortality and Readmission Rates: Systematic Review and Meta-Analysis of Controlled Trials. | journal=J Am Heart Assoc | year= 2016 | volume= 5 | issue= 6 | pages=  | pmid=27317347 | doi=10.1161/JAHA.115.002606 | pmc=4937243 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27317347  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>

|}

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]

|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' In [[patients]] with [[HF]], vaccinating against [[respiratory]] [[illnesses]] is reasonable to reduce [[mortality]].<ref name="pmid34280332">{{cite journal| author=Butt AA, Omer SB, Yan P, Shaikh OS, Mayr FB| title=SARS-CoV-2 Vaccine Effectiveness in a High-Risk National Population in a Real-World Setting. | journal=Ann Intern Med | year= 2021 | volume= 174 | issue= 10 | pages= 1404-1408 | pmid=34280332 | doi=10.7326/M21-1577 | pmc=8381771 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34280332  }} </ref><ref name="pmid32650907">{{cite journal| author=Gotsman I, Shuvy M, Tahiroglu I, Zwas DR, Keren A| title=Influenza Vaccination and Outcome in Heart Failure. | journal=Am J Cardiol | year= 2020 | volume= 128 | issue=  | pages= 134-139 | pmid=32650907 | doi=10.1016/j.amjcard.2020.05.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32650907  }} </ref><ref name="pmid30586760">{{cite journal| author=Modin D, Jørgensen ME, Gislason G, Jensen JS, Køber L, Claggett B | display-authors=etal| title=Influenza Vaccine in Heart Failure. | journal=Circulation | year= 2019 | volume= 139 | issue= 5 | pages= 575-586 | pmid=30586760 | doi=10.1161/CIRCULATIONAHA.118.036788 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30586760  }} </ref><ref name="pmid27660378">{{cite journal| author=Mohseni H, Kiran A, Khorshidi R, Rahimi K| title=Influenza vaccination and risk of hospitalization in patients with heart failure: a self-controlled case series study. | journal=Eur Heart J | year= 2017 | volume= 38 | issue= 5 | pages= 326-333 | pmid=27660378 | doi=10.1093/eurheartj/ehw411 | pmc=5837634 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27660378  }} </ref><ref name="pmid26746371">{{cite journal| author=Vardeny O, Claggett B, Udell JA, Packer M, Zile M, Rouleau J | display-authors=etal| title=Influenza Vaccination in Patients With Chronic Heart Failure: The PARADIGM-HF Trial. | journal=JACC Heart Fail | year= 2016 | volume= 4 | issue= 2 | pages= 152-158 | pmid=26746371 | doi=10.1016/j.jchf.2015.10.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26746371  }} </ref><ref name="pmid33719496">{{cite journal| author=Yedlapati SH, Khan SU, Talluri S, Lone AN, Khan MZ, Khan MS | display-authors=etal| title=Effects of Influenza Vaccine on Mortality and Cardiovascular Outcomes in Patients With Cardiovascular Disease: A Systematic Review and Meta-Analysis. | journal=J Am Heart Assoc | year= 2021 | volume= 10 | issue= 6 | pages= e019636 | pmid=33719496 | doi=10.1161/JAHA.120.019636 | pmc=8174205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33719496  }} </ref><ref name="pmid27668089">{{cite journal| author=Ahmed MB, Patel K, Fonarow GC, Morgan CJ, Butler J, Bittner V | display-authors=etal| title=Higher risk for incident heart failure and cardiovascular mortality among community-dwelling octogenarians without pneumococcal vaccination. | journal=ESC Heart Fail | year= 2016 | volume= 3 | issue= 1 | pages= 11-17 | pmid=27668089 | doi=10.1002/ehf2.12056 | pmc=5019269 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27668089  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>

|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' In [[adults]] with [[HF]], screening for [[depression]], <ref name="pmid26840627">{{cite journal| author=Freedland KE, Carney RM, Rich MW, Steinmeyer BC, Skala JA, Dávila-Román VG| title=Depression and Multiple Rehospitalizations in Patients With Heart Failure. | journal=Clin Cardiol | year= 2016 | volume= 39 | issue= 5 | pages= 257-62 | pmid=26840627 | doi=10.1002/clc.22520 | pmc=4879082 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26840627  }} </ref><ref name="pmid27187847">{{cite journal| author=Freedland KE, Hesseler MJ, Carney RM, Steinmeyer BC, Skala JA, Dávila-Román VG | display-authors=etal| title=Major Depression and Long-Term Survival of Patients With Heart Failure. | journal=Psychosom Med | year= 2016 | volume= 78 | issue= 8 | pages= 896-903 | pmid=27187847 | doi=10.1097/PSY.0000000000000346 | pmc=5067963 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27187847  }} </ref>, social isolation,<ref name="pmid15666956">{{cite journal| author=Murberg TA| title=Long-term effect of social relationships on mortality in patients with congestive heart failure. | journal=Int J Psychiatry Med | year= 2004 | volume= 34 | issue= 3 | pages= 207-17 | pmid=15666956 | doi=10.2190/GKJ2-P8BD-V59X-MJNQ | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15666956  }} </ref><ref name="pmid11602222">{{cite journal| author=Murberg TA, Bru E| title=Social relationships and mortality in patients with congestive heart failure. | journal=J Psychosom Res | year= 2001 | volume= 51 | issue= 3 | pages= 521-7 | pmid=11602222 | doi=10.1016/s0022-3999(01)00226-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11602222  }} </ref><ref name="pmid31310898">{{cite journal| author=Heidari Gorji MA, Fatahian A, Farsavian A| title=The impact of perceived and objective social isolation on hospital readmission in patients with heart failure: A systematic review and meta-analysis of observational studies. | journal=Gen Hosp Psychiatry | year= 2019 | volume= 60 | issue=  | pages= 27-36 | pmid=31310898 | doi=10.1016/j.genhosppsych.2019.07.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31310898  }} </ref><ref name="pmid21372734">{{cite journal| author=Gallagher R, Luttik ML, Jaarsma T| title=Social support and self-care in heart failure. | journal=J Cardiovasc Nurs | year= 2011 | volume= 26 | issue= 6 | pages= 439-45 | pmid=21372734 | doi=10.1097/JCN.0b013e31820984e1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21372734  }} </ref>, frailty, <ref name="pmid32955168">{{cite journal| author=Uchmanowicz I, Lee CS, Vitale C, Manulik S, Denfeld QE, Uchmanowicz B | display-authors=etal| title=Frailty and the risk of all-cause mortality and hospitalization in chronic heart failure: a meta-analysis. | journal=ESC Heart Fail | year= 2020 | volume=  | issue=  | pages=  | pmid=32955168 | doi=10.1002/ehf2.12827 | pmc=7754732 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32955168  }} </ref><ref name="pmid26028966">{{cite journal| author=Uchmanowicz I, Wleklik M, Gobbens RJ| title=Frailty syndrome and self-care ability in elderly patients with heart failure. | journal=Clin Interv Aging | year= 2015 | volume= 10 | issue=  | pages= 871-7 | pmid=26028966 | doi=10.2147/CIA.S83414 | pmc=4441356 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26028966  }} </ref> and low health literacy <ref name="pmid32466837">{{cite journal| author=Fabbri M, Murad MH, Wennberg AM, Turcano P, Erwin PJ, Alahdab F | display-authors=etal| title=Health Literacy and Outcomes Among Patients With Heart Failure: A Systematic Review and Meta-Analysis. | journal=JACC Heart Fail | year= 2020 | volume= 8 | issue= 6 | pages= 451-460 | pmid=32466837 | doi=10.1016/j.jchf.2019.11.007 | pmc=7263350 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32466837  }} </ref><ref name="pmid21369770">{{cite journal| author=Macabasco-O'Connell A, DeWalt DA, Broucksou KA, Hawk V, Baker DW, Schillinger D | display-authors=etal| title=Relationship between literacy, knowledge, self-care behaviors, and heart failure-related quality of life among patients with heart failure. | journal=J Gen Intern Med | year= 2011 | volume= 26 | issue= 9 | pages= 979-86 | pmid=21369770 | doi=10.1007/s11606-011-1668-y | pmc=3157534 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21369770  }} </ref> as risk factors for poor self-care  is reasonable to improve management. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>

|}

====[[Dietary]] Sodium Restriction====

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]

|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' For [[patients]] with stage C [[HF]], avoiding excessive [[sodium]] intake is reasonable to reduce [[congestive]] [[symptoms]]. <ref name="pmid23787719">{{cite journal| author=Philipson H, Ekman I, Forslund HB, Swedberg K, Schaufelberger M| title=Salt and fluid restriction is effective in patients with chronic heart failure. | journal=Eur J Heart Fail | year= 2013 | volume= 15 | issue= 11 | pages= 1304-10 | pmid=23787719 | doi=10.1093/eurjhf/hft097 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23787719  }} </ref><ref name="pmid26738949">{{cite journal| author=Doukky R, Avery E, Mangla A, Collado FM, Ibrahim Z, Poulin MF | display-authors=etal| title=Impact of Dietary Sodium Restriction on Heart Failure Outcomes. | journal=JACC Heart Fail | year= 2016 | volume= 4 | issue= 1 | pages= 24-35 | pmid=26738949 | doi=10.1016/j.jchf.2015.08.007 | pmc=4705447 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26738949  }} </ref><ref name="pmid31959014">{{cite journal| author=Kalogeropoulos A, Papadimitriou L, Georgiopoulou VV, Dunbar SB, Skopicki H, Butler J| title=Low- Versus Moderate-Sodium Diet in Patients With Recent Hospitalization for Heart Failure: The PROHIBIT (Prevent Adverse Outcomes in Heart Failure by Limiting Sodium) Pilot Study. | journal=Circ Heart Fail | year= 2020 | volume= 13 | issue= 1 | pages= e006389 | pmid=31959014 | doi=10.1161/CIRCHEARTFAILURE.119.006389 | pmc=7233690 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31959014  }} </ref><ref name="pmid25641537">{{cite journal| author=Colin-Ramirez E, McAlister FA, Zheng Y, Sharma S, Armstrong PW, Ezekowitz JA| title=The long-term effects of dietary sodium restriction on clinical outcomes in patients with heart failure. The SODIUM-HF (Study of Dietary Intervention Under 100 mmol in Heart Failure): a pilot study. | journal=Am Heart J | year= 2015 | volume= 169 | issue= 2 | pages= 274-281.e1 | pmid=25641537 | doi=10.1016/j.ahj.2014.11.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25641537  }} </ref><ref name="pmid28531423">{{cite journal| author=Colin-Ramirez E, McAlister FA, Zheng Y, Sharma S, Ezekowitz JA| title=Changes in dietary intake and nutritional status associated with a significant reduction in sodium intake in patients with heart failure. A sub-analysis of the SODIUM-HF pilot study. | journal=Clin Nutr ESPEN | year= 2016 | volume= 11 | issue=  | pages= e26-e32 | pmid=28531423 | doi=10.1016/j.clnesp.2015.11.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28531423  }} </ref><ref name="pmid30354562">{{cite journal| author=Hummel SL, Karmally W, Gillespie BW, Helmke S, Teruya S, Wells J | display-authors=etal| title=Home-Delivered Meals Postdischarge From Heart Failure Hospitalization. | journal=Circ Heart Fail | year= 2018 | volume= 11 | issue= 8 | pages= e004886 | pmid=30354562 | doi=10.1161/CIRCHEARTFAILURE.117.004886 | pmc=6205816 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30354562  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])'' <nowiki>"</nowiki>

|}

====[[Management]] of Stage C [[HF]]: Activity, [[Exercise]] Prescription, and [[Cardiac]] Rehabilitation====
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]

|-
|bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' For [[patients]] with [[HF]] who are able to participate, [[exercise]] (or regular [[physical activity]]) is recommended to improve functional status, [[exercise]] performance, and [[QOL]]. <ref name="pmid19351941">{{cite journal| author=O'Connor CM, Whellan DJ, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ | display-authors=etal| title=Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. | journal=JAMA | year= 2009 | volume= 301 | issue= 14 | pages= 1439-50 | pmid=19351941 | doi=10.1001/jama.2009.454 | pmc=2916661 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19351941  }} </ref><ref name="pmid20494922">{{cite journal| author=Davies EJ, Moxham T, Rees K, Singh S, Coats AJ, Ebrahim S | display-authors=etal| title=Exercise training for systolic heart failure: Cochrane systematic review and meta-analysis. | journal=Eur J Heart Fail | year= 2010 | volume= 12 | issue= 7 | pages= 706-15 | pmid=20494922 | doi=10.1093/eurjhf/hfq056 | pmc=2891490 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20494922  }} </ref><ref name="pmid23433767">{{cite journal| author=Haykowsky MJ, Timmons MP, Kruger C, McNeely M, Taylor DA, Clark AM| title=Meta-analysis of aerobic interval training on exercise capacity and systolic function in patients with heart failure and reduced ejection fractions. | journal=Am J Cardiol | year= 2013 | volume= 111 | issue= 10 | pages= 1466-9 | pmid=23433767 | doi=10.1016/j.amjcard.2013.01.303 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23433767  }} </ref><ref name="pmid29199385">{{cite journal| author=Santos FV, Chiappa GR, Ramalho SHR, de Lima ACGB, de Souza FSJ, Cahalin LP | display-authors=etal| title=Resistance exercise enhances oxygen uptake without worsening cardiac function in patients with systolic heart failure: a systematic review and meta-analysis. | journal=Heart Fail Rev | year= 2018 | volume= 23 | issue= 1 | pages= 73-89 | pmid=29199385 | doi=10.1007/s10741-017-9658-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29199385  }} </ref><ref name="pmid30922474">{{cite journal| author=Taylor RS, Walker S, Smart NA, Piepoli MF, Warren FC, Ciani O | display-authors=etal| title=Impact of Exercise Rehabilitation on Exercise Capacity and Quality-of-Life in Heart Failure: Individual Participant Meta-Analysis. | journal=J Am Coll Cardiol | year= 2019 | volume= 73 | issue= 12 | pages= 1430-1443 | pmid=30922474 | doi=10.1016/j.jacc.2018.12.072 | pmc=8351793 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30922474  }} </ref><ref name="pmid25685361">{{cite journal| author=Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal HM, Lough F | display-authors=etal| title=Exercise-based rehabilitation for heart failure: systematic review and meta-analysis. | journal=Open Heart | year= 2015 | volume= 2 | issue= 1 | pages= e000163 | pmid=25685361 | doi=10.1136/openhrt-2014-000163 | pmc=4316592 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25685361  }} </ref><ref name="pmid14729656">{{cite journal| author=Piepoli MF, Davos C, Francis DP, Coats AJ, ExTraMATCH Collaborative| title=Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH). | journal=BMJ | year= 2004 | volume= 328 | issue= 7433 | pages= 189 | pmid=14729656 | doi=10.1136/bmj.37938.645220.EE | pmc=318480 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14729656  }} </ref><ref name="pmid24771460">{{cite journal| author=Taylor RS, Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal H | display-authors=etal| title=Exercise-based rehabilitation for heart failure. | journal=Cochrane Database Syst Rev | year= 2014 | volume=  | issue= 4 | pages= CD003331 | pmid=24771460 | doi=10.1002/14651858.CD003331.pub4 | pmc=6485909 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24771460  }} </ref><ref name="pmid33999544">{{cite journal| author=Kitzman DW, Whellan DJ, Duncan P, Pastva AM, Mentz RJ, Reeves GR | display-authors=etal| title=Physical Rehabilitation for Older Patients Hospitalized for Heart Failure. | journal=N Engl J Med | year= 2021 | volume= 385 | issue= 3 | pages= 203-216 | pmid=33999544 | doi=10.1056/NEJMoa2026141 | pmc=8353658 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33999544  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A ]])'' <nowiki>"</nowiki>

|}

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]

|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' In [[patients]] with [[HF]], a [[cardiac]] [[rehabilitation program]] can be useful to improve functional capacity, [[exercise]] tolerance, and [[health]]-related [[QOL]]. <ref name="pmid19351941">{{cite journal| author=O'Connor CM, Whellan DJ, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ | display-authors=etal| title=Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. | journal=JAMA | year= 2009 | volume= 301 | issue= 14 | pages= 1439-50 | pmid=19351941 | doi=10.1001/jama.2009.454 | pmc=2916661 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19351941  }} </ref><ref name="pmid20494922">{{cite journal| author=Davies EJ, Moxham T, Rees K, Singh S, Coats AJ, Ebrahim S | display-authors=etal| title=Exercise training for systolic heart failure: Cochrane systematic review and meta-analysis. | journal=Eur J Heart Fail | year= 2010 | volume= 12 | issue= 7 | pages= 706-15 | pmid=20494922 | doi=10.1093/eurjhf/hfq056 | pmc=2891490 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20494922  }} </ref><ref name="pmid30922474">{{cite journal| author=Taylor RS, Walker S, Smart NA, Piepoli MF, Warren FC, Ciani O | display-authors=etal| title=Impact of Exercise Rehabilitation on Exercise Capacity and Quality-of-Life in Heart Failure: Individual Participant Meta-Analysis. | journal=J Am Coll Cardiol | year= 2019 | volume= 73 | issue= 12 | pages= 1430-1443 | pmid=30922474 | doi=10.1016/j.jacc.2018.12.072 | pmc=8351793 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30922474  }} </ref><ref name="pmid25685361">{{cite journal| author=Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal HM, Lough F | display-authors=etal| title=Exercise-based rehabilitation for heart failure: systematic review and meta-analysis. | journal=Open Heart | year= 2015 | volume= 2 | issue= 1 | pages= e000163 | pmid=25685361 | doi=10.1136/openhrt-2014-000163 | pmc=4316592 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25685361  }} </ref><ref name="pmid24771460">{{cite journal| author=Taylor RS, Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal H | display-authors=etal| title=Exercise-based rehabilitation for heart failure. | journal=Cochrane Database Syst Rev | year= 2014 | volume=  | issue= 4 | pages= CD003331 | pmid=24771460 | doi=10.1002/14651858.CD003331.pub4 | pmc=6485909 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24771460  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>

|}

===[[Diuretics]] and [[Decongestion]] Strategies in [[Patients]] with [[HF]] (DO NOT EDIT)<ref name="pmid35363500">{{cite journal| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM | display-authors=etal| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2022 | volume= 145 | issue= 18 | pages= e876-e894 | pmid=35363500 | doi=10.1161/CIR.0000000000001062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500  }} </ref><ref name="pmid23747642">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE et al.| title=2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume=  | issue=  | pages=  | pmid=23747642 | doi=10.1016/j.jacc.2013.05.019 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23747642  }} </ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID:[http://pubmed.gov/19324967 19324967]</ref>===

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]

|-
|bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In [[patients]] with [[HF]] who have fluid retention, [[diuretics]] are recommended to relieve [[congestion]], improve [[symptoms]], and prevent worsening [[HF]]. <ref name="pmid7997385">{{cite journal| author=Patterson JH, Adams KF, Applefeld MM, Corder CN, Masse BR| title=Oral torsemide in patients with chronic congestive heart failure: effects on body weight, edema, and electrolyte excretion. Torsemide Investigators Group. | journal=Pharmacotherapy | year= 1994 | volume= 14 | issue= 5 | pages= 514-21 | pmid=7997385 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7997385  }} </ref><ref name="pmid8111802">{{cite journal| author=Goebel KM| title=Six-week study of torsemide in patients with congestive heart failure. | journal=Clin Ther | year= 1993 | volume= 15 | issue= 6 | pages= 1051-9 | pmid=8111802 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8111802  }} </ref><ref name="pmid7468610">{{cite journal| author=Wilson JR, Reichek N, Dunkman WB, Goldberg S| title=Effect of diuresis on the performance of the failing left ventricle in man. | journal=Am J Med | year= 1981 | volume= 70 | issue= 2 | pages= 234-9 | pmid=7468610 | doi=10.1016/0002-9343(81)90755-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7468610  }} </ref><ref name="pmid8225657">{{cite journal| author=Parker JO| title=The effects of oral ibopamine in patients with mild heart failure--a double blind placebo controlled comparison to furosemide. The Ibopamine Study Group. | journal=Int J Cardiol | year= 1993 | volume= 40 | issue= 3 | pages= 221-7 | pmid=8225657 | doi=10.1016/0167-5273(93)90004-z | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8225657  }} </ref><ref name="pmid2888942">{{cite journal| author=Richardson A, Bayliss J, Scriven AJ, Parameshwar J, Poole-Wilson PA, Sutton GC| title=Double-blind comparison of captopril alone against frusemide plus amiloride in mild heart failure. | journal=Lancet | year= 1987 | volume= 2 | issue= 8561 | pages= 709-11 | pmid=2888942 | doi=10.1016/s0140-6736(87)91074-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2888942  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>

|-
|bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' For [[patients]] with [[HF]] and [[congestive symptoms]], addition of a [[thiazide]] (eg, [[metolazone]]) to [[treatment]] with a [[loop diuretic]] should be reserved for [[patients]] who do not respond to moderate or high-dose [[loop diuretics]] to minimize [[electrolyte]] abnormalities. <ref name="pmid26209004">{{cite journal| author=Grodin JL, Stevens SR, de Las Fuentes L, Kiernan M, Birati EY, Gupta D | display-authors=etal| title=Intensification of Medication Therapy for Cardiorenal Syndrome in Acute Decompensated Heart Failure. | journal=J Card Fail | year= 2016 | volume= 22 | issue= 1 | pages= 26-32 | pmid=26209004 | doi=10.1016/j.cardfail.2015.07.007 | pmc=4706474 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26209004  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>

|}

===[[Pharmacological]] [[Treatment]] for [[HFrEF]] (DO NOT EDIT)<ref name="pmid35363500">{{cite journal| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM | display-authors=etal| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2022 | volume= 145 | issue= 18 | pages= e876-e894 | pmid=35363500 | doi=10.1161/CIR.0000000000001062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500  }} </ref><ref name="pmid23747642">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE et al.| title=2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume=  | issue=  | pages=  | pmid=23747642 | doi=10.1016/j.jacc.2013.05.019 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23747642  }} </ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID:[http://pubmed.gov/19324967 19324967]</ref>===

====[[Renin-Angiotensin System]] Inhibition With [[ACEi]] or [[ARB]] or [[ARNi]]====

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]

|-
|bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In [[patients]] with [[HFrEF]] and [[NYHA]] class II to III [[symptoms]], the use of [[ARNi]] is recommended to reduce [[morbidity]] and [[mortality]]. <ref name="pmid25176015">{{cite journal| author=McMurray JJ, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR | display-authors=etal| title=Angiotensin-neprilysin inhibition versus enalapril in heart failure. | journal=N Engl J Med | year= 2014 | volume= 371 | issue= 11 | pages= 993-1004 | pmid=25176015 | doi=10.1056/NEJMoa1409077 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25176015  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=25659916 Review in: Evid Based Med. 2015 Apr;20(2):61]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=25686189 Review in: Ann Intern Med. 2015 Feb 17;162(4):JC2] </ref><ref name="pmid31134724">{{cite journal| author=Wachter R, Senni M, Belohlavek J, Straburzynska-Migaj E, Witte KK, Kobalava Z | display-authors=etal| title=Initiation of sacubitril/valsartan in haemodynamically stabilised heart failure patients in hospital or early after discharge: primary results of the randomised TRANSITION study. | journal=Eur J Heart Fail | year= 2019 | volume= 21 | issue= 8 | pages= 998-1007 | pmid=31134724 | doi=10.1002/ejhf.1498 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31134724  }} </ref><ref name="pmid30415601">{{cite journal| author=Velazquez EJ, Morrow DA, DeVore AD, Duffy CI, Ambrosy AP, McCague K | display-authors=etal| title=Angiotensin-Neprilysin Inhibition in Acute Decompensated Heart Failure. | journal=N Engl J Med | year= 2019 | volume= 380 | issue= 6 | pages= 539-548 | pmid=30415601 | doi=10.1056/NEJMoa1812851 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30415601  }} </ref><ref name="pmid31475296">{{cite journal| author=Desai AS, Solomon SD, Shah AM, Claggett BL, Fang JC, Izzo J | display-authors=etal| title=Effect of Sacubitril-Valsartan vs Enalapril on Aortic Stiffness in Patients With Heart Failure and Reduced Ejection Fraction: A Randomized Clinical Trial. | journal=JAMA | year= 2019 | volume= 322 | issue= 11 | pages= 1077-1084 | pmid=31475296 | doi=10.1001/jama.2019.12843 | pmc=6749534 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31475296  }} </ref><ref name="pmid31240976">{{cite journal| author=Wang Y, Zhou R, Lu C, Chen Q, Xu T, Li D| title=Effects of the Angiotensin-Receptor Neprilysin Inhibitor on Cardiac Reverse Remodeling: Meta-Analysis. | journal=J Am Heart Assoc | year= 2019 | volume= 8 | issue= 13 | pages= e012272 | pmid=31240976 | doi=10.1161/JAHA.119.012272 | pmc=6662364 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31240976  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>

|-
|bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' In [[patients]] with previous or current [[symptoms]] of [[chronic]] [[HFrEF]], the use of [[ACEi]] is beneficial to reduce [[morbidity]] and [[mortality]] when the use of [[ARNi]] is not feasible.<ref name="pmid2883575">{{cite journal| author=CONSENSUS Trial Study Group| title=Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). | journal=N Engl J Med | year= 1987 | volume= 316 | issue= 23 | pages= 1429-35 | pmid=2883575 | doi=10.1056/NEJM198706043162301 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2883575  }} </ref><ref name="pmid2057034">{{cite journal| author=SOLVD Investigators. Yusuf S, Pitt B, Davis CE, Hood WB, Cohn JN| title=Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. | journal=N Engl J Med | year= 1991 | volume= 325 | issue= 5 | pages= 293-302 | pmid=2057034 | doi=10.1056/NEJM199108013250501 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2057034  }} </ref><ref name="pmid10587334">{{cite journal| author=Packer M, Poole-Wilson PA, Armstrong PW, Cleland JG, Horowitz JD, Massie BM | display-authors=etal| title=Comparative effects of low and high doses of the angiotensin-converting enzyme inhibitor, lisinopril, on morbidity and mortality in chronic heart failure. ATLAS Study Group. | journal=Circulation | year= 1999 | volume= 100 | issue= 23 | pages= 2312-8 | pmid=10587334 | doi=10.1161/01.cir.100.23.2312 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10587334  }} </ref><ref name="pmid1386652">{{cite journal| author=Pfeffer MA, Braunwald E, Moyé LA, Basta L, Brown EJ, Cuddy TE | display-authors=etal| title=Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators. | journal=N Engl J Med | year= 1992 | volume= 327 | issue= 10 | pages= 669-77 | pmid=1386652 | doi=10.1056/NEJM199209033271001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1386652  }} </ref><ref name="pmid8104270">{{cite journal| author=| title=Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. | journal=Lancet | year= 1993 | volume= 342 | issue= 8875 | pages= 821-8 | pmid=8104270 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8104270  }} </ref><ref name="pmid7477219">{{cite journal| author=Køber L, Torp-Pedersen C, Carlsen JE, Bagger H, Eliasen P, Lyngborg K | display-authors=etal| title=A clinical trial of the angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. Trandolapril Cardiac Evaluation (TRACE) Study Group. | journal=N Engl J Med | year= 1995 | volume= 333 | issue= 25 | pages= 1670-6 | pmid=7477219 | doi=10.1056/NEJM199512213332503 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7477219  }} </ref><ref name="pmid7654275">{{cite journal| author=Garg R, Yusuf S| title=Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials. | journal=JAMA | year= 1995 | volume= 273 | issue= 18 | pages= 1450-6 | pmid=7654275 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7654275  }} </ref><ref name="pmid20625347">{{cite journal| author=Woodard-Grice AV, Lucisano AC, Byrd JB, Stone ER, Simmons WH, Brown NJ| title=Sex-dependent and race-dependent association of XPNPEP2 C-2399A polymorphism with angiotensin-converting enzyme inhibitor-associated angioedema. | journal=Pharmacogenet Genomics | year= 2010 | volume= 20 | issue= 9 | pages= 532-6 | pmid=20625347 | doi=10.1097/FPC.0b013e32833d3acb | pmc=2945219 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20625347  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>

|-
|bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' In [[patients]] with previous or current [[symptoms]] of [[chronic]] [[HFrEF]] who are intolerant to [[ACEi]] because of [[cough]] or [[angioedema]] and when the use of [[ARNi]] is not feasible, the use of [[ARB]] is recommended to reduce [[morbidity]] and [[mortality]]. <ref name="pmid11759645">{{cite journal| author=Cohn JN, Tognoni G, Valsartan Heart Failure Trial Investigators| title=A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. | journal=N Engl J Med | year= 2001 | volume= 345 | issue= 23 | pages= 1667-75 | pmid=11759645 | doi=10.1056/NEJMoa010713 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11759645  }} </ref><ref name="pmid14610160">{{cite journal| author=Pfeffer MA, McMurray JJ, Velazquez EJ, Rouleau JL, Køber L, Maggioni AP | display-authors=etal| title=Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. | journal=N Engl J Med | year= 2003 | volume= 349 | issue= 20 | pages= 1893-906 | pmid=14610160 | doi=10.1056/NEJMoa032292 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14610160  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=15230551 Review in: ACP J Club. 2004 Jul-Aug;141(1):3] </ref><ref name="pmid19922995">{{cite journal| author=Konstam MA, Neaton JD, Dickstein K, Drexler H, Komajda M, Martinez FA | display-authors=etal| title=Effects of high-dose versus low-dose losartan on clinical outcomes in patients with heart failure (HEAAL study): a randomised, double-blind trial. | journal=Lancet | year= 2009 | volume= 374 | issue= 9704 | pages= 1840-8 | pmid=19922995 | doi=10.1016/S0140-6736(09)61913-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19922995  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=20436124 Review in: Evid Based Med. 2010 Apr;15(2):51-2] </ref><ref name="pmid18700309">{{cite journal| author=Dominiak M| title=[Commentary to the article: ONTARGET Investigators, Yusuf S, Teo KK, Pogue J et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008; 358: 1547-59]. | journal=Kardiol Pol | year= 2008 | volume= 66 | issue= 6 | pages= 705-6; discussion 707 | pmid=18700309 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18700309  }} </ref><ref name="pmid18757085">{{cite journal| author=Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (TRANSCEND) Investigators. Yusuf S, Teo K, Anderson C, Pogue J, Dyal L | display-authors=etal| title=Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomised controlled trial. | journal=Lancet | year= 2008 | volume= 372 | issue= 9644 | pages= 1174-83 | pmid=18757085 | doi=10.1016/S0140-6736(08)61242-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18757085  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=19238604 Review in: Ann Intern Med. 2009 Feb 17;150(4):JC2-6] </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>

|-
|bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.''' In [[patients]] with [[chronic]] [[symptomatic]] [[HFrEF]] [[NYHA]] class II or III who tolerate an [[ACEi]] or [[ARB]], replacement by an [[ARNi]] is recommended to further reduce [[morbidity]] and [[mortality]].  <ref name="pmid25176015">{{cite journal| author=McMurray JJ, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR | display-authors=etal| title=Angiotensin-neprilysin inhibition versus enalapril in heart failure. | journal=N Engl J Med | year= 2014 | volume= 371 | issue= 11 | pages= 993-1004 | pmid=25176015 | doi=10.1056/NEJMoa1409077 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25176015  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=25659916 Review in: Evid Based Med. 2015 Apr;20(2):61]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=25686189 Review in: Ann Intern Med. 2015 Feb 17;162(4):JC2] </ref><ref name="pmid31134724">{{cite journal| author=Wachter R, Senni M, Belohlavek J, Straburzynska-Migaj E, Witte KK, Kobalava Z | display-authors=etal| title=Initiation of sacubitril/valsartan in haemodynamically stabilised heart failure patients in hospital or early after discharge: primary results of the randomised TRANSITION study. | journal=Eur J Heart Fail | year= 2019 | volume= 21 | issue= 8 | pages= 998-1007 | pmid=31134724 | doi=10.1002/ejhf.1498 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31134724  }} </ref><ref name="pmid30415601">{{cite journal| author=Velazquez EJ, Morrow DA, DeVore AD, Duffy CI, Ambrosy AP, McCague K | display-authors=etal| title=Angiotensin-Neprilysin Inhibition in Acute Decompensated Heart Failure. | journal=N Engl J Med | year= 2019 | volume= 380 | issue= 6 | pages= 539-548 | pmid=30415601 | doi=10.1056/NEJMoa1812851 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30415601  }} </ref><ref name="pmid31475296">{{cite journal| author=Desai AS, Solomon SD, Shah AM, Claggett BL, Fang JC, Izzo J | display-authors=etal| title=Effect of Sacubitril-Valsartan vs Enalapril on Aortic Stiffness in Patients With Heart Failure and Reduced Ejection Fraction: A Randomized Clinical Trial. | journal=JAMA | year= 2019 | volume= 322 | issue= 11 | pages= 1077-1084 | pmid=31475296 | doi=10.1001/jama.2019.12843 | pmc=6749534 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31475296  }} </ref><ref name="pmid31240976">{{cite journal| author=Wang Y, Zhou R, Lu C, Chen Q, Xu T, Li D| title=Effects of the Angiotensin-Receptor Neprilysin Inhibitor on Cardiac Reverse Remodeling: Meta-Analysis. | journal=J Am Heart Assoc | year= 2019 | volume= 8 | issue= 13 | pages= e012272 | pmid=31240976 | doi=10.1161/JAHA.119.012272 | pmc=6662364 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31240976  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>

|}

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:"White"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class Value Statement: High Value]]

|-
|bgcolor="White"|<nowiki>"</nowiki>'''4.''' In [[patients]] with previous or current [[symptoms]] of [[chronic]] [[HFrEF]], in whom [[ARNi]] is not feasible, [[treatment]] with an [[ACEi]] or [[ARB]] provides high economic value. <ref name="pmid23433562">{{cite journal| author=Banka G, Heidenreich PA, Fonarow GC| title=Incremental cost-effectiveness of guideline-directed medical therapies for heart failure. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 13 | pages= 1440-6 | pmid=23433562 | doi=10.1016/j.jacc.2012.12.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23433562  }} </ref><ref name="pmid10516413">{{cite journal| author=Dasbach EJ, Rich MW, Segal R, Gerth WC, Carides GW, Cook JR | display-authors=etal| title=The cost-effectiveness of losartan versus captopril in patients with symptomatic heart failure. | journal=Cardiology | year= 1999 | volume= 91 | issue= 3 | pages= 189-94 | pmid=10516413 | doi=10.1159/000006908 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10516413  }} </ref><ref name="pmid12836712">{{cite journal| author=Glick H, Cook J, Kinosian B, Pitt B, Bourassa MG, Pouleur H | display-authors=etal| title=Costs and effects of enalapril therapy in patients with symptomatic heart failure: an economic analysis of the Studies of Left Ventricular Dysfunction (SOLVD) Treatment Trial. | journal=J Card Fail | year= 1995 | volume= 1 | issue= 5 | pages= 371-80 | pmid=12836712 | doi=10.1016/s1071-9164(05)80006-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12836712  }} </ref><ref name="pmid8185426">{{cite journal| author=Paul SD, Kuntz KM, Eagle KA, Weinstein MC| title=Costs and effectiveness of angiotensin converting enzyme inhibition in patients with congestive heart failure. | journal=Arch Intern Med | year= 1994 | volume= 154 | issue= 10 | pages= 1143-9 | pmid=8185426 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8185426  }} </ref><ref name="pmid15215801">{{cite journal| author=Reed SD, Friedman JY, Velazquez EJ, Gnanasakthy A, Califf RM, Schulman KA| title=Multinational economic evaluation of valsartan in patients with chronic heart failure: results from the Valsartan Heart Failure Trial (Val-HeFT). | journal=Am Heart J | year= 2004 | volume= 148 | issue= 1 | pages= 122-8 | pmid=15215801 | doi=10.1016/j.ahj.2003.12.040 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15215801  }} </ref><ref name="pmid14571595">{{cite journal| author=Shekelle P, Morton S, Atkinson S, Suttorp M, Tu W, Heidenreich P | display-authors=etal| title=Pharmacologic management of heart failure and left ventricular systolic dysfunction: effect in female, black, and diabetic patients, and cost-effectiveness. | journal=Evid Rep Technol Assess (Summ) | year= 2003 | volume=  | issue= 82 | pages= 1-6 | pmid=14571595 | doi= | pmc=4781559 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14571595  }} </ref><ref name="pmid7560617">{{cite journal| author=Tsevat J, Duke D, Goldman L, Pfeffer MA, Lamas GA, Soukup JR | display-authors=etal| title=Cost-effectiveness of captopril therapy after myocardial infarction. | journal=J Am Coll Cardiol | year= 1995 | volume= 26 | issue= 4 | pages= 914-9 | pmid=7560617 | doi=10.1016/0735-1097(95)00284-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7560617  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>

|-
|bgcolor="White"|<nowiki>"</nowiki>'''6.''' In [[patients]] with [[chronic]] [[symptomatic]] [[HFrEF]], [[treatment]] with an [[ARNi]] instead of an [[ACEi]] provides high economic value. <ref name="pmid27438344">{{cite journal| author=Gaziano TA, Fonarow GC, Claggett B, Chan WW, Deschaseaux-Voinet C, Turner SJ | display-authors=etal| title=Cost-effectiveness Analysis of Sacubitril/Valsartan vs Enalapril in Patients With Heart Failure and Reduced Ejection Fraction. | journal=JAMA Cardiol | year= 2016 | volume= 1 | issue= 6 | pages= 666-72 | pmid=27438344 | doi=10.1001/jamacardio.2016.1747 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27438344  }} </ref><ref name="pmid32785628">{{cite journal| author=Gaziano TA, Fonarow GC, Velazquez EJ, Morrow DA, Braunwald E, Solomon SD| title=Cost-effectiveness of Sacubitril-Valsartan in Hospitalized Patients Who Have Heart Failure With Reduced Ejection Fraction. | journal=JAMA Cardiol | year= 2020 | volume= 5 | issue= 11 | pages= 1236-1244 | pmid=32785628 | doi=10.1001/jamacardio.2020.2822 | pmc=7675099 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32785628  }} </ref><ref name="pmid27039128">{{cite journal| author=King JB, Shah RU, Bress AP, Nelson RE, Bellows BK| title=Cost-Effectiveness of Sacubitril-Valsartan Combination Therapy Compared With Enalapril for the Treatment of Heart Failure With Reduced Ejection Fraction. | journal=JACC Heart Fail | year= 2016 | volume= 4 | issue= 5 | pages= 392-402 | pmid=27039128 | doi=10.1016/j.jchf.2016.02.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27039128  }} </ref><ref name="pmid27571284">{{cite journal| author=Sandhu AT, Ollendorf DA, Chapman RH, Pearson SD, Heidenreich PA| title=Cost-Effectiveness of Sacubitril-Valsartan in Patients With Heart Failure With Reduced Ejection Fraction. | journal=Ann Intern Med | year= 2016 | volume= 165 | issue= 10 | pages= 681-689 | pmid=27571284 | doi=10.7326/M16-0057 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27571284  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>

|}

{|class="wikitable" style="width:80%"
|-
|colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)

|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''7.''' [[ARNi]] should not be administered concomitantly with [[ACEi]] or within 36 hours of the last [[dose]] of an [[ACEi]]. <ref name="pmid12186794">{{cite journal| author=Packer M, Califf RM, Konstam MA, Krum H, McMurray JJ, Rouleau JL | display-authors=etal| title=Comparison of omapatrilat and enalapril in patients with chronic heart failure: the Omapatrilat Versus Enalapril Randomized Trial of Utility in Reducing Events (OVERTURE). | journal=Circulation | year= 2002 | volume= 106 | issue= 8 | pages= 920-6 | pmid=12186794 | doi=10.1161/01.cir.0000029801.86489.50 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12186794  }} </ref><ref name="pmid14751650">{{cite journal| author=Kostis JB, Packer M, Black HR, Schmieder R, Henry D, Levy E| title=Omapatrilat and enalapril in patients with hypertension: the Omapatrilat Cardiovascular Treatment vs. Enalapril (OCTAVE) trial. | journal=Am J Hypertens | year= 2004 | volume= 17 | issue= 2 | pages= 103-11 | pmid=14751650 | doi=10.1016/j.amjhyper.2003.09.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14751650  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>

|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''8.''' [[ARNi]] should not be administered to [[patients]] with any [[history]] of [[angioedema]].<ref name="pmid25306450">{{cite journal| author=Vardeny O, Miller R, Solomon SD| title=Combined neprilysin and renin-angiotensin system inhibition for the treatment of heart failure. | journal=JACC Heart Fail | year= 2014 | volume= 2 | issue= 6 | pages= 663-70 | pmid=25306450 | doi=10.1016/j.jchf.2014.09.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25306450  }} </ref><ref name="pmid10968427">{{cite journal| author=Messerli FH, Nussberger J| title=Vasopeptidase inhibition and angio-oedema. | journal=Lancet | year= 2000 | volume= 356 | issue= 9230 | pages= 608-9 | pmid=10968427 | doi=10.1016/S0140-6736(00)02596-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10968427  }} </ref><ref name="pmid25766951">{{cite journal| author=Braunwald E| title=The path to an angiotensin receptor antagonist-neprilysin inhibitor in the treatment of heart failure. | journal=J Am Coll Cardiol | year= 2015 | volume= 65 | issue= 10 | pages= 1029-41 | pmid=25766951 | doi=10.1016/j.jacc.2015.01.033 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25766951  }} </ref><ref name="pmid20236700">{{cite journal| author=Ruilope LM, Dukat A, Böhm M, Lacourcière Y, Gong J, Lefkowitz MP| title=Blood-pressure reduction with LCZ696, a novel dual-acting inhibitor of the angiotensin II receptor and neprilysin: a randomised, double-blind, placebo-controlled, active comparator study. | journal=Lancet | year= 2010 | volume= 375 | issue= 9722 | pages= 1255-66 | pmid=20236700 | doi=10.1016/S0140-6736(09)61966-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20236700  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])'' <nowiki>"</nowiki>
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''9.''' [[ACEi]] should not be administered to [[patients]] with any [[history]] of [[angioedema]]. <ref name="pmid17085287">{{cite journal| author=Byrd JB, Adam A, Brown NJ| title=Angiotensin-converting enzyme inhibitor-associated angioedema. | journal=Immunol Allergy Clin North Am | year= 2006 | volume= 26 | issue= 4 | pages= 725-37 | pmid=17085287 | doi=10.1016/j.iac.2006.08.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17085287  }} </ref><ref name="pmid23147456">{{cite journal| author=Toh S, Reichman ME, Houstoun M, Ross Southworth M, Ding X, Hernandez AF | display-authors=etal| title=Comparative risk for angioedema associated with the use of drugs that target the renin-angiotensin-aldosterone system. | journal=Arch Intern Med | year= 2012 | volume= 172 | issue= 20 | pages= 1582-9 | pmid=23147456 | doi=10.1001/2013.jamainternmed.34 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23147456  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=23635842 Review in: Evid Based Med. 2013 Dec;18(6):e52] </ref><ref name="pmid22521308">{{cite journal| author=Makani H, Messerli FH, Romero J, Wever-Pinzon O, Korniyenko A, Berrios RS | display-authors=etal| title=Meta-analysis of randomized trials of angioedema as an adverse event of renin-angiotensin system inhibitors. | journal=Am J Cardiol | year= 2012 | volume= 110 | issue= 3 | pages= 383-91 | pmid=22521308 | doi=10.1016/j.amjcard.2012.03.034 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22521308  }} </ref><ref name="pmid30618189">{{cite journal| author=Rasmussen ER, Pottegård A, Bygum A, von Buchwald C, Homøe P, Hallas J| title=Angiotensin II receptor blockers are safe in patients with prior angioedema related to angiotensin-converting enzyme inhibitors - a nationwide registry-based cohort study. | journal=J Intern Med | year= 2019 | volume= 285 | issue= 5 | pages= 553-561 | pmid=30618189 | doi=10.1111/joim.12867 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30618189  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])'' <nowiki>"</nowiki>

|}

====Beta Blockers====

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]

|-
|bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In [[patients]] with [[HFrEF]], with current or previous [[symptoms]], use of 1 of the 3 [[beta blockers]] proven to reduce [[mortality]] (eg, bisoprolol, carvedilol,sustained-release metoprolol succinate) is recommended to reduce mortality and hospitalizations. <ref name="pmid10023943">{{cite journal| author=| title=The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. | journal=Lancet | year= 1999 | volume= 353 | issue= 9146 | pages= 9-13 | pmid=10023943 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10023943  }} </ref><ref name="pmid10376614">{{cite journal| author=| title=Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF) | journal=Lancet | year= 1999 | volume= 353 | issue= 9169 | pages= 2001-7 | pmid=10376614 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10376614  }} </ref><ref name="pmid12390947">{{cite journal| author=Packer M, Fowler MB, Roecker EB, Coats AJ, Katus HA, Krum H | display-authors=etal| title=Effect of carvedilol on the morbidity of patients with severe chronic heart failure: results of the carvedilol prospective randomized cumulative survival (COPERNICUS) study. | journal=Circulation | year= 2002 | volume= 106 | issue= 17 | pages= 2194-9 | pmid=12390947 | doi=10.1161/01.cir.0000035653.72855.bf | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12390947  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>

|}

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:"White"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class Value Statement: High Value]]

|-
|bgcolor="White"|<nowiki>"</nowiki>'''2.''' In [[patients]] with [[HFrEF]], with current or previous [[symptoms]], [[beta blocker]] [[therapy]] provides high economic values. <ref name="pmid23433562">{{cite journal| author=Banka G, Heidenreich PA, Fonarow GC| title=Incremental cost-effectiveness of guideline-directed medical therapies for heart failure. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 13 | pages= 1440-6 | pmid=23433562 | doi=10.1016/j.jacc.2012.12.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23433562  }} </ref><ref name="pmid16360958">{{cite journal| author=Caro JJ, Migliaccio-Walle K, O'Brien JA, Nova W, Kim J, Hauch O | display-authors=etal| title=Economic implications of extended-release metoprolol succinate for heart failure in the MERIT-HF trial: a US perspective of the MERIT-HF trial. | journal=J Card Fail | year= 2005 | volume= 11 | issue= 9 | pages= 647-56 | pmid=16360958 | doi=10.1016/j.cardfail.2005.06.433 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16360958  }} </ref><ref name="pmid10190405">{{cite journal| author=Delea TE, Vera-Llonch M, Richner RE, Fowler MB, Oster G| title=Cost effectiveness of carvedilol for heart failure. | journal=Am J Cardiol | year= 1999 | volume= 83 | issue= 6 | pages= 890-6 | pmid=10190405 | doi=10.1016/s0002-9149(98)01066-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10190405  }} </ref><ref name="pmid11334781">{{cite journal| author=Gregory D, Udelson JE, Konstam MA| title=Economic impact of beta blockade in heart failure. | journal=Am J Med | year= 2001 | volume= 110 Suppl 7A | issue=  | pages= 74S-80S | pmid=11334781 | doi=10.1016/s0002-9343(98)00387-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11334781  }} </ref><ref name="pmid11485131">{{cite journal| author=Vera-Llonch M, Menzin J, Richner RE, Oster G| title=Cost-effectiveness results from the US Carvedilol Heart Failure Trials Program. | journal=Ann Pharmacother | year= 2001 | volume= 35 | issue= 7-8 | pages= 846-51 | pmid=11485131 | doi=10.1345/aph.10114 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11485131  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>

|}

====Mineralocorticoid Receptor Antagonists (MRAs)====

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]

|-
|bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In [[patients]] with [[HFrEF]] and [[NYHA]] class II to IV [[symptoms]], an [[MRA]] ([[spironolactone]] or [[epleronone]]) is recommended to reduce [[morbidity]] and [[mortality]], if [[eGFR]] is >30 mL/min/1.73 m<sup>2</sup> and [[serum]] [[potassium]] is <5.0 mEq/L. Careful monitoring of [[potassium]], [[renal function]], and [[diuretic]] dosing should be performed at initiation and closely monitored thereafter to minimize risk of [[hyperkalemia]] and [[renal insufficiency]]. <ref name="pmid10471456">{{cite journal| author=Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A | display-authors=etal| title=The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. | journal=N Engl J Med | year= 1999 | volume= 341 | issue= 10 | pages= 709-17 | pmid=10471456 | doi=10.1056/NEJM199909023411001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10471456  }} </ref><ref name="pmid12668699">{{cite journal| author=Pitt B, Remme W, Zannad F, Neaton J, Martinez F, Roniker B | display-authors=etal| title=Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. | journal=N Engl J Med | year= 2003 | volume= 348 | issue= 14 | pages= 1309-21 | pmid=12668699 | doi=10.1056/NEJMoa030207 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12668699  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=12899810 Review in: J Fam Pract. 2003 Aug;52(8):598-9]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=12954024 Review in: ACP J Club. 2003 Sep-Oct;139(2):32] </ref><ref name="pmid21073363">{{cite journal| author=Zannad F, McMurray JJ, Krum H, van Veldhuisen DJ, Swedberg K, Shi H | display-authors=etal| title=Eplerenone in patients with systolic heart failure and mild symptoms. | journal=N Engl J Med | year= 2011 | volume= 364 | issue= 1 | pages= 11-21 | pmid=21073363 | doi=10.1056/NEJMoa1009492 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21073363  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=21558564 Review in: Evid Based Med. 2011 Aug;16(4):121-2]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=21814643 Review in: J Fam Pract. 2011 Aug;60(8):482-4] </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>

|}

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:White"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Value Statement: High Value]]

|-
|bgcolor="White"|<nowiki>"</nowiki>'''2.''' In [[patients]] with [[HFrEF]] and [[NYHA]] II to IV [[symptoms]], [[MRA]] [[therapy]] provides high economic value.<ref name="pmid23433562">{{cite journal| author=Banka G, Heidenreich PA, Fonarow GC| title=Incremental cost-effectiveness of guideline-directed medical therapies for heart failure. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 13 | pages= 1440-6 | pmid=23433562 | doi=10.1016/j.jacc.2012.12.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23433562  }} </ref><ref name="pmid12085979">{{cite journal| author=Glick HA, Orzol SM, Tooley JF, Remme WJ, Sasayama S, Pitt B| title=Economic evaluation of the randomized aldactone evaluation study (RALES): treatment of patients with severe heart failure. | journal=Cardiovasc Drugs Ther | year= 2002 | volume= 16 | issue= 1 | pages= 53-9 | pmid=12085979 | doi=10.1023/a:1015371616135 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12085979  }} </ref><ref name="pmid15723981">{{cite journal| author=Weintraub WS, Zhang Z, Mahoney EM, Kolm P, Spertus JA, Caro J | display-authors=etal| title=Cost-effectiveness of eplerenone compared with placebo in patients with myocardial infarction complicated by left ventricular dysfunction and heart failure. | journal=Circulation | year= 2005 | volume= 111 | issue= 9 | pages= 1106-13 | pmid=15723981 | doi=10.1161/01.CIR.0000157146.86758.BC | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15723981  }} </ref><ref name="pmid20104935">{{cite journal| author=Zhang Z, Mahoney EM, Kolm P, Spertus J, Caro J, Willke R | display-authors=etal| title=Cost effectiveness of eplerenone in patients with heart failure after acute myocardial infarction who were taking both ACE inhibitors and beta-blockers: subanalysis of the EPHESUS. | journal=Am J Cardiovasc Drugs | year= 2010 | volume= 10 | issue= 1 | pages= 55-63 | pmid=20104935 | doi=10.2165/11319940-000000000-00000 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20104935  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>

|}

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)

|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''3.''' In [[patients]] taking [[MRA]] whose [[serum]] [[potassium]] cannot be maintained at <5.5 mEq/L, [[MRA]] should be discontinued to avoid life-threatening [[hyperkalemia]]. <ref name="pmid23188026">{{cite journal| author=Hernandez AF, Mi X, Hammill BG, Hammill SC, Heidenreich PA, Masoudi FA | display-authors=etal| title=Associations between aldosterone antagonist therapy and risks of mortality and readmission among patients with heart failure and reduced ejection fraction. | journal=JAMA | year= 2012 | volume= 308 | issue= 20 | pages= 2097-107 | pmid=23188026 | doi=10.1001/jama.2012.14795 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23188026  }} </ref><ref name="pmid15295047">{{cite journal| author=Juurlink DN, Mamdani MM, Lee DS, Kopp A, Austin PC, Laupacis A | display-authors=etal| title=Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. | journal=N Engl J Med | year= 2004 | volume= 351 | issue= 6 | pages= 543-51 | pmid=15295047 | doi=10.1056/NEJMoa040135 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15295047  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>

|}

====Sodium-Glucose Contransporter 2 Inhibitors====

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]

|-
|bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In [[patients]] with [[symptomatic]] chronic [[HFrEF]], [[SGLT2i]] are recommended to reduce [[hospitalization]] for [[HF]] and [[cardiovascular]] [[mortality]], irrespective of the presence of [[type 2 diabetes]]. <ref name="pmid31535829">{{cite journal| author=McMurray JJV, Solomon SD, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA | display-authors=etal| title=Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. | journal=N Engl J Med | year= 2019 | volume= 381 | issue= 21 | pages= 1995-2008 | pmid=31535829 | doi=10.1056/NEJMoa1911303 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31535829  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=32066149 Review in: Ann Intern Med. 2020 Feb 18;172(4):JC16] </ref><ref name="pmid32865377">{{cite journal| author=Packer M, Anker SD, Butler J, Filippatos G, Pocock SJ, Carson P | display-authors=etal| title=Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. | journal=N Engl J Med | year= 2020 | volume= 383 | issue= 15 | pages= 1413-1424 | pmid=32865377 | doi=10.1056/NEJMoa2022190 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32865377  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=33197352 Review in: Ann Intern Med. 2020 Nov 17;173(10):JC51] </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>

|}

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:White"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Value Statement: Intermediate Value]]

|
|bgcolor="White"|<nowiki>"</nowiki>'''2.''' In [[patients]] with [[symptomatic]] chronic [[HFreF]], [[SGLT2i]] [[therapy]] provides intermediate economic value. <ref name="pmid34037681">{{cite journal| author=Parizo JT, Goldhaber-Fiebert JD, Salomon JA, Khush KK, Spertus JA, Heidenreich PA | display-authors=etal| title=Cost-effectiveness of Dapagliflozin for Treatment of Patients With Heart Failure With Reduced Ejection Fraction. | journal=JAMA Cardiol | year= 2021 | volume= 6 | issue= 8 | pages= 926-935 | pmid=34037681 | doi=10.1001/jamacardio.2021.1437 | pmc=8156166 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34037681  }} </ref><ref name="pmid34313742">{{cite journal| author=Isaza N, Calvachi P, Raber I, Liu CL, Bellows BK, Hernandez I | display-authors=etal| title=Cost-effectiveness of Dapagliflozin for the Treatment of Heart Failure With Reduced Ejection Fraction. | journal=JAMA Netw Open | year= 2021 | volume= 4 | issue= 7 | pages= e2114501 | pmid=34313742 | doi=10.1001/jamanetworkopen.2021.14501 | pmc=8317009 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34313742  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>

|}

====[[Hydralazine]] and [[Isosorbide Dinitrate]]====

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]

|-
|bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' For [[patients]] self-identified as African American with [[NYHA]] class III-IV [[HFrEF]] who are receiving optimal [[medical therapy]], the combination of [[hydralazine]] and [[isosorbide dinitrate]] is recommended to improve [[symptoms]] and reduce [[morbidity]] and [[mortality]]. <ref name="pmid10496190">{{cite journal| author=Carson P, Ziesche S, Johnson G, Cohn JN| title=Racial differences in response to therapy for heart failure: analysis of the vasodilator-heart failure trials. Vasodilator-Heart Failure Trial Study Group. | journal=J Card Fail | year= 1999 | volume= 5 | issue= 3 | pages= 178-87 | pmid=10496190 | doi=10.1016/s1071-9164(99)90001-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10496190  }} </ref><ref name="pmid15533851">{{cite journal| author=Taylor AL, Ziesche S, Yancy C, Carson P, D'Agostino R, Ferdinand K | display-authors=etal| title=Combination of isosorbide dinitrate and hydralazine in blacks with heart failure. | journal=N Engl J Med | year= 2004 | volume= 351 | issue= 20 | pages= 2049-57 | pmid=15533851 | doi=10.1056/NEJMoa042934 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15533851  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=15739984 Review in: ACP J Club. 2005 Mar-Apr;142(2):37] </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>

|}

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:White"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Value Statement: High Value]]

|-
|bgcolor="White"|<nowiki>"</nowiki>'''2.''' For [[patients]] self-identified as African American with [[NYHA]] class III to IV [[HFrEF]] who are receiving optimal [[medical therapy]] with [[ACEi]] or [[ARB]], [[beta blockers]], and [[MRA]], the combination of [[hydralazine]] and [[isosorbide dinitrate]] provides high economic value.<ref name="pmid16344404">{{cite journal| author=Angus DC, Linde-Zwirble WT, Tam SW, Ghali JK, Sabolinski ML, Villagra VG | display-authors=etal| title=Cost-effectiveness of fixed-dose combination of isosorbide dinitrate and hydralazine therapy for blacks with heart failure. | journal=Circulation | year= 2005 | volume= 112 | issue= 24 | pages= 3745-53 | pmid=16344404 | doi=10.1161/CIRCULATIONAHA.105.563882 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16344404  }} </ref>   ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>

|}

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]

|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' In [[patients]] with current or previous [[symptomatic]] [[HFrEF]] who cannot be given first-line agents, such as [[ARNi]], [[ACEi]], or [[ARB]], because of [[drug]] intolerance or [[renal insufficiency]], a combination of [[hydralazine]] and [[isosorbide dinitrate]] might be considered to reduce [[morbidity]] and [[mortality]]. <ref name="pmid3520315">{{cite journal| author=Cohn JN, Archibald DG, Ziesche S, Franciosa JA, Harston WE, Tristani FE | display-authors=etal| title=Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administration Cooperative Study. | journal=N Engl J Med | year= 1986 | volume= 314 | issue= 24 | pages= 1547-52 | pmid=3520315 | doi=10.1056/NEJM198606123142404 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3520315  }} </ref><ref name="pmid26867758">{{cite journal| author=Khazanie P, Liang L, Curtis LH, Butler J, Eapen ZJ, Heidenreich PA | display-authors=etal| title=Clinical Effectiveness of Hydralazine-Isosorbide Dinitrate Therapy in Patients With Heart Failure and Reduced Ejection Fraction: Findings From the Get With The Guidelines-Heart Failure Registry. | journal=Circ Heart Fail | year= 2016 | volume= 9 | issue= 2 | pages= e002444 | pmid=26867758 | doi=10.1161/CIRCHEARTFAILURE.115.002444 | pmc=4755330 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26867758  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])'' <nowiki>"</nowiki>

|}

====Other [[Drug]] [[Treatment]]====

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]

|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' In [[patients]] with [[HF]] class II to IV [[symptoms]], [[omega-3 polyunsaturated fatty acid]] ([[PUFA]]) supplementation may be reasonable to use as [[adjunctive therapy]] to reduce [[mortality]] and [[cardiovascular]] [[hospitalizations]]. <ref name="pmid16087142">{{cite journal| author=Macchia A, Levantesi G, Franzosi MG, Geraci E, Maggioni AP, Marfisi R | display-authors=etal| title=Left ventricular systolic dysfunction, total mortality, and sudden death in patients with myocardial infarction treated with n-3 polyunsaturated fatty acids. | journal=Eur J Heart Fail | year= 2005 | volume= 7 | issue= 5 | pages= 904-9 | pmid=16087142 | doi=10.1016/j.ejheart.2005.04.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16087142  }} </ref><ref name="pmid18757090">{{cite journal| author=Tavazzi L, Maggioni AP, Marchioli R, Barlera S, Franzosi MG, Latini R | display-authors=etal| title=Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial. | journal=Lancet | year= 2008 | volume= 372 | issue= 9645 | pages= 1223-30 | pmid=18757090 | doi=10.1016/S0140-6736(08)61239-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18757090  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=19172716 Review in: Ann Intern Med. 2009 Jan 20;150(2):JC1-11] </ref><ref name="pmid30415628">{{cite journal| author=Bhatt DL, Steg PG, Miller M, Brinton EA, Jacobson TA, Ketchum SB | display-authors=etal| title=Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia. | journal=N Engl J Med | year= 2019 | volume= 380 | issue= 1 | pages= 11-22 | pmid=30415628 | doi=10.1056/NEJMoa1812792 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30415628  }} </ref><ref name="pmid33148016">{{cite journal| author=Peterson BE, Bhatt DL, Steg PG, Miller M, Brinton EA, Jacobson TA | display-authors=etal| title=Reduction in Revascularization With Icosapent Ethyl: Insights From REDUCE-IT Revascularization Analyses. | journal=Circulation | year= 2021 | volume= 143 | issue= 1 | pages= 33-44 | pmid=33148016 | doi=10.1161/CIRCULATIONAHA.120.050276 | pmc=7752247 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33148016  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>

|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' In [[patients]] with [[HF]] who experience [[hyperkalemia]] ([[serum]] [[potassium]] level ≥ 5.5 mEq/L) while taking a [[renin-angiotensin-aldosterone system]] inhibitor ([[RAAS]]i), the effectiveness of [[potassium binders]] ([[patiromer]], [[sodium zirconium cyclosilicate]]) to improve outcomes by facilitating continuation of [[RAAS]]i [[therapy]] is uncertain. <ref name="pmid21208974">{{cite journal| author=Pitt B, Anker SD, Bushinsky DA, Kitzman DW, Zannad F, Huang IZ | display-authors=etal| title=Evaluation of the efficacy and safety of RLY5016, a polymeric potassium binder, in a double-blind, placebo-controlled study in patients with chronic heart failure (the PEARL-HF) trial. | journal=Eur Heart J | year= 2011 | volume= 32 | issue= 7 | pages= 820-8 | pmid=21208974 | doi=10.1093/eurheartj/ehq502 | pmc=3069389 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21208974  }} </ref><ref name="pmid26011677">{{cite journal| author=Anker SD, Kosiborod M, Zannad F, Piña IL, McCullough PA, Filippatos G | display-authors=etal| title=Maintenance of serum potassium with sodium zirconium cyclosilicate (ZS-9) in heart failure patients: results from a phase 3 randomized, double-blind, placebo-controlled trial. | journal=Eur J Heart Fail | year= 2015 | volume= 17 | issue= 10 | pages= 1050-6 | pmid=26011677 | doi=10.1002/ejhf.300 | pmc=5033065 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26011677  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>
|}

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)

|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''3.''' In [[patients]] with chronic [[HFrEF]] without a specific indication (eg, [[venous thromboembolism]] [VTE], [[AF]], a previous [[thromboembolic]] event, or a [[cardioembolic]] source), [[anticoagulation]] is not recommended. <ref name="pmid19289640">{{cite journal| author=Massie BM, Collins JF, Ammon SE, Armstrong PW, Cleland JG, Ezekowitz M | display-authors=etal| title=Randomized trial of warfarin, aspirin, and clopidogrel in patients with chronic heart failure: the Warfarin and Antiplatelet Therapy in Chronic Heart Failure (WATCH) trial. | journal=Circulation | year= 2009 | volume= 119 | issue= 12 | pages= 1616-24 | pmid=19289640 | doi=10.1161/CIRCULATIONAHA.108.801753 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19289640  }} </ref><ref name="pmid22551105">{{cite journal| author=Homma S, Thompson JL, Pullicino PM, Levin B, Freudenberger RS, Teerlink JR | display-authors=etal| title=Warfarin and aspirin in patients with heart failure and sinus rhythm. | journal=N Engl J Med | year= 2012 | volume= 366 | issue= 20 | pages= 1859-69 | pmid=22551105 | doi=10.1056/NEJMoa1202299 | pmc=3723382 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22551105  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=22910961 Review in: Ann Intern Med. 2012 Aug 21;157(4):JC2-7]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=22918068 Review in: Evid Based Med. 2013 Apr;18(2):69-70] </ref><ref name="pmid30146935">{{cite journal| author=Zannad F, Anker SD, Byra WM, Cleland JGF, Fu M, Gheorghiade M | display-authors=etal| title=Rivaroxaban in Patients with Heart Failure, Sinus Rhythm, and Coronary Disease. | journal=N Engl J Med | year= 2018 | volume= 379 | issue= 14 | pages= 1332-1342 | pmid=30146935 | doi=10.1056/NEJMoa1808848 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30146935  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>

|}

====Drugs of Unproven Value or That May Worsen HF====

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)

|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' In [[patients]] with [[HFrEF]], [[dihydropiridine calcium  channel-blocking  drugs]] are not recommended [[treatment]] for [[HF]].<ref name="pmid8813041">{{cite journal| author=Packer M, O'Connor CM, Ghali JK, Pressler ML, Carson PE, Belkin RN | display-authors=etal| title=Effect of amlodipine on morbidity and mortality in severe chronic heart failure. Prospective Randomized Amlodipine Survival Evaluation Study Group. | journal=N Engl J Med | year= 1996 | volume= 335 | issue= 15 | pages= 1107-14 | pmid=8813041 | doi=10.1056/NEJM199610103351504 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8813041  }} </ref><ref name="pmid24621933">{{cite journal| author=Packer M, Carson P, Elkayam U, Konstam MA, Moe G, O'Connor C | display-authors=etal| title=Effect of amlodipine on the survival of patients with severe chronic heart failure due to a nonischemic cardiomyopathy: results of the PRAISE-2 study (prospective randomized amlodipine survival evaluation 2). | journal=JACC Heart Fail | year= 2013 | volume= 1 | issue= 4 | pages= 308-314 | pmid=24621933 | doi=10.1016/j.jchf.2013.04.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24621933  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>

|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' In [[patients]] with [[HFrEF]], [[vitamins]], [[nutritional supplements]], and [[hormonal therapy]] are not recommended other than to correct specific deficiencies. <ref name="pmid31709816">{{cite journal| author=Djoussé L, Cook NR, Kim E, Bodar V, Walter J, Bubes V | display-authors=etal| title=Supplementation With Vitamin D and Omega-3 Fatty Acids and Incidence of Heart Failure Hospitalization: VITAL-Heart Failure. | journal=Circulation | year= 2020 | volume= 141 | issue= 9 | pages= 784-786 | pmid=31709816 | doi=10.1161/CIRCULATIONAHA.119.044645 | pmc=7054158 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31709816  }} </ref><ref name="pmid31032644">{{cite journal| author=Wang T, Liu Z, Fu J, Min Z| title=Meta-analysis of vitamin D supplementation in the treatment of chronic heart failure. | journal=Scand Cardiovasc J | year= 2019 | volume= 53 | issue= 3 | pages= 110-116 | pmid=31032644 | doi=10.1080/14017431.2019.1612084 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31032644  }} </ref><ref name="pmid30654912">{{cite journal| author=Zittermann A, Ernst JB, Prokop S, Fuchs U, Gruszka A, Dreier J | display-authors=etal| title=Vitamin D supplementation of 4000 IU daily and cardiac function in patients with advanced heart failure: The EVITA trial. | journal=Int J Cardiol | year= 2019 | volume= 280 | issue=  | pages= 117-123 | pmid=30654912 | doi=10.1016/j.ijcard.2019.01.027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30654912  }} </ref><ref name="pmid15769967">{{cite journal| author=Lonn E, Bosch J, Yusuf S, Sheridan P, Pogue J, Arnold JM | display-authors=etal| title=Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. | journal=JAMA | year= 2005 | volume= 293 | issue= 11 | pages= 1338-47 | pmid=15769967 | doi=10.1001/jama.293.11.1338 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15769967  }} </ref><ref name="pmid16645413">{{cite journal| author=Marchioli R, Levantesi G, Macchia A, Marfisi RM, Nicolosi GL, Tavazzi L | display-authors=etal| title=Vitamin E increases the risk of developing heart failure after myocardial infarction: Results from the GISSI-Prevenzione trial. | journal=J Cardiovasc Med (Hagerstown) | year= 2006 | volume= 7 | issue= 5 | pages= 347-50 | pmid=16645413 | doi=10.2459/01.JCM.0000223257.09062.17 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16645413  }} </ref><ref name="pmid25282031">{{cite journal| author=Mortensen SA, Rosenfeldt F, Kumar A, Dolliner P, Filipiak KJ, Pella D | display-authors=etal| title=The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure: results from Q-SYMBIO: a randomized double-blind trial. | journal=JACC Heart Fail | year= 2014 | volume= 2 | issue= 6 | pages= 641-9 | pmid=25282031 | doi=10.1016/j.jchf.2014.06.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25282031  }} </ref><ref name="pmid24049047">{{cite journal| author=Madmani ME, Yusuf Solaiman A, Tamr Agha K, Madmani Y, Shahrour Y, Essali A | display-authors=etal| title=Coenzyme Q10 for heart failure. | journal=Cochrane Database Syst Rev | year= 2014 | volume=  | issue= 6 | pages= CD008684 | pmid=24049047 | doi=10.1002/14651858.CD008684.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24049047  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>
|}

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)

|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''3.''' In [[patients]] with [[HFrEF]], [[non-dihydropiridine calcium channel-blocking drugs]] are not recommended. <ref name="pmid2220572">{{cite journal| author=| title=Effect of verapamil on mortality and major events after acute myocardial infarction (the Danish Verapamil Infarction Trial II--DAVIT II) | journal=Am J Cardiol | year= 1990 | volume= 66 | issue= 10 | pages= 779-85 | pmid=2220572 | doi=10.1016/0002-9149(90)90351-z | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2220572  }} </ref><ref name="pmid2899840">{{cite journal| author=Multicenter Diltiazem Postinfarction Trial Research Group| title=The effect of diltiazem on mortality and reinfarction after myocardial infarction. | journal=N Engl J Med | year= 1988 | volume= 319 | issue= 7 | pages= 385-92 | pmid=2899840 | doi=10.1056/NEJM198808183190701 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2899840  }} </ref><ref name="pmid1984898">{{cite journal| author=Goldstein RE, Boccuzzi SJ, Cruess D, Nattel S| title=Diltiazem increases late-onset congestive heart failure in postinfarction patients with early reduction in ejection fraction. The Adverse Experience Committee; and the Multicenter Diltiazem Postinfarction Research Group. | journal=Circulation | year= 1991 | volume= 83 | issue= 1 | pages= 52-60 | pmid=1984898 | doi=10.1161/01.cir.83.1.52 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1984898  }} </ref><ref name="pmid8759075">{{cite journal| author=Figulla HR, Gietzen F, Zeymer U, Raiber M, Hegselmann J, Soballa R | display-authors=etal| title=Diltiazem improves cardiac function and exercise capacity in patients with idiopathic dilated cardiomyopathy. Results of the Diltiazem in Dilated Cardiomyopathy Trial. | journal=Circulation | year= 1996 | volume= 94 | issue= 3 | pages= 346-52 | pmid=8759075 | doi=10.1161/01.cir.94.3.346 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8759075  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>

|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''4.'''In [[patients]] with [[HFrEF]], class IC [[antiarrhythmic]] [[medications]] and [[dronedarone]] may increase the risk of [[mortality]]. <ref name="pmid1900101">{{cite journal| author=Echt DS, Liebson PR, Mitchell LB, Peters RW, Obias-Manno D, Barker AH | display-authors=etal| title=Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial. | journal=N Engl J Med | year= 1991 | volume= 324 | issue= 12 | pages= 781-8 | pmid=1900101 | doi=10.1056/NEJM199103213241201 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1900101  }} </ref><ref name="pmid8691967">{{cite journal| author=Waldo AL, Camm AJ, deRuyter H, Friedman PL, MacNeil DJ, Pauls JF | display-authors=etal| title=Effect of d-sotalol on mortality in patients with left ventricular dysfunction after recent and remote myocardial infarction. The SWORD Investigators. Survival With Oral d-Sotalol. | journal=Lancet | year= 1996 | volume= 348 | issue= 9019 | pages= 7-12 | pmid=8691967 | doi=10.1016/s0140-6736(96)02149-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8691967  }} </ref><ref name="pmid18565860">{{cite journal| author=Køber L, Torp-Pedersen C, McMurray JJ, Gøtzsche O, Lévy S, Crijns H | display-authors=etal| title=Increased mortality after dronedarone therapy for severe heart failure. | journal=N Engl J Med | year= 2008 | volume= 358 | issue= 25 | pages= 2678-87 | pmid=18565860 | doi=10.1056/NEJMoa0800456 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18565860  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>

|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''5.'''In [[patients]] with [[HFrEF]], [[thiazolidinediones]] increase the risk of worsening [[HF]] [[symptoms]] and [[hospitalizations]]. <ref name="pmid18073359">{{cite journal| author=Lipscombe LL, Gomes T, Lévesque LE, Hux JE, Juurlink DN, Alter DA| title=Thiazolidinediones and cardiovascular outcomes in older patients with diabetes. | journal=JAMA | year= 2007 | volume= 298 | issue= 22 | pages= 2634-43 | pmid=18073359 | doi=10.1001/jama.298.22.2634 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18073359  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=18588264 Review in: ACP J Club. 2008 Jun 17;148(4):13] </ref><ref name="pmid17905165">{{cite journal| author=Lago RM, Singh PP, Nesto RW| title=Congestive heart failure and cardiovascular death in patients with prediabetes and type 2 diabetes given thiazolidinediones: a meta-analysis of randomised clinical trials. | journal=Lancet | year= 2007 | volume= 370 | issue= 9593 | pages= 1129-36 | pmid=17905165 | doi=10.1016/S0140-6736(07)61514-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17905165  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=18311869 Review in: ACP J Club. 2008 Mar-Apr;148(2):39] </ref><ref name="pmid17448371">{{cite journal| author=Dargie HJ, Hildebrandt PR, Riegger GA, McMurray JJ, McMorn SO, Roberts JN | display-authors=etal| title=A randomized, placebo-controlled trial assessing the effects of rosiglitazone on echocardiographic function and cardiac status in type 2 diabetic patients with New York Heart Association Functional Class I or II Heart Failure. | journal=J Am Coll Cardiol | year= 2007 | volume= 49 | issue= 16 | pages= 1696-704 | pmid=17448371 | doi=10.1016/j.jacc.2006.10.077 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17448371  }} </ref><ref name="pmid19501900">{{cite journal| author=Home PD, Pocock SJ, Beck-Nielsen H, Curtis PS, Gomis R, Hanefeld M | display-authors=etal| title=Rosiglitazone evaluated for cardiovascular outcomes in oral agent combination therapy for type 2 diabetes (RECORD): a multicentre, randomised, open-label trial. | journal=Lancet | year= 2009 | volume= 373 | issue= 9681 | pages= 2125-35 | pmid=19501900 | doi=10.1016/S0140-6736(09)60953-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19501900  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=19841445 Review in: Ann Intern Med. 2009 Oct 20;151(8):JC4-8]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=19949171 Review in: Evid Based Med. 2009 Dec;14(6):168] </ref><ref name="pmid18672190">{{cite journal| author=Giles TD, Miller AB, Elkayam U, Bhattacharya M, Perez A| title=Pioglitazone and heart failure: results from a controlled study in patients with type 2 diabetes mellitus and systolic dysfunction. | journal=J Card Fail | year= 2008 | volume= 14 | issue= 6 | pages= 445-52 | pmid=18672190 | doi=10.1016/j.cardfail.2008.02.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18672190  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>

|-[[
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''6.'''In [[patients]] with [[type 2 diabetes]] and high [[cardiovascular]] risk, the [[dipeptidyl peptidase-4]] ([[DPP-4]]) inhibitors [[saxagliptin]] and [[alogliptin]] increase the risk of [[HF]] [[hospitalization]] and should be avoided in [[patients]] with [[HF]]. <ref name="pmid25189213">{{cite journal| author=Scirica BM, Braunwald E, Raz I, Cavender MA, Morrow DA, Jarolim P | display-authors=etal| title=Heart failure, saxagliptin, and diabetes mellitus: observations from the SAVOR-TIMI 53 randomized trial. | journal=Circulation | year= 2014 | volume= 130 | issue= 18 | pages= 1579-88 | pmid=25189213 | doi=10.1161/CIRCULATIONAHA.114.010389 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25189213  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=25894044 Review in: Ann Intern Med. 2015 Apr 21;162(8):JC11] </ref><ref name="pmid25765696">{{cite journal| author=Zannad F, Cannon CP, Cushman WC, Bakris GL, Menon V, Perez AT | display-authors=etal| title=Heart failure and mortality outcomes in patients with type 2 diabetes taking alogliptin versus placebo in EXAMINE: a multicentre, randomised, double-blind trial. | journal=Lancet | year= 2015 | volume= 385 | issue= 9982 | pages= 2067-76 | pmid=25765696 | doi=10.1016/S0140-6736(14)62225-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25765696  }} </ref><ref name="pmid28459046">{{cite journal| author=Verma S, Goldenberg RM, Bhatt DL, Farkouh ME, Quan A, Teoh H | display-authors=etal| title=Dipeptidyl peptidase-4 inhibitors and the risk of heart failure: a systematic review and meta-analysis. | journal=CMAJ Open | year= 2017 | volume= 5 | issue= 1 | pages= E152-E177 | pmid=28459046 | doi=10.9778/cmajo.20160058 | pmc=5403656 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28459046  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>

|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''7.'''In [[patients]] with [[HFrEF]], [[NSAIDs]] worsen [[HF]] [[symptoms]] and should be avoided or withdrawn whenever possible. <ref name="pmid15172772">{{cite journal| author=Mamdani M, Juurlink DN, Lee DS, Rochon PA, Kopp A, Naglie G | display-authors=etal| title=Cyclo-oxygenase-2 inhibitors versus non-selective non-steroidal anti-inflammatory drugs and congestive heart failure outcomes in elderly patients: a population-based cohort study. | journal=Lancet | year= 2004 | volume= 363 | issue= 9423 | pages= 1751-6 | pmid=15172772 | doi=10.1016/S0140-6736(04)16299-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15172772  }} </ref><ref name="pmid15947399">{{cite journal| author=Hudson M, Richard H, Pilote L| title=Differences in outcomes of patients with congestive heart failure prescribed celecoxib, rofecoxib, or non-steroidal anti-inflammatory drugs: population based study. | journal=BMJ | year= 2005 | volume= 330 | issue= 7504 | pages= 1370 | pmid=15947399 | doi=10.1136/bmj.330.7504.1370 | pmc=558290 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15947399  }} </ref><ref name="pmid19171810">{{cite journal| author=Gislason GH, Rasmussen JN, Abildstrom SZ, Schramm TK, Hansen ML, Fosbøl EL | display-authors=etal| title=Increased mortality and cardiovascular morbidity associated with use of nonsteroidal anti-inflammatory drugs in chronic heart failure. | journal=Arch Intern Med | year= 2009 | volume= 169 | issue= 2 | pages= 141-9 | pmid=19171810 | doi=10.1001/archinternmed.2008.525 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19171810  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=19528557 Review in: Ann Intern Med. 2009 Jun 16;150(12):JC6-12] </ref><ref name="pmid11822918">{{cite journal| author=Feenstra J, Heerdink ER, Grobbee DE, Stricker BH| title=Association of nonsteroidal anti-inflammatory drugs with first occurrence of heart failure and with relapsing heart failure: the Rotterdam Study. | journal=Arch Intern Med | year= 2002 | volume= 162 | issue= 3 | pages= 265-70 | pmid=11822918 | doi=10.1001/archinte.162.3.265 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11822918  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>
|}

====GDMT Dosing: Sequencing and Uptitration====
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]

|-
|bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In [[patients]] with [[HFrEF]], titration of guideline-directed [[medication]] [[dosing]] to achieve target [[doses]] showed to be efficacious in [[RCTs]] is recommended, to reduce [[cardiovascular]] [[mortality]] and [[HF]] [[hospitalizations]], unless not well tolerated. <ref name="pmid10023943">{{cite journal| author=| title=The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. | journal=Lancet | year= 1999 | volume= 353 | issue= 9146 | pages= 9-13 | pmid=10023943 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10023943  }} </ref><ref name="pmid12390947">{{cite journal| author=Packer M, Fowler MB, Roecker EB, Coats AJ, Katus HA, Krum H | display-authors=etal| title=Effect of carvedilol on the morbidity of patients with severe chronic heart failure: results of the carvedilol prospective randomized cumulative survival (COPERNICUS) study. | journal=Circulation | year= 2002 | volume= 106 | issue= 17 | pages= 2194-9 | pmid=12390947 | doi=10.1161/01.cir.0000035653.72855.bf | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12390947  }} </ref><ref name="pmid2057034">{{cite journal| author=SOLVD Investigators. Yusuf S, Pitt B, Davis CE, Hood WB, Cohn JN| title=Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. | journal=N Engl J Med | year= 1991 | volume= 325 | issue= 5 | pages= 293-302 | pmid=2057034 | doi=10.1056/NEJM199108013250501 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2057034  }} </ref><ref name="pmid7654275">{{cite journal| author=Garg R, Yusuf S| title=Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials. | journal=JAMA | year= 1995 | volume= 273 | issue= 18 | pages= 1450-6 | pmid=7654275 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7654275  }} </ref><ref name="pmid25176015">{{cite journal| author=McMurray JJ, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR | display-authors=etal| title=Angiotensin-neprilysin inhibition versus enalapril in heart failure. | journal=N Engl J Med | year= 2014 | volume= 371 | issue= 11 | pages= 993-1004 | pmid=25176015 | doi=10.1056/NEJMoa1409077 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25176015  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=25659916 Review in: Evid Based Med. 2015 Apr;20(2):61]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=25686189 Review in: Ann Intern Med. 2015 Feb 17;162(4):JC2] </ref><ref name="pmid10471456">{{cite journal| author=Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A | display-authors=etal| title=The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. | journal=N Engl J Med | year= 1999 | volume= 341 | issue= 10 | pages= 709-17 | pmid=10471456 | doi=10.1056/NEJM199909023411001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10471456  }} </ref><ref name="pmid21073363">{{cite journal| author=Zannad F, McMurray JJ, Krum H, van Veldhuisen DJ, Swedberg K, Shi H | display-authors=etal| title=Eplerenone in patients with systolic heart failure and mild symptoms. | journal=N Engl J Med | year= 2011 | volume= 364 | issue= 1 | pages= 11-21 | pmid=21073363 | doi=10.1056/NEJMoa1009492 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21073363  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=21558564 Review in: Evid Based Med. 2011 Aug;16(4):121-2]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=21814643 Review in: J Fam Pract. 2011 Aug;60(8):482-4] </ref><ref name="pmid31535829">{{cite journal| author=McMurray JJV, Solomon SD, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA | display-authors=etal| title=Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. | journal=N Engl J Med | year= 2019 | volume= 381 | issue= 21 | pages= 1995-2008 | pmid=31535829 | doi=10.1056/NEJMoa1911303 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31535829  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=32066149 Review in: Ann Intern Med. 2020 Feb 18;172(4):JC16] </ref><ref name="pmid32865377">{{cite journal| author=Packer M, Anker SD, Butler J, Filippatos G, Pocock SJ, Carson P | display-authors=etal| title=Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. | journal=N Engl J Med | year= 2020 | volume= 383 | issue= 15 | pages= 1413-1424 | pmid=32865377 | doi=10.1056/NEJMoa2022190 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32865377  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=33197352 Review in: Ann Intern Med. 2020 Nov 17;173(10):JC51] </ref><ref name="pmid15533851">{{cite journal| author=Taylor AL, Ziesche S, Yancy C, Carson P, D'Agostino R, Ferdinand K | display-authors=etal| title=Combination of isosorbide dinitrate and hydralazine in blacks with heart failure. | journal=N Engl J Med | year= 2004 | volume= 351 | issue= 20 | pages= 2049-57 | pmid=15533851 | doi=10.1056/NEJMoa042934 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15533851  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=15739984 Review in: ACP J Club. 2005 Mar-Apr;142(2):37] </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>

|}

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]

|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' In [[patients]] with [[HFrEF]], titration and optimization of guideline-directed [[medication]]s as frequently as every 1 to 2 weeks depending on the [[patien]]t's [[symptoms]], [[vital signs]], and [[laboratory findings]] can be useful to optimize [[management]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-EO]])'' <nowiki>"</nowiki>

|}

====Additional [[Medical Therapies]]====
=====[[Management]] of Stage C [[HF]]: [[Ivabadrine]]=====
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]

|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' For [[patients]] with [[symptomatic]] ([[NYHA]] class II to III) stable chronic [[HFrEF]] ([[LVEF]] ≤ 35%) who are receiving GDMT, including a [[beta blocker]] at maximum tolerated [[dose]], and who are in [[sinus rhythm]] with a [[heart rate]] of ≥70 bpm at rest, [[ivabradine]] can be beneficial to reduce [[HF]] [[hospitalizations]] and [[cardiovascular death]]. <ref name="pmid20801500">{{cite journal| author=Swedberg K, Komajda M, Böhm M, Borer JS, Ford I, Dubost-Brama A | display-authors=etal| title=Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. | journal=Lancet | year= 2010 | volume= 376 | issue= 9744 | pages= 875-85 | pmid=20801500 | doi=10.1016/S0140-6736(10)61198-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20801500  }} </ref><ref name="pmid22927555">{{cite journal| author=Borer JS, Böhm M, Ford I, Komajda M, Tavazzi L, Sendon JL | display-authors=etal| title=Effect of ivabradine on recurrent hospitalization for worsening heart failure in patients with chronic systolic heart failure: the SHIFT Study. | journal=Eur Heart J | year= 2012 | volume= 33 | issue= 22 | pages= 2813-20 | pmid=22927555 | doi=10.1093/eurheartj/ehs259 | pmc=3498004 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22927555  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>

|}

=====[[Pharmacological]] [[Treatment]] for Stage C [[HFrEF]]: [[Digoxin]]=====
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]

|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' In [[patients]] with [[symptomatic]] [[HFrEF]] despite GDMT (or who are unable to tolerate GDMT), [[digoxin]] might be considered to decrease [[hospitalizations]] for [[HF]]. <ref name="pmid9036306">{{cite journal| author=Digitalis Investigation Group| title=The effect of digoxin on mortality and morbidity in patients with heart failure. | journal=N Engl J Med | year= 1997 | volume= 336 | issue= 8 | pages= 525-33 | pmid=9036306 | doi=10.1056/NEJM199702203360801 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9036306  }} </ref><ref name="pmid16339157">{{cite journal| author=Ahmed A, Rich MW, Love TE, Lloyd-Jones DM, Aban IB, Colucci WS | display-authors=etal| title=Digoxin and reduction in mortality and hospitalization in heart failure: a comprehensive post hoc analysis of the DIG trial. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 2 | pages= 178-86 | pmid=16339157 | doi=10.1093/eurheartj/ehi687 | pmc=2685167 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16339157  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>

|}

===Device and Interventional [[Therapies]] for [[HFrEF]]===

====[[ICDs]] and CRTs====

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]

|-
|bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In [[patients]] with nonischemic DCM or [[ischemic heart disease]] at least 40 days post-[[MI]] with [[LVEF]] ≤ 35% and [[NYHA]] class II or III [[symptoms]] or chronic GDMT, who have reasonable expectation of meaningful [[survival]] for >1 year, [[ICD therapy]] is recommended for [[primary prevention]] of [[SCD]] to reduce total [[mortality]]. <ref name="pmid9411221">{{cite journal| author=Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators| title=A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. | journal=N Engl J Med | year= 1997 | volume= 337 | issue= 22 | pages= 1576-83 | pmid=9411221 | doi=10.1056/NEJM199711273372202 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9411221  }} </ref><ref name="pmid10942742">{{cite journal| author=Kuck KH, Cappato R, Siebels J, Rüppel R| title=Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest : the Cardiac Arrest Study Hamburg (CASH). | journal=Circulation | year= 2000 | volume= 102 | issue= 7 | pages= 748-54 | pmid=10942742 | doi=10.1161/01.cir.102.7.748 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10942742  }} </ref><ref name="pmid10725290">{{cite journal| author=Connolly SJ, Gent M, Roberts RS, Dorian P, Roy D, Sheldon RS | display-authors=etal| title=Canadian implantable defibrillator study (CIDS) : a randomized trial of the implantable cardioverter defibrillator against amiodarone. | journal=Circulation | year= 2000 | volume= 101 | issue= 11 | pages= 1297-302 | pmid=10725290 | doi=10.1161/01.cir.101.11.1297 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10725290  }} </ref><ref name="pmid8960472">{{cite journal| author=Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H | display-authors=etal| title=Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. | journal=N Engl J Med | year= 1996 | volume= 335 | issue= 26 | pages= 1933-40 | pmid=8960472 | doi=10.1056/NEJM199612263352601 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8960472  }} </ref><ref name="pmid10601507">{{cite journal| author=Buxton AE, Lee KL, Fisher JD, Josephson ME, Prystowsky EN, Hafley G| title=A randomized study of the prevention of sudden death in patients with coronary artery disease. Multicenter Unsustained Tachycardia Trial Investigators. | journal=N Engl J Med | year= 1999 | volume= 341 | issue= 25 | pages= 1882-90 | pmid=10601507 | doi=10.1056/NEJM199912163412503 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10601507  }} </ref><ref name="pmid: 11907286">{{cite journal| author=Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS | display-authors=etal| title=Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. | journal=N Engl J Med | year= 2002 | volume= 346 | issue= 12 | pages= 877-83 | pmid=: 11907286 | doi=10.1056/NEJMoa013474 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11907286  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=12418821 Review in: ACP J Club. 2002 Nov-Dec;137(3):81] </ref><ref name="pmid15152060">{{cite journal| author=Kadish A, Dyer A, Daubert JP, Quigg R, Estes NA, Anderson KP | display-authors=etal| title=Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 21 | pages= 2151-8 | pmid=15152060 | doi=10.1056/NEJMoa033088 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15152060  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=15518445 Review in: ACP J Club. 2004 Nov-Dec;141(3):61] </ref><ref name="pmid15659722">{{cite journal| author=Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R | display-authors=etal| title=Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 3 | pages= 225-37 | pmid=15659722 | doi=10.1056/NEJMoa043399 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15659722  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=15989294 Review in: ACP J Club. 2005 Jul-Aug;143(1):6] </ref><ref name="pmid27571011">{{cite journal| author=Køber L, Thune JJ, Nielsen JC, Haarbo J, Videbæk L, Korup E | display-authors=etal| title=Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure. | journal=N Engl J Med | year= 2016 | volume= 375 | issue= 13 | pages= 1221-30 | pmid=27571011 | doi=10.1056/NEJMoa1608029 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27571011  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=27842392 Review in: Ann Intern Med. 2016 Nov 15;165(10 ):JC55] </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>

|}

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:White"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Value Statement:High Value]]

|-
|bgcolor="White"|<nowiki>"</nowiki>'''2.''' A transvenous [[ICD]] provides high economic value in the [[primary prevention]] of [[SCD]] particularly when the [[patient]]'s risk of [[death]] caused by [[ventricular]] [[arrhythmia]] is deemed high and the risk of non-[[arrhythmic]] [[death]] (either [[cardiac]] or [[noncardiac]]) is deemed low based on the [[patient]]'s burden of [[comorbidities]] and functional status. <ref name="pmid15838065">{{cite journal| author=Al-Khatib SM, Anstrom KJ, Eisenstein EL, Peterson ED, Jollis JG, Mark DB | display-authors=etal| title=Clinical and economic implications of the Multicenter Automatic Defibrillator Implantation Trial-II. | journal=Ann Intern Med | year= 2005 | volume= 142 | issue= 8 | pages= 593-600 | pmid=15838065 | doi=10.7326/0003-4819-142-8-200504190-00007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15838065  }} </ref><ref name="pmid19359333">{{cite journal| author=Cowie MR, Marshall D, Drummond M, Ferko N, Maschio M, Ekman M | display-authors=etal| title=Lifetime cost-effectiveness of prophylactic implantation of a cardioverter defibrillator in patients with reduced left ventricular systolic function: results of Markov modelling in a European population. | journal=Europace | year= 2009 | volume= 11 | issue= 6 | pages= 716-26 | pmid=19359333 | doi=10.1093/europace/eup068 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19359333  }} </ref><ref name="pmid16818817">{{cite journal| author=Mark DB, Nelson CL, Anstrom KJ, Al-Khatib SM, Tsiatis AA, Cowper PA | display-authors=etal| title=Cost-effectiveness of defibrillator therapy or amiodarone in chronic stable heart failure: results from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). | journal=Circulation | year= 2006 | volume= 114 | issue= 2 | pages= 135-42 | pmid=16818817 | doi=10.1161/CIRCULATIONAHA.105.581884 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16818817  }} </ref><ref name="pmid9626173">{{cite journal| author=Mushlin AI, Hall WJ, Zwanziger J, Gajary E, Andrews M, Marron R | display-authors=etal| title=The cost-effectiveness of automatic implantable cardiac defibrillators: results from MADIT. Multicenter Automatic Defibrillator Implantation Trial. | journal=Circulation | year= 1998 | volume= 97 | issue= 21 | pages= 2129-35 | pmid=9626173 | doi=10.1161/01.cir.97.21.2129 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9626173  }} </ref><ref name="pmid16207849">{{cite journal| author=Sanders GD, Hlatky MA, Owens DK| title=Cost-effectiveness of implantable cardioverter-defibrillators. | journal=N Engl J Med | year= 2005 | volume= 353 | issue= 14 | pages= 1471-80 | pmid=16207849 | doi=10.1056/NEJMsa051989 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16207849  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=16539367 Review in: ACP J Club. 2006 Mar-Apr;144(2):52] </ref><ref name="pmid16750701">{{cite journal| author=Zwanziger J, Hall WJ, Dick AW, Zhao H, Mushlin AI, Hahn RM | display-authors=etal| title=The cost effectiveness of implantable cardioverter-defibrillators: results from the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II. | journal=J Am Coll Cardiol | year= 2006 | volume= 47 | issue= 11 | pages= 2310-8 | pmid=16750701 | doi=10.1016/j.jacc.2006.03.032 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16750701  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>

|}

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGReen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]

|-
|bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' In [[patients]] at least 40 days post-[[MI]] with [[LVEF]] ≤ 30% and [[NYHA]] class I [[symptoms]] while receiving GDMT, who have reasonable expectation of meaningful [[survival]] for > 1 year, [[ICD therapy]] is recommended for [[primary preve≤ntion]] of [[SCD]] to reduce total [[mortality]]. <ref name="pmid11907286">{{cite journal| author=Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS | display-authors=etal| title=Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. | journal=N Engl J Med | year= 2002 | volume= 346 | issue= 12 | pages= 877-83 | pmid=11907286 | doi=10.1056/NEJMoa013474 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11907286  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=12418821 Review in: ACP J Club. 2002 Nov-Dec;137(3):81] </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>

|-
|bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' For [[patients]] who have [[LVEF]] ≤ 35%, [[sinus rhythm]], [[LBBB]] with a [[QRS duration]] ≥150ms, and [[NYHA]] class II, III, or ambulatory IV [[symptoms]] on GDMT, CRT is indicated to reduce total [[mortality]], reduce [[hospitalizations]], and improve [[symptoms]] and [[QOL]].<ref name="pmid12063368">{{cite journal| author=Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E | display-authors=etal| title=Cardiac resynchronization in chronic heart failure. | journal=N Engl J Med | year= 2002 | volume= 346 | issue= 24 | pages= 1845-53 | pmid=12063368 | doi=10.1056/NEJMoa013168 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12063368  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=12418822 Review in: ACP J Club. 2002 Nov-Dec;137(3):82] </ref><ref name="pmid15152059">{{cite journal| author=Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T | display-authors=etal| title=Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 21 | pages= 2140-50 | pmid=15152059 | doi=10.1056/NEJMoa032423 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15152059  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=15518444 Review in: ACP J Club. 2004 Nov-Dec;141(3):60] </ref><ref name="pmid15753115">{{cite journal| author=Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L | display-authors=etal| title=The effect of cardiac resynchronization on morbidity and mortality in heart failure. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 15 | pages= 1539-49 | pmid=15753115 | doi=10.1056/NEJMoa050496 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15753115  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=16134903 Review in: ACP J Club. 2005 Sep-Oct;143(2):29] </ref><ref name="pmid19038680">{{cite journal| author=Linde C, Abraham WT, Gold MR, St John Sutton M, Ghio S, Daubert C | display-authors=etal| title=Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 23 | pages= 1834-1843 | pmid=19038680 | doi=10.1016/j.jacc.2008.08.027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038680  }} </ref><ref name="pmid24678999">{{cite journal| author=Goldenberg I, Kutyifa V, Klein HU, Cannom DS, Brown MW, Dan A | display-authors=etal| title=Survival with cardiac-resynchronization therapy in mild heart failure. | journal=N Engl J Med | year= 2014 | volume= 370 | issue= 18 | pages= 1694-701 | pmid=24678999 | doi=10.1056/NEJMoa1401426 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24678999  }} </ref><ref name="pmid21073365">{{cite journal| author=Tang AS, Wells GA, Talajic M, Arnold MO, Sheldon R, Connolly S | display-authors=etal| title=Cardiac-resynchronization therapy for mild-to-moderate heart failure. | journal=N Engl J Med | year= 2010 | volume= 363 | issue= 25 | pages= 2385-95 | pmid=21073365 | doi=10.1056/NEJMoa1009540 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21073365  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=21436182 Review in: Evid Based Med. 2011 Oct;16(5):138-9] </ref>   ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>
|}

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:White"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Value Statement:High Value]]

|-
|bgcolor="White"|<nowiki>"</nowiki>'''5.''' For [[patients]] who have [[LVEF]] ≤ 35%, [[sinus rhythm]], [[LBBB]] with a [[QRS duration]] of ≥ 150ms, and [[NYHA]] class II, III, or ambulatory class IV [[symptoms]] on GDMT, CRT implementation provides high economic value. <ref name="pmid16360064">{{cite journal| author=Feldman AM, de Lissovoy G, Bristow MR, Saxon LA, De Marco T, Kass DA | display-authors=etal| title=Cost effectiveness of cardiac resynchronization therapy in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) trial. | journal=J Am Coll Cardiol | year= 2005 | volume= 46 | issue= 12 | pages= 2311-21 | pmid=16360064 | doi=10.1016/j.jacc.2005.08.033 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16360064  }} </ref><ref name="pmid28254126">{{cite journal| author=Gold MR, Padhiar A, Mealing S, Sidhu MK, Tsintzos SI, Abraham WT| title=Economic Value and Cost-Effectiveness of Cardiac Resynchronization Therapy Among Patients With Mild Heart Failure: Projections From the REVERSE Long-Term Follow-Up. | journal=JACC Heart Fail | year= 2017 | volume= 5 | issue= 3 | pages= 204-212 | pmid=28254126 | doi=10.1016/j.jchf.2016.10.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28254126  }} </ref><ref name="pmid16555866">{{cite journal| author=Heerey A, Lauer M, Alsolaiman F, Czerr J, James K| title=Cost effectiveness of biventricular pacemakers in heart failure patients. | journal=Am J Cardiovasc Drugs | year= 2006 | volume= 6 | issue= 2 | pages= 129-37 | pmid=16555866 | doi=10.2165/00129784-200606020-00007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16555866  }} </ref><ref name="pmid15353425">{{cite journal| author=Nichol G, Kaul P, Huszti E, Bridges JF| title=Cost-effectiveness of cardiac resynchronization therapy in patients with symptomatic heart failure. | journal=Ann Intern Med | year= 2004 | volume= 141 | issue= 5 | pages= 343-51 | pmid=15353425 | doi=10.7326/0003-4819-141-5-200409070-00102 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15353425  }} </ref><ref name="pmid22913474">{{cite journal| author=Noyes K, Veazie P, Hall WJ, Zhao H, Buttaccio A, Thevenet-Morrison K | display-authors=etal| title=Cost-effectiveness of cardiac resynchronization therapy in the MADIT-CRT trial. | journal=J Cardiovasc Electrophysiol | year= 2013 | volume= 24 | issue= 1 | pages= 66-74 | pmid=22913474 | doi=10.1111/j.1540-8167.2012.02413.x | pmc=3711178 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22913474  }} </ref><ref name="pmid26301323">{{cite journal| author=Woo CY, Strandberg EJ, Schmiegelow MD, Pitt AL, Hlatky MA, Owens DK | display-authors=etal| title=Cost-Effectiveness of Adding Cardiac Resynchronization Therapy to an Implantable Cardioverter-Defibrillator Among Patients With Mild Heart Failure. | journal=Ann Intern Med | year= 2015 | volume= 163 | issue= 6 | pages= 417-26 | pmid=26301323 | doi=10.7326/M14-1804 | pmc=8105088 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26301323  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=26887422 Review in: Evid Based Med. 2016 Jun;21(3):88] </ref>    ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>

|}

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]

|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''6.'''For [[patients]] who have [[LVEF]] ≤ 35%, [[sinus rhythm]], a non-[[LBBB]] pattern with a [[QRS duration]] ≥ 150ms, and [[NYHA]] class II, III, or ambulatory class IV [[symptoms]] on GDMT, CRT can be useful to reduce total [[mortality]], reduce [[hospitalizations]], and improve [[symptoms]] and [[QOL]]. <ref name="pmid12063368">{{cite journal| author=Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E | display-authors=etal| title=Cardiac resynchronization in chronic heart failure. | journal=N Engl J Med | year= 2002 | volume= 346 | issue= 24 | pages= 1845-53 | pmid=12063368 | doi=10.1056/NEJMoa013168 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12063368  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=12418822 Review in: ACP J Club. 2002 Nov-Dec;137(3):82] </ref><ref name="pmid15152059">{{cite journal| author=Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T | display-authors=etal| title=Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 21 | pages= 2140-50 | pmid=15152059 | doi=10.1056/NEJMoa032423 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15152059  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=15518444 Review in: ACP J Club. 2004 Nov-Dec;141(3):60] </ref><ref name="pmid15753115">{{cite journal| author=Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L | display-authors=etal| title=The effect of cardiac resynchronization on morbidity and mortality in heart failure. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 15 | pages= 1539-49 | pmid=15753115 | doi=10.1056/NEJMoa050496 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15753115  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=16134903 Review in: ACP J Club. 2005 Sep-Oct;143(2):29] </ref><ref name="pmid19038680">{{cite journal| author=Linde C, Abraham WT, Gold MR, St John Sutton M, Ghio S, Daubert C | display-authors=etal| title=Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 23 | pages= 1834-1843 | pmid=19038680 | doi=10.1016/j.jacc.2008.08.027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038680  }} </ref><ref name="pmid24678999">{{cite journal| author=Goldenberg I, Kutyifa V, Klein HU, Cannom DS, Brown MW, Dan A | display-authors=etal| title=Survival with cardiac-resynchronization therapy in mild heart failure. | journal=N Engl J Med | year= 2014 | volume= 370 | issue= 18 | pages= 1694-701 | pmid=24678999 | doi=10.1056/NEJMoa1401426 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24678999  }} </ref><ref name="pmid21073365">{{cite journal| author=Tang AS, Wells GA, Talajic M, Arnold MO, Sheldon R, Connolly S | display-authors=etal| title=Cardiac-resynchronization therapy for mild-to-moderate heart failure. | journal=N Engl J Med | year= 2010 | volume= 363 | issue= 25 | pages= 2385-95 | pmid=21073365 | doi=10.1056/NEJMoa1009540 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21073365  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=21436182 Review in: Evid Based Med. 2011 Oct;16(5):138-9] </ref><ref name="pmid22305845">{{cite journal| author=Sipahi I, Chou JC, Hyden M, Rowland DY, Simon DI, Fang JC| title=Effect of QRS morphology on clinical event reduction with cardiac resynchronization therapy: meta-analysis of randomized controlled trials. | journal=Am Heart J | year= 2012 | volume= 163 | issue= 2 | pages= 260-7.e3 | pmid=22305845 | doi=10.1016/j.ahj.2011.11.014 | pmc=4113034 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22305845  }} </ref><ref name="pmid19505883">{{cite journal| author=Gervais R, Leclercq C, Shankar A, Jacobs S, Eiskjaer H, Johannessen A | display-authors=etal| title=Surface electrocardiogram to predict outcome in candidates for cardiac resynchronization therapy: a sub-analysis of the CARE-HF trial. | journal=Eur J Heart Fail | year= 2009 | volume= 11 | issue= 7 | pages= 699-705 | pmid=19505883 | doi=10.1093/eurjhf/hfp074 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19505883  }} </ref><ref name="pmid21357819">{{cite journal| author=Zareba W, Klein H, Cygankiewicz I, Hall WJ, McNitt S, Brown M | display-authors=etal| title=Effectiveness of Cardiac Resynchronization Therapy by QRS Morphology in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT). | journal=Circulation | year= 2011 | volume= 123 | issue= 10 | pages= 1061-72 | pmid=21357819 | doi=10.1161/CIRCULATIONAHA.110.960898 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21357819  }} </ref><ref name="pmid22781424">{{cite journal| author=Gold MR, Thébault C, Linde C, Abraham WT, Gerritse B, Ghio S | display-authors=etal| title=Effect of QRS duration and morphology on cardiac resynchronization therapy outcomes in mild heart failure: results from the Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE) study. | journal=Circulation | year= 2012 | volume= 126 | issue= 7 | pages= 822-9 | pmid=22781424 | doi=10.1161/CIRCULATIONAHA.112.097709 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22781424  }} </ref><ref name="pmid23995437">{{cite journal| author=Birnie DH, Ha A, Higginson L, Sidhu K, Green M, Philippon F | display-authors=etal| title=Impact of QRS morphology and duration on outcomes after cardiac resynchronization therapy: Results from the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT). | journal=Circ Heart Fail | year= 2013 | volume= 6 | issue= 6 | pages= 1190-8 | pmid=23995437 | doi=10.1161/CIRCHEARTFAILURE.113.000380 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23995437  }} </ref><ref name="pmid21300176">{{cite journal| author=Nery PB, Ha AC, Keren A, Birnie DH| title=Cardiac resynchronization therapy in patients with left ventricular systolic dysfunction and right bundle branch block: a systematic review. | journal=Heart Rhythm | year= 2011 | volume= 8 | issue= 7 | pages= 1083-7 | pmid=21300176 | doi=10.1016/j.hrthm.2011.01.041 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21300176  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>

|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''7.''' In [[patients]] with high-degree or [[complete heart block]] and [[LVEF]] of 36% to 50%, CRT is reasonable to reduce total [[mortality]], reduce [[hospitalizations]], and improve [[symptoms]] and [[QOL]]. <ref name="pmid23924013">{{cite journal| author=Curtis AB| title=Biventricular pacing for atrioventricular block and systolic dysfunction. | journal=N Engl J Med | year= 2013 | volume= 369 | issue= 6 | pages= 579 | pmid=23924013 | doi=10.1056/NEJMc1306998 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23924013  }} </ref><ref name="pmid16302897">{{cite journal| author=Doshi RN, Daoud EG, Fellows C, Turk K, Duran A, Hamdan MH | display-authors=etal| title=Left ventricular-based cardiac stimulation post AV nodal ablation evaluation (the PAVE study). | journal=J Cardiovasc Electrophysiol | year= 2005 | volume= 16 | issue= 11 | pages= 1160-5 | pmid=16302897 | doi=10.1111/j.1540-8167.2005.50062.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16302897  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>

|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''8.''' For [[patients]] who have [[LVEF]] ≤ 35%, [[sinus rhythm]], [[LBBB]] with a [[QRS duration]] of 120 to 149 ms, and [[NYHA]] class II, III, or ambulatory IV [[symptoms]] on GDMT, CRT can be useful to reduce total [[mortality]] reduce [[hospitalizations]], and improve [[symptoms]] and [[QOL]]. <ref name="pmid12063368">{{cite journal| author=Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E | display-authors=etal| title=Cardiac resynchronization in chronic heart failure. | journal=N Engl J Med | year= 2002 | volume= 346 | issue= 24 | pages= 1845-53 | pmid=12063368 | doi=10.1056/NEJMoa013168 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12063368  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=12418822 Review in: ACP J Club. 2002 Nov-Dec;137(3):82] </ref><ref name="pmid15152059">{{cite journal| author=Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T | display-authors=etal| title=Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 21 | pages= 2140-50 | pmid=15152059 | doi=10.1056/NEJMoa032423 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15152059  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=15518444 Review in: ACP J Club. 2004 Nov-Dec;141(3):60] </ref><ref name="pmid15753115">{{cite journal| author=Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L | display-authors=etal| title=The effect of cardiac resynchronization on morbidity and mortality in heart failure. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 15 | pages= 1539-49 | pmid=15753115 | doi=10.1056/NEJMoa050496 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15753115  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=16134903 Review in: ACP J Club. 2005 Sep-Oct;143(2):29] </ref><ref name="pmid19038680">{{cite journal| author=Linde C, Abraham WT, Gold MR, St John Sutton M, Ghio S, Daubert C | display-authors=etal| title=Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 23 | pages= 1834-1843 | pmid=19038680 | doi=10.1016/j.jacc.2008.08.027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038680  }} </ref><ref name="pmid24678999">{{cite journal| author=Goldenberg I, Kutyifa V, Klein HU, Cannom DS, Brown MW, Dan A | display-authors=etal| title=Survival with cardiac-resynchronization therapy in mild heart failure. | journal=N Engl J Med | year= 2014 | volume= 370 | issue= 18 | pages= 1694-701 | pmid=24678999 | doi=10.1056/NEJMoa1401426 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24678999  }} </ref><ref name="pmid21073365">{{cite journal| author=Tang AS, Wells GA, Talajic M, Arnold MO, Sheldon R, Connolly S | display-authors=etal| title=Cardiac-resynchronization therapy for mild-to-moderate heart failure. | journal=N Engl J Med | year= 2010 | volume= 363 | issue= 25 | pages= 2385-95 | pmid=21073365 | doi=10.1056/NEJMoa1009540 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21073365  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=21436182 Review in: Evid Based Med. 2011 Oct;16(5):138-9] </ref><ref name="pmid22305845">{{cite journal| author=Sipahi I, Chou JC, Hyden M, Rowland DY, Simon DI, Fang JC| title=Effect of QRS morphology on clinical event reduction with cardiac resynchronization therapy: meta-analysis of randomized controlled trials. | journal=Am Heart J | year= 2012 | volume= 163 | issue= 2 | pages= 260-7.e3 | pmid=22305845 | doi=10.1016/j.ahj.2011.11.014 | pmc=4113034 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22305845  }} </ref><ref name="pmid19505883">{{cite journal| author=Gervais R, Leclercq C, Shankar A, Jacobs S, Eiskjaer H, Johannessen A | display-authors=etal| title=Surface electrocardiogram to predict outcome in candidates for cardiac resynchronization therapy: a sub-analysis of the CARE-HF trial. | journal=Eur J Heart Fail | year= 2009 | volume= 11 | issue= 7 | pages= 699-705 | pmid=19505883 | doi=10.1093/eurjhf/hfp074 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19505883  }} </ref><ref name="pmid21357819">{{cite journal| author=Zareba W, Klein H, Cygankiewicz I, Hall WJ, McNitt S, Brown M | display-authors=etal| title=Effectiveness of Cardiac Resynchronization Therapy by QRS Morphology in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT). | journal=Circulation | year= 2011 | volume= 123 | issue= 10 | pages= 1061-72 | pmid=21357819 | doi=10.1161/CIRCULATIONAHA.110.960898 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21357819  }} </ref><ref name="pmid22781424">{{cite journal| author=Gold MR, Thébault C, Linde C, Abraham WT, Gerritse B, Ghio S | display-authors=etal| title=Effect of QRS duration and morphology on cardiac resynchronization therapy outcomes in mild heart failure: results from the Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE) study. | journal=Circulation | year= 2012 | volume= 126 | issue= 7 | pages= 822-9 | pmid=22781424 | doi=10.1161/CIRCULATIONAHA.112.097709 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22781424  }} </ref><ref name="pmid23995437">{{cite journal| author=Birnie DH, Ha A, Higginson L, Sidhu K, Green M, Philippon F | display-authors=etal| title=Impact of QRS morphology and duration on outcomes after cardiac resynchronization therapy: Results from the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT). | journal=Circ Heart Fail | year= 2013 | volume= 6 | issue= 6 | pages= 1190-8 | pmid=23995437 | doi=10.1161/CIRCHEARTFAILURE.113.000380 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23995437  }} </ref><ref name="pmid21300176">{{cite journal| author=Nery PB, Ha AC, Keren A, Birnie DH| title=Cardiac resynchronization therapy in patients with left ventricular systolic dysfunction and right bundle branch block: a systematic review. | journal=Heart Rhythm | year= 2011 | volume= 8 | issue= 7 | pages= 1083-7 | pmid=21300176 | doi=10.1016/j.hrthm.2011.01.041 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21300176  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>

|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''9.''' In [[patients]] with [[AF]] and [[LVEF]] ≤ 35% on GDMT, CRT can be useful to reduce total [[mortality]], improve [[symptoms]] and [[QOL]], and increase [[LVEF]], if: a) the [[patient]] requires [[ventricular pacing]] or otherwise meets CRT criteria and b) [[atrioventricular nodal ablation]] or [[pharmacological]] [[rate control]] will allow near 100% [[ventricular pacing]] with CRT. <ref name="pmid12063368">{{cite journal| author=Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E | display-authors=etal| title=Cardiac resynchronization in chronic heart failure. | journal=N Engl J Med | year= 2002 | volume= 346 | issue= 24 | pages= 1845-53 | pmid=12063368 | doi=10.1056/NEJMoa013168 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12063368  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=12418822 Review in: ACP J Club. 2002 Nov-Dec;137(3):82] </ref><ref name="pmid15152059">{{cite journal| author=Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T | display-authors=etal| title=Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 21 | pages= 2140-50 | pmid=15152059 | doi=10.1056/NEJMoa032423 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15152059  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=15518444 Review in: ACP J Club. 2004 Nov-Dec;141(3):60] </ref><ref name="pmid15753115">{{cite journal| author=Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L | display-authors=etal| title=The effect of cardiac resynchronization on morbidity and mortality in heart failure. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 15 | pages= 1539-49 | pmid=15753115 | doi=10.1056/NEJMoa050496 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15753115  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=16134903 Review in: ACP J Club. 2005 Sep-Oct;143(2):29] </ref><ref name="pmid19038680">{{cite journal| author=Linde C, Abraham WT, Gold MR, St John Sutton M, Ghio S, Daubert C | display-authors=etal| title=Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 23 | pages= 1834-1843 | pmid=19038680 | doi=10.1016/j.jacc.2008.08.027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038680  }} </ref><ref name="pmid24678999">{{cite journal| author=Goldenberg I, Kutyifa V, Klein HU, Cannom DS, Brown MW, Dan A | display-authors=etal| title=Survival with cardiac-resynchronization therapy in mild heart failure. | journal=N Engl J Med | year= 2014 | volume= 370 | issue= 18 | pages= 1694-701 | pmid=24678999 | doi=10.1056/NEJMoa1401426 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24678999  }} </ref><ref name="pmid21073365">{{cite journal| author=Tang AS, Wells GA, Talajic M, Arnold MO, Sheldon R, Connolly S | display-authors=etal| title=Cardiac-resynchronization therapy for mild-to-moderate heart failure. | journal=N Engl J Med | year= 2010 | volume= 363 | issue= 25 | pages= 2385-95 | pmid=21073365 | doi=10.1056/NEJMoa1009540 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21073365  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=21436182 Review in: Evid Based Med. 2011 Oct;16(5):138-9] </ref><ref name="pmid22305845">{{cite journal| author=Sipahi I, Chou JC, Hyden M, Rowland DY, Simon DI, Fang JC| title=Effect of QRS morphology on clinical event reduction with cardiac resynchronization therapy: meta-analysis of randomized controlled trials. | journal=Am Heart J | year= 2012 | volume= 163 | issue= 2 | pages= 260-7.e3 | pmid=22305845 | doi=10.1016/j.ahj.2011.11.014 | pmc=4113034 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22305845  }} </ref><ref name="pmid19505883">{{cite journal| author=Gervais R, Leclercq C, Shankar A, Jacobs S, Eiskjaer H, Johannessen A | display-authors=etal| title=Surface electrocardiogram to predict outcome in candidates for cardiac resynchronization therapy: a sub-analysis of the CARE-HF trial. | journal=Eur J Heart Fail | year= 2009 | volume= 11 | issue= 7 | pages= 699-705 | pmid=19505883 | doi=10.1093/eurjhf/hfp074 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19505883  }} </ref><ref name="pmid21357819">{{cite journal| author=Zareba W, Klein H, Cygankiewicz I, Hall WJ, McNitt S, Brown M | display-authors=etal| title=Effectiveness of Cardiac Resynchronization Therapy by QRS Morphology in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT). | journal=Circulation | year= 2011 | volume= 123 | issue= 10 | pages= 1061-72 | pmid=21357819 | doi=10.1161/CIRCULATIONAHA.110.960898 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21357819  }} </ref><ref name="pmid22781424">{{cite journal| author=Gold MR, Thébault C, Linde C, Abraham WT, Gerritse B, Ghio S | display-authors=etal| title=Effect of QRS duration and morphology on cardiac resynchronization therapy outcomes in mild heart failure: results from the Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE) study. | journal=Circulation | year= 2012 | volume= 126 | issue= 7 | pages= 822-9 | pmid=22781424 | doi=10.1161/CIRCULATIONAHA.112.097709 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22781424  }} </ref><ref name="pmid23995437">{{cite journal| author=Birnie DH, Ha A, Higginson L, Sidhu K, Green M, Philippon F | display-authors=etal| title=Impact of QRS morphology and duration on outcomes after cardiac resynchronization therapy: Results from the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT). | journal=Circ Heart Fail | year= 2013 | volume= 6 | issue= 6 | pages= 1190-8 | pmid=23995437 | doi=10.1161/CIRCHEARTFAILURE.113.000380 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23995437  }} </ref><ref name="pmid21300176">{{cite journal| author=Nery PB, Ha AC, Keren A, Birnie DH| title=Cardiac resynchronization therapy in patients with left ventricular systolic dysfunction and right bundle branch block: a systematic review. | journal=Heart Rhythm | year= 2011 | volume= 8 | issue= 7 | pages= 1083-7 | pmid=21300176 | doi=10.1016/j.hrthm.2011.01.041 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21300176  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>

|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''10.''' For [[patients]] on GDMT who have [[LVEF]] ≤ 35% and are undergoing placement of a new or replacement device implantation with anticipated requirement for significant (>40%) [[ventricular pacing]], CRT can be useful to reduce total [[mortality]], reduce [[hospitalizations]], and improve [[symptoms]] and [[QOL]]. <ref name="pmid12063368">{{cite journal| author=Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E | display-authors=etal| title=Cardiac resynchronization in chronic heart failure. | journal=N Engl J Med | year= 2002 | volume= 346 | issue= 24 | pages= 1845-53 | pmid=12063368 | doi=10.1056/NEJMoa013168 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12063368  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=12418822 Review in: ACP J Club. 2002 Nov-Dec;137(3):82] </ref><ref name="pmid15152059">{{cite journal| author=Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T | display-authors=etal| title=Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 21 | pages= 2140-50 | pmid=15152059 | doi=10.1056/NEJMoa032423 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15152059  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=15518444 Review in: ACP J Club. 2004 Nov-Dec;141(3):60] </ref><ref name="pmid15753115">{{cite journal| author=Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L | display-authors=etal| title=The effect of cardiac resynchronization on morbidity and mortality in heart failure. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 15 | pages= 1539-49 | pmid=15753115 | doi=10.1056/NEJMoa050496 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15753115  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=16134903 Review in: ACP J Club. 2005 Sep-Oct;143(2):29] </ref><ref name="pmid19038680">{{cite journal| author=Linde C, Abraham WT, Gold MR, St John Sutton M, Ghio S, Daubert C | display-authors=etal| title=Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 23 | pages= 1834-1843 | pmid=19038680 | doi=10.1016/j.jacc.2008.08.027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038680  }} </ref><ref name="pmid24678999">{{cite journal| author=Goldenberg I, Kutyifa V, Klein HU, Cannom DS, Brown MW, Dan A | display-authors=etal| title=Survival with cardiac-resynchronization therapy in mild heart failure. | journal=N Engl J Med | year= 2014 | volume= 370 | issue= 18 | pages= 1694-701 | pmid=24678999 | doi=10.1056/NEJMoa1401426 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24678999  }} </ref><ref name="pmid21073365">{{cite journal| author=Tang AS, Wells GA, Talajic M, Arnold MO, Sheldon R, Connolly S | display-authors=etal| title=Cardiac-resynchronization therapy for mild-to-moderate heart failure. | journal=N Engl J Med | year= 2010 | volume= 363 | issue= 25 | pages= 2385-95 | pmid=21073365 | doi=10.1056/NEJMoa1009540 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21073365  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=21436182 Review in: Evid Based Med. 2011 Oct;16(5):138-9] </ref><ref name="pmid22305845">{{cite journal| author=Sipahi I, Chou JC, Hyden M, Rowland DY, Simon DI, Fang JC| title=Effect of QRS morphology on clinical event reduction with cardiac resynchronization therapy: meta-analysis of randomized controlled trials. | journal=Am Heart J | year= 2012 | volume= 163 | issue= 2 | pages= 260-7.e3 | pmid=22305845 | doi=10.1016/j.ahj.2011.11.014 | pmc=4113034 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22305845  }} </ref><ref name="pmid19505883">{{cite journal| author=Gervais R, Leclercq C, Shankar A, Jacobs S, Eiskjaer H, Johannessen A | display-authors=etal| title=Surface electrocardiogram to predict outcome in candidates for cardiac resynchronization therapy: a sub-analysis of the CARE-HF trial. | journal=Eur J Heart Fail | year= 2009 | volume= 11 | issue= 7 | pages= 699-705 | pmid=19505883 | doi=10.1093/eurjhf/hfp074 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19505883  }} </ref><ref name="pmid21357819">{{cite journal| author=Zareba W, Klein H, Cygankiewicz I, Hall WJ, McNitt S, Brown M | display-authors=etal| title=Effectiveness of Cardiac Resynchronization Therapy by QRS Morphology in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT). | journal=Circulation | year= 2011 | volume= 123 | issue= 10 | pages= 1061-72 | pmid=21357819 | doi=10.1161/CIRCULATIONAHA.110.960898 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21357819  }} </ref><ref name="pmid22781424">{{cite journal| author=Gold MR, Thébault C, Linde C, Abraham WT, Gerritse B, Ghio S | display-authors=etal| title=Effect of QRS duration and morphology on cardiac resynchronization therapy outcomes in mild heart failure: results from the Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE) study. | journal=Circulation | year= 2012 | volume= 126 | issue= 7 | pages= 822-9 | pmid=22781424 | doi=10.1161/CIRCULATIONAHA.112.097709 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22781424  }} </ref><ref name="pmid23995437">{{cite journal| author=Birnie DH, Ha A, Higginson L, Sidhu K, Green M, Philippon F | display-authors=etal| title=Impact of QRS morphology and duration on outcomes after cardiac resynchronization therapy: Results from the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT). | journal=Circ Heart Fail | year= 2013 | volume= 6 | issue= 6 | pages= 1190-8 | pmid=23995437 | doi=10.1161/CIRCHEARTFAILURE.113.000380 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23995437  }} </ref><ref name="pmid21300176">{{cite journal| author=Nery PB, Ha AC, Keren A, Birnie DH| title=Cardiac resynchronization therapy in patients with left ventricular systolic dysfunction and right bundle branch block: a systematic review. | journal=Heart Rhythm | year= 2011 | volume= 8 | issue= 7 | pages= 1083-7 | pmid=21300176 | doi=10.1016/j.hrthm.2011.01.041 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21300176  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>

|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''11.''' In [[patients]] with [[genetic]] [[arrhythmogenic]] [[cardiomyopathy]] with high-risk features of [[sudden death]], with [[EF]] ≤ 45%, [[implantation]] of [[ICD]] is reasonable to decrease sudden death. <ref name="pmid24503780">{{cite journal| author=Pugh TJ, Kelly MA, Gowrisankar S, Hynes E, Seidman MA, Baxter SM | display-authors=etal| title=The landscape of genetic variation in dilated cardiomyopathy as surveyed by clinical DNA sequencing. | journal=Genet Med | year= 2014 | volume= 16 | issue= 8 | pages= 601-8 | pmid=24503780 | doi=10.1038/gim.2013.204 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24503780  }} </ref><ref name="pmid31514951">{{cite journal| author=Gigli M, Merlo M, Graw SL, Barbati G, Rowland TJ, Slavov DB | display-authors=etal| title=Genetic Risk of Arrhythmic Phenotypes in Patients With Dilated Cardiomyopathy. | journal=J Am Coll Cardiol | year= 2019 | volume= 74 | issue= 11 | pages= 1480-1490 | pmid=31514951 | doi=10.1016/j.jacc.2019.06.072 | pmc=6750731 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31514951  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>

|}

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]

|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''12.''' For [[patients]] who have [[LVEF]] ≤ 35%, [[sinus rhythm]], a non-[[LBBB]] pattern with [[QRS duration]] of 120 to 149 ms, and NYHA class III or ambulatory class IV on GDMT, CRT may be considered to reduce total [[mortality]], reduce [[hospitalizations]], and improve [[symptoms]] and [[QOL]]. <ref name="pmid12063368">{{cite journal| author=Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E | display-authors=etal| title=Cardiac resynchronization in chronic heart failure. | journal=N Engl J Med | year= 2002 | volume= 346 | issue= 24 | pages= 1845-53 | pmid=12063368 | doi=10.1056/NEJMoa013168 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12063368  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=12418822 Review in: ACP J Club. 2002 Nov-Dec;137(3):82] </ref><ref name="pmid15152059">{{cite journal| author=Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T | display-authors=etal| title=Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 21 | pages= 2140-50 | pmid=15152059 | doi=10.1056/NEJMoa032423 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15152059  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=15518444 Review in: ACP J Club. 2004 Nov-Dec;141(3):60] </ref><ref name="pmid15753115">{{cite journal| author=Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L | display-authors=etal| title=The effect of cardiac resynchronization on morbidity and mortality in heart failure. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 15 | pages= 1539-49 | pmid=15753115 | doi=10.1056/NEJMoa050496 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15753115  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=16134903 Review in: ACP J Club. 2005 Sep-Oct;143(2):29] </ref><ref name="pmid19038680">{{cite journal| author=Linde C, Abraham WT, Gold MR, St John Sutton M, Ghio S, Daubert C | display-authors=etal| title=Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 23 | pages= 1834-1843 | pmid=19038680 | doi=10.1016/j.jacc.2008.08.027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038680  }} </ref><ref name="pmid24678999">{{cite journal| author=Goldenberg I, Kutyifa V, Klein HU, Cannom DS, Brown MW, Dan A | display-authors=etal| title=Survival with cardiac-resynchronization therapy in mild heart failure. | journal=N Engl J Med | year= 2014 | volume= 370 | issue= 18 | pages= 1694-701 | pmid=24678999 | doi=10.1056/NEJMoa1401426 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24678999  }} </ref><ref name="pmid21073365">{{cite journal| author=Tang AS, Wells GA, Talajic M, Arnold MO, Sheldon R, Connolly S | display-authors=etal| title=Cardiac-resynchronization therapy for mild-to-moderate heart failure. | journal=N Engl J Med | year= 2010 | volume= 363 | issue= 25 | pages= 2385-95 | pmid=21073365 | doi=10.1056/NEJMoa1009540 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21073365  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=21436182 Review in: Evid Based Med. 2011 Oct;16(5):138-9] </ref><ref name="pmid22305845">{{cite journal| author=Sipahi I, Chou JC, Hyden M, Rowland DY, Simon DI, Fang JC| title=Effect of QRS morphology on clinical event reduction with cardiac resynchronization therapy: meta-analysis of randomized controlled trials. | journal=Am Heart J | year= 2012 | volume= 163 | issue= 2 | pages= 260-7.e3 | pmid=22305845 | doi=10.1016/j.ahj.2011.11.014 | pmc=4113034 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22305845  }} </ref><ref name="pmid19505883">{{cite journal| author=Gervais R, Leclercq C, Shankar A, Jacobs S, Eiskjaer H, Johannessen A | display-authors=etal| title=Surface electrocardiogram to predict outcome in candidates for cardiac resynchronization therapy: a sub-analysis of the CARE-HF trial. | journal=Eur J Heart Fail | year= 2009 | volume= 11 | issue= 7 | pages= 699-705 | pmid=19505883 | doi=10.1093/eurjhf/hfp074 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19505883  }} </ref><ref name="pmid21357819">{{cite journal| author=Zareba W, Klein H, Cygankiewicz I, Hall WJ, McNitt S, Brown M | display-authors=etal| title=Effectiveness of Cardiac Resynchronization Therapy by QRS Morphology in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT). | journal=Circulation | year= 2011 | volume= 123 | issue= 10 | pages= 1061-72 | pmid=21357819 | doi=10.1161/CIRCULATIONAHA.110.960898 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21357819  }} </ref><ref name="pmid22781424">{{cite journal| author=Gold MR, Thébault C, Linde C, Abraham WT, Gerritse B, Ghio S | display-authors=etal| title=Effect of QRS duration and morphology on cardiac resynchronization therapy outcomes in mild heart failure: results from the Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE) study. | journal=Circulation | year= 2012 | volume= 126 | issue= 7 | pages= 822-9 | pmid=22781424 | doi=10.1161/CIRCULATIONAHA.112.097709 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22781424  }} </ref><ref name="pmid23995437">{{cite journal| author=Birnie DH, Ha A, Higginson L, Sidhu K, Green M, Philippon F | display-authors=etal| title=Impact of QRS morphology and duration on outcomes after cardiac resynchronization therapy: Results from the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT). | journal=Circ Heart Fail | year= 2013 | volume= 6 | issue= 6 | pages= 1190-8 | pmid=23995437 | doi=10.1161/CIRCHEARTFAILURE.113.000380 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23995437  }} </ref><ref name="pmid21300176">{{cite journal| author=Nery PB, Ha AC, Keren A, Birnie DH| title=Cardiac resynchronization therapy in patients with left ventricular systolic dysfunction and right bundle branch block: a systematic review. | journal=Heart Rhythm | year= 2011 | volume= 8 | issue= 7 | pages= 1083-7 | pmid=21300176 | doi=10.1016/j.hrthm.2011.01.041 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21300176  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>

|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''13.'''For [[patients]] who have [[LVEF]] ≤ 30%, [[ischemic]] case of [[HF]], [[sinus rhythm]], [[LBBB]] with a [[QRS duration]] ≥ 150ms, and [[NYHA]] class I [[symptoms]] on GDMT, CRT may be considered to reduce [[hospitalizations]] and improve [[symptoms]] and [[QOL]]. <ref name="pmid12063368">{{cite journal| author=Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E | display-authors=etal| title=Cardiac resynchronization in chronic heart failure. | journal=N Engl J Med | year= 2002 | volume= 346 | issue= 24 | pages= 1845-53 | pmid=12063368 | doi=10.1056/NEJMoa013168 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12063368  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=12418822 Review in: ACP J Club. 2002 Nov-Dec;137(3):82] </ref><ref name="pmid15152059">{{cite journal| author=Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T | display-authors=etal| title=Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 21 | pages= 2140-50 | pmid=15152059 | doi=10.1056/NEJMoa032423 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15152059  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=15518444 Review in: ACP J Club. 2004 Nov-Dec;141(3):60] </ref><ref name="pmid15753115">{{cite journal| author=Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L | display-authors=etal| title=The effect of cardiac resynchronization on morbidity and mortality in heart failure. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 15 | pages= 1539-49 | pmid=15753115 | doi=10.1056/NEJMoa050496 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15753115  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=16134903 Review in: ACP J Club. 2005 Sep-Oct;143(2):29] </ref><ref name="pmid19038680">{{cite journal| author=Linde C, Abraham WT, Gold MR, St John Sutton M, Ghio S, Daubert C | display-authors=etal| title=Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 23 | pages= 1834-1843 | pmid=19038680 | doi=10.1016/j.jacc.2008.08.027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038680  }} </ref><ref name="pmid24678999">{{cite journal| author=Goldenberg I, Kutyifa V, Klein HU, Cannom DS, Brown MW, Dan A | display-authors=etal| title=Survival with cardiac-resynchronization therapy in mild heart failure. | journal=N Engl J Med | year= 2014 | volume= 370 | issue= 18 | pages= 1694-701 | pmid=24678999 | doi=10.1056/NEJMoa1401426 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24678999  }} </ref><ref name="pmid21073365">{{cite journal| author=Tang AS, Wells GA, Talajic M, Arnold MO, Sheldon R, Connolly S | display-authors=etal| title=Cardiac-resynchronization therapy for mild-to-moderate heart failure. | journal=N Engl J Med | year= 2010 | volume= 363 | issue= 25 | pages= 2385-95 | pmid=21073365 | doi=10.1056/NEJMoa1009540 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21073365  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=21436182 Review in: Evid Based Med. 2011 Oct;16(5):138-9] </ref><ref name="pmid22305845">{{cite journal| author=Sipahi I, Chou JC, Hyden M, Rowland DY, Simon DI, Fang JC| title=Effect of QRS morphology on clinical event reduction with cardiac resynchronization therapy: meta-analysis of randomized controlled trials. | journal=Am Heart J | year= 2012 | volume= 163 | issue= 2 | pages= 260-7.e3 | pmid=22305845 | doi=10.1016/j.ahj.2011.11.014 | pmc=4113034 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22305845  }} </ref><ref name="pmid19505883">{{cite journal| author=Gervais R, Leclercq C, Shankar A, Jacobs S, Eiskjaer H, Johannessen A | display-authors=etal| title=Surface electrocardiogram to predict outcome in candidates for cardiac resynchronization therapy: a sub-analysis of the CARE-HF trial. | journal=Eur J Heart Fail | year= 2009 | volume= 11 | issue= 7 | pages= 699-705 | pmid=19505883 | doi=10.1093/eurjhf/hfp074 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19505883  }} </ref><ref name="pmid21357819">{{cite journal| author=Zareba W, Klein H, Cygankiewicz I, Hall WJ, McNitt S, Brown M | display-authors=etal| title=Effectiveness of Cardiac Resynchronization Therapy by QRS Morphology in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT). | journal=Circulation | year= 2011 | volume= 123 | issue= 10 | pages= 1061-72 | pmid=21357819 | doi=10.1161/CIRCULATIONAHA.110.960898 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21357819  }} </ref><ref name="pmid22781424">{{cite journal| author=Gold MR, Thébault C, Linde C, Abraham WT, Gerritse B, Ghio S | display-authors=etal| title=Effect of QRS duration and morphology on cardiac resynchronization therapy outcomes in mild heart failure: results from the Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE) study. | journal=Circulation | year= 2012 | volume= 126 | issue= 7 | pages= 822-9 | pmid=22781424 | doi=10.1161/CIRCULATIONAHA.112.097709 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22781424  }} </ref><ref name="pmid23995437">{{cite journal| author=Birnie DH, Ha A, Higginson L, Sidhu K, Green M, Philippon F | display-authors=etal| title=Impact of QRS morphology and duration on outcomes after cardiac resynchronization therapy: Results from the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT). | journal=Circ Heart Fail | year= 2013 | volume= 6 | issue= 6 | pages= 1190-8 | pmid=23995437 | doi=10.1161/CIRCHEARTFAILURE.113.000380 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23995437  }} </ref><ref name="pmid21300176">{{cite journal| author=Nery PB, Ha AC, Keren A, Birnie DH| title=Cardiac resynchronization therapy in patients with left ventricular systolic dysfunction and right bundle branch block: a systematic review. | journal=Heart Rhythm | year= 2011 | volume= 8 | issue= 7 | pages= 1083-7 | pmid=21300176 | doi=10.1016/j.hrthm.2011.01.041 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21300176  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>

|}

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)

|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''14.''' In [[patients]] with [[QRS duration]] < 120 ms, CRT is not recommended. <ref name="pmid24503780">{{cite journal| author=Pugh TJ, Kelly MA, Gowrisankar S, Hynes E, Seidman MA, Baxter SM | display-authors=etal| title=The landscape of genetic variation in dilated cardiomyopathy as surveyed by clinical DNA sequencing. | journal=Genet Med | year= 2014 | volume= 16 | issue= 8 | pages= 601-8 | pmid=24503780 | doi=10.1038/gim.2013.204 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24503780  }} </ref><ref name="pmid31514951">{{cite journal| author=Gigli M, Merlo M, Graw SL, Barbati G, Rowland TJ, Slavov DB | display-authors=etal| title=Genetic Risk of Arrhythmic Phenotypes in Patients With Dilated Cardiomyopathy. | journal=J Am Coll Cardiol | year= 2019 | volume= 74 | issue= 11 | pages= 1480-1490 | pmid=31514951 | doi=10.1016/j.jacc.2019.06.072 | pmc=6750731 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31514951  }} </ref><ref name="pmid31078652">{{cite journal| author=Towbin JA, McKenna WJ, Abrams DJ, Ackerman MJ, Calkins H, Darrieux FCC | display-authors=etal| title=2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy. | journal=Heart Rhythm | year= 2019 | volume= 16 | issue= 11 | pages= e301-e372 | pmid=31078652 | doi=10.1016/j.hrthm.2019.05.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31078652  }} </ref><ref name="pmid19723701">{{cite journal| author=Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP | display-authors=etal| title=Cardiac-resynchronization therapy for the prevention of heart-failure events. | journal=N Engl J Med | year= 2009 | volume= 361 | issue= 14 | pages= 1329-38 | pmid=19723701 | doi=10.1056/NEJMoa0906431 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19723701  }} </ref><ref name="pmid17986493">{{cite journal| author=Beshai JF, Grimm RA, Nagueh SF, Baker JH, Beau SL, Greenberg SM | display-authors=etal| title=Cardiac-resynchronization therapy in heart failure with narrow QRS complexes. | journal=N Engl J Med | year= 2007 | volume= 357 | issue= 24 | pages= 2461-71 | pmid=17986493 | doi=10.1056/NEJMoa0706695 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17986493  }} </ref><ref name="pmid23998714">{{cite journal| author=Ruschitzka F, Abraham WT, Singh JP, Bax JJ, Borer JS, Brugada J | display-authors=etal| title=Cardiac-resynchronization therapy in heart failure with a narrow QRS complex. | journal=N Engl J Med | year= 2013 | volume= 369 | issue= 15 | pages= 1395-405 | pmid=23998714 | doi=10.1056/NEJMoa1306687 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23998714  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>

|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''15.''' For [[patients]] with [[NYHA]] class I or II [[symptoms]] and non-[[LBBB]] pattern with [[QRS durati]]150 ms, CRT is not recommended.<ref name="pmid12063368">{{cite journal| author=Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E | display-authors=etal| title=Cardiac resynchronization in chronic heart failure. | journal=N Engl J Med | year= 2002 | volume= 346 | issue= 24 | pages= 1845-53 | pmid=12063368 | doi=10.1056/NEJMoa013168 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12063368  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=12418822 Review in: ACP J Club. 2002 Nov-Dec;137(3):82] </ref><ref name="pmid15152059">{{cite journal| author=Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T | display-authors=etal| title=Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 21 | pages= 2140-50 | pmid=15152059 | doi=10.1056/NEJMoa032423 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15152059  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=15518444 Review in: ACP J Club. 2004 Nov-Dec;141(3):60] </ref><ref name="pmid15753115">{{cite journal| author=Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L | display-authors=etal| title=The effect of cardiac resynchronization on morbidity and mortality in heart failure. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 15 | pages= 1539-49 | pmid=15753115 | doi=10.1056/NEJMoa050496 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15753115  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=16134903 Review in: ACP J Club. 2005 Sep-Oct;143(2):29] </ref><ref name="pmid19038680">{{cite journal| author=Linde C, Abraham WT, Gold MR, St John Sutton M, Ghio S, Daubert C | display-authors=etal| title=Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 23 | pages= 1834-1843 | pmid=19038680 | doi=10.1016/j.jacc.2008.08.027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038680  }} </ref><ref name="pmid24678999">{{cite journal| author=Goldenberg I, Kutyifa V, Klein HU, Cannom DS, Brown MW, Dan A | display-authors=etal| title=Survival with cardiac-resynchronization therapy in mild heart failure. | journal=N Engl J Med | year= 2014 | volume= 370 | issue= 18 | pages= 1694-701 | pmid=24678999 | doi=10.1056/NEJMoa1401426 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24678999  }} </ref><ref name="pmid21073365">{{cite journal| author=Tang AS, Wells GA, Talajic M, Arnold MO, Sheldon R, Connolly S | display-authors=etal| title=Cardiac-resynchronization therapy for mild-to-moderate heart failure. | journal=N Engl J Med | year= 2010 | volume= 363 | issue= 25 | pages= 2385-95 | pmid=21073365 | doi=10.1056/NEJMoa1009540 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21073365  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=21436182 Review in: Evid Based Med. 2011 Oct;16(5):138-9] </ref><ref name="pmid22305845">{{cite journal| author=Sipahi I, Chou JC, Hyden M, Rowland DY, Simon DI, Fang JC| title=Effect of QRS morphology on clinical event reduction with cardiac resynchronization therapy: meta-analysis of randomized controlled trials. | journal=Am Heart J | year= 2012 | volume= 163 | issue= 2 | pages= 260-7.e3 | pmid=22305845 | doi=10.1016/j.ahj.2011.11.014 | pmc=4113034 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22305845  }} </ref><ref name="pmid19505883">{{cite journal| author=Gervais R, Leclercq C, Shankar A, Jacobs S, Eiskjaer H, Johannessen A | display-authors=etal| title=Surface electrocardiogram to predict outcome in candidates for cardiac resynchronization therapy: a sub-analysis of the CARE-HF trial. | journal=Eur J Heart Fail | year= 2009 | volume= 11 | issue= 7 | pages= 699-705 | pmid=19505883 | doi=10.1093/eurjhf/hfp074 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19505883  }} </ref><ref name="pmid21357819">{{cite journal| author=Zareba W, Klein H, Cygankiewicz I, Hall WJ, McNitt S, Brown M | display-authors=etal| title=Effectiveness of Cardiac Resynchronization Therapy by QRS Morphology in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT). | journal=Circulation | year= 2011 | volume= 123 | issue= 10 | pages= 1061-72 | pmid=21357819 | doi=10.1161/CIRCULATIONAHA.110.960898 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21357819  }} </ref><ref name="pmid22781424">{{cite journal| author=Gold MR, Thébault C, Linde C, Abraham WT, Gerritse B, Ghio S | display-authors=etal| title=Effect of QRS duration and morphology on cardiac resynchronization therapy outcomes in mild heart failure: results from the Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE) study. | journal=Circulation | year= 2012 | volume= 126 | issue= 7 | pages= 822-9 | pmid=22781424 | doi=10.1161/CIRCULATIONAHA.112.097709 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22781424  }} </ref><ref name="pmid23995437">{{cite journal| author=Birnie DH, Ha A, Higginson L, Sidhu K, Green M, Philippon F | display-authors=etal| title=Impact of QRS morphology and duration on outcomes after cardiac resynchronization therapy: Results from the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT). | journal=Circ Heart Fail | year= 2013 | volume= 6 | issue= 6 | pages= 1190-8 | pmid=23995437 | doi=10.1161/CIRCHEARTFAILURE.113.000380 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23995437  }} </ref><ref name="pmid21300176">{{cite journal| author=Nery PB, Ha AC, Keren A, Birnie DH| title=Cardiac resynchronization therapy in patients with left ventricular systolic dysfunction and right bundle branch block: a systematic review. | journal=Heart Rhythm | year= 2011 | volume= 8 | issue= 7 | pages= 1083-7 | pmid=21300176 | doi=10.1016/j.hrthm.2011.01.041 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21300176  }} </ref ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>


|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''16.''' For [[patients]] whose [[comorbidities]] or frailty limit [[survival]] with good functional capacity to <1 year, [[ICD]] and [[cardiac resynchronization therapy]] with [[defibrillation]] (CRT-D) are not indicated. <ref name="pmid9411221">{{cite journal| author=Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators| title=A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. | journal=N Engl J Med | year= 1997 | volume= 337 | issue= 22 | pages= 1576-83 | pmid=9411221 | doi=10.1056/NEJM199711273372202 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9411221  }} </ref><ref name="pmid10942742">{{cite journal| author=Kuck KH, Cappato R, Siebels J, Rüppel R| title=Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest : the Cardiac Arrest Study Hamburg (CASH). | journal=Circulation | year= 2000 | volume= 102 | issue= 7 | pages= 748-54 | pmid=10942742 | doi=10.1161/01.cir.102.7.748 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10942742  }} </ref><ref name="pmid10725290">{{cite journal| author=Connolly SJ, Gent M, Roberts RS, Dorian P, Roy D, Sheldon RS | display-authors=etal| title=Canadian implantable defibrillator study (CIDS) : a randomized trial of the implantable cardioverter defibrillator against amiodarone. | journal=Circulation | year= 2000 | volume= 101 | issue= 11 | pages= 1297-302 | pmid=10725290 | doi=10.1161/01.cir.101.11.1297 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10725290  }} </ref><ref name="pmid8960472">{{cite journal| author=Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H | display-authors=etal| title=Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. | journal=N Engl J Med | year= 1996 | volume= 335 | issue= 26 | pages= 1933-40 | pmid=8960472 | doi=10.1056/NEJM199612263352601 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8960472  }} </ref><ref name="pmid10601507">{{cite journal| author=Buxton AE, Lee KL, Fisher JD, Josephson ME, Prystowsky EN, Hafley G| title=A randomized study of the prevention of sudden death in patients with coronary artery disease. Multicenter Unsustained Tachycardia Trial Investigators. | journal=N Engl J Med | year= 1999 | volume= 341 | issue= 25 | pages= 1882-90 | pmid=10601507 | doi=10.1056/NEJM199912163412503 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10601507  }} </ref><ref name="pmid: 11907286">{{cite journal| author=Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS | display-authors=etal| title=Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. | journal=N Engl J Med | year= 2002 | volume= 346 | issue= 12 | pages= 877-83 | pmid=: 11907286 | doi=10.1056/NEJMoa013474 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11907286  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=12418821 Review in: ACP J Club. 2002 Nov-Dec;137(3):81] </ref><ref name="pmid15152060">{{cite journal| author=Kadish A, Dyer A, Daubert JP, Quigg R, Estes NA, Anderson KP | display-authors=etal| title=Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 21 | pages= 2151-8 | pmid=15152060 | doi=10.1056/NEJMoa033088 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15152060  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=15518445 Review in: ACP J Club. 2004 Nov-Dec;141(3):61] </ref><ref name="pmid15659722">{{cite journal| author=Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R | display-authors=etal| title=Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 3 | pages= 225-37 | pmid=15659722 | doi=10.1056/NEJMoa043399 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15659722  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=15989294 Review in: ACP J Club. 2005 Jul-Aug;143(1):6] </ref><ref name="pmid27571011">{{cite journal| author=Køber L, Thune JJ, Nielsen JC, Haarbo J, Videbæk L, Korup E | display-authors=etal| title=Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure. | journal=N Engl J Med | year= 2016 | volume= 375 | issue= 13 | pages= 1221-30 | pmid=27571011 | doi=10.1056/NEJMoa1608029 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27571011  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=27842392 Review in: Ann Intern Med. 2016 Nov 15;165(10 ):JC55] </ref><ref name="pmid12063368">{{cite journal| author=Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E | display-authors=etal| title=Cardiac resynchronization in chronic heart failure. | journal=N Engl J Med | year= 2002 | volume= 346 | issue= 24 | pages= 1845-53 | pmid=12063368 | doi=10.1056/NEJMoa013168 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12063368  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=12418822 Review in: ACP J Club. 2002 Nov-Dec;137(3):82] </ref><ref name="pmid15152059">{{cite journal| author=Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T | display-authors=etal| title=Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 21 | pages= 2140-50 | pmid=15152059 | doi=10.1056/NEJMoa032423 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15152059  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=15518444 Review in: ACP J Club. 2004 Nov-Dec;141(3):60] </ref><ref name="pmid15753115">{{cite journal| author=Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L | display-authors=etal| title=The effect of cardiac resynchronization on morbidity and mortality in heart failure. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 15 | pages= 1539-49 | pmid=15753115 | doi=10.1056/NEJMoa050496 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15753115  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=16134903 Review in: ACP J Club. 2005 Sep-Oct;143(2):29] </ref><ref name="pmid19038680">{{cite journal| author=Linde C, Abraham WT, Gold MR, St John Sutton M, Ghio S, Daubert C | display-authors=etal| title=Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 23 | pages= 1834-1843 | pmid=19038680 | doi=10.1016/j.jacc.2008.08.027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038680  }} </ref><ref name="pmid24678999">{{cite journal| author=Goldenberg I, Kutyifa V, Klein HU, Cannom DS, Brown MW, Dan A | display-authors=etal| title=Survival with cardiac-resynchronization therapy in mild heart failure. | journal=N Engl J Med | year= 2014 | volume= 370 | issue= 18 | pages= 1694-701 | pmid=24678999 | doi=10.1056/NEJMoa1401426 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24678999  }} </ref><ref name="pmid21073365">{{cite journal| author=Tang AS, Wells GA, Talajic M, Arnold MO, Sheldon R, Connolly S | display-authors=etal| title=Cardiac-resynchronization therapy for mild-to-moderate heart failure. | journal=N Engl J Med | year= 2010 | volume= 363 | issue= 25 | pages= 2385-95 | pmid=21073365 | doi=10.1056/NEJMoa1009540 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21073365  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=21436182 Review in: Evid Based Med. 2011 Oct;16(5):138-9] </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])'' <nowiki>"</nowiki>

|}

====[[Revascularization]] for [[CAD]]====

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]

|-
|bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In selected [[patients]] with [[HF]], reduced [[EF]] ([[EF]] ≤ 35%), and suitable [[coronary]] anatomy, [[surgical]] [[revascularization]] plus GDMT is beneficial to improve [[symptoms]], [[cardiovascular]] [[hospitalizations]], and long-term all-cause [[mortality]]. <ref name="pmid7729019">{{cite journal| author=Caracciolo EA, Davis KB, Sopko G, Kaiser GC, Corley SD, Schaff H | display-authors=etal| title=Comparison of surgical and medical group survival in patients with left main equivalent coronary artery disease. Long-term CASS experience. | journal=Circulation | year= 1995 | volume= 91 | issue= 9 | pages= 2335-44 | pmid=7729019 | doi=10.1161/01.cir.91.9.2335 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7729019  }} </ref><ref name="pmid31521682">{{cite journal| author=Howlett JG, Stebbins A, Petrie MC, Jhund PS, Castelvecchio S, Cherniavsky A | display-authors=etal| title=CABG Improves Outcomes in Patients With Ischemic Cardiomyopathy: 10-Year Follow-Up of the STICH Trial. | journal=JACC Heart Fail | year= 2019 | volume= 7 | issue= 10 | pages= 878-887 | pmid=31521682 | doi=10.1016/j.jchf.2019.04.018 | pmc=7375257 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31521682  }} </ref><ref name="pmid25222386">{{cite journal| author=Mark DB, Knight JD, Velazquez EJ, Wasilewski J, Howlett JG, Smith PK | display-authors=etal| title=Quality-of-life outcomes with coronary artery bypass graft surgery in ischemic left ventricular dysfunction: a randomized trial. | journal=Ann Intern Med | year= 2014 | volume= 161 | issue= 6 | pages= 392-9 | pmid=25222386 | doi=10.7326/M13-1380 | pmc=4182862 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25222386  }} </ref><ref name="pmid32943156">{{cite journal| author=Park S, Ahn JM, Kim TO, Park H, Kang DY, Lee PH | display-authors=etal| title=Revascularization in Patients With Left Main Coronary Artery Disease and Left Ventricular Dysfunction. | journal=J Am Coll Cardiol | year= 2020 | volume= 76 | issue= 12 | pages= 1395-1406 | pmid=32943156 | doi=10.1016/j.jacc.2020.07.047 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32943156  }} </ref><ref name="pmid27573034">{{cite journal| author=Petrie MC, Jhund PS, She L, Adlbrecht C, Doenst T, Panza JA | display-authors=etal| title=Ten-Year Outcomes After Coronary Artery Bypass Grafting According to Age in Patients With Heart Failure and Left Ventricular Systolic Dysfunction: An Analysis of the Extended Follow-Up of the STICH Trial (Surgical Treatment for Ischemic Heart Failure). | journal=Circulation | year= 2016 | volume= 134 | issue= 18 | pages= 1314-1324 | pmid=27573034 | doi=10.1161/CIRCULATIONAHA.116.024800 | pmc=5089908 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27573034  }} </ref><ref name="pmid32883408">{{cite journal| author=Tam DY, Dharma C, Rocha R, Farkouh ME, Abdel-Qadir H, Sun LY | display-authors=etal| title=Long-Term Survival After Surgical or Percutaneous Revascularization in Patients With Diabetes and Multivessel Coronary Disease. | journal=J Am Coll Cardiol | year= 2020 | volume= 76 | issue= 10 | pages= 1153-1164 | pmid=32883408 | doi=10.1016/j.jacc.2020.06.052 | pmc=7861124 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32883408  }} </ref><ref name="pmid21463150">{{cite journal| author=Velazquez EJ, Lee KL, Deja MA, Jain A, Sopko G, Marchenko A | display-authors=etal| title=Coronary-artery bypass surgery in patients with left ventricular dysfunction. | journal=N Engl J Med | year= 2011 | volume= 364 | issue= 17 | pages= 1607-16 | pmid=21463150 | doi=10.1056/NEJMoa1100356 | pmc=3415273 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21463150  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=21844542 Review in: Ann Intern Med. 2011 Aug 16;155(4):JC2-9]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=22736663 Review in: Evid Based Med. 2012 Dec;17(6):178-9] </ref><ref name="pmid27040723">{{cite journal| author=Velazquez EJ, Lee KL, Jones RH, Al-Khalidi HR, Hill JA, Panza JA | display-authors=etal| title=Coronary-Artery Bypass Surgery in Patients with Ischemic Cardiomyopathy. | journal=N Engl J Med | year= 2016 | volume= 374 | issue= 16 | pages= 1511-20 | pmid=27040723 | doi=10.1056/NEJMoa1602001 | pmc=4938005 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27040723  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=27538176 Review in: Ann Intern Med. 2016 Aug 16;165(4):JC15]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=27913564 Review in: Evid Based Med. 2017 Mar;22(1):32] </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>

|}

===[[Valvular Heart Disease]]===

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]

|-
|bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In [[patients]] with [[HF]], [[VHD]] should be managed in a multidisciplinary manner in accordance with clinical practice guidelines for [[VHD]] to prevent worsening of [[HF]] and adverse clinical outcomes. <ref name="pmid28859754">{{cite journal| author=Nasser R, Van Assche L, Vorlat A, Vermeulen T, Van Craenenbroeck E, Conraads V | display-authors=etal| title=Evolution of Functional Mitral Regurgitation and Prognosis in Medically Managed Heart Failure Patients With Reduced Ejection Fraction. | journal=JACC Heart Fail | year= 2017 | volume= 5 | issue= 9 | pages= 652-659 | pmid=28859754 | doi=10.1016/j.jchf.2017.06.015 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28859754  }} </ref><ref name="pmid10215284">{{cite journal| author=Lowes BD, Gill EA, Abraham WT, Larrain JR, Robertson AD, Bristow MR | display-authors=etal| title=Effects of carvedilol on left ventricular mass, chamber geometry, and mitral regurgitation in chronic heart failure. | journal=Am J Cardiol | year= 1999 | volume= 83 | issue= 8 | pages= 1201-5 | pmid=10215284 | doi=10.1016/s0002-9149(99)00059-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10215284  }} </ref><ref name="pmid10740140">{{cite journal| author=Capomolla S, Febo O, Gnemmi M, Riccardi G, Opasich C, Caporotondi A | display-authors=etal| title=Beta-blockade therapy in chronic heart failure: diastolic function and mitral regurgitation improvement by carvedilol. | journal=Am Heart J | year= 2000 | volume= 139 | issue= 4 | pages= 596-608 | pmid=10740140 | doi=10.1016/s0002-8703(00)90036-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10740140  }} </ref><ref name="pmid30586756">{{cite journal| author=Kang DH, Park SJ, Shin SH, Hong GR, Lee S, Kim MS | display-authors=etal| title=Angiotensin Receptor Neprilysin Inhibitor for Functional Mitral Regurgitation. | journal=Circulation | year= 2019 | volume= 139 | issue= 11 | pages= 1354-1365 | pmid=30586756 | doi=10.1161/CIRCULATIONAHA.118.037077 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30586756  }} </ref><ref name="pmid21810666">{{cite journal| author=van Bommel RJ, Marsan NA, Delgado V, Borleffs CJ, van Rijnsoever EP, Schalij MJ | display-authors=etal| title=Cardiac resynchronization therapy as a therapeutic option in patients with moderate-severe functional mitral regurgitation and high operative risk. | journal=Circulation | year= 2011 | volume= 124 | issue= 8 | pages= 912-9 | pmid=21810666 | doi=10.1161/CIRCULATIONAHA.110.009803 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21810666  }} </ref><ref name="pmid30145927">{{cite journal| author=Obadia JF, Messika-Zeitoun D, Leurent G, Iung B, Bonnet G, Piriou N | display-authors=etal| title=Percutaneous Repair or Medical Treatment for Secondary Mitral Regurgitation. | journal=N Engl J Med | year= 2018 | volume= 379 | issue= 24 | pages= 2297-2306 | pmid=30145927 | doi=10.1056/NEJMoa1805374 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30145927  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=30641559 Review in: Ann Intern Med. 2019 Jan 15;170(2):JC8] </ref><ref name="pmid30512100">{{cite journal| author=Inohara T, Manandhar P, Kosinski AS, Matsouaka RA, Kohsaka S, Mentz RJ | display-authors=etal| title=Association of Renin-Angiotensin Inhibitor Treatment With Mortality and Heart Failure Readmission in Patients With Transcatheter Aortic Valve Replacement. | journal=JAMA | year= 2018 | volume= 320 | issue= 21 | pages= 2231-2241 | pmid=30512100 | doi=10.1001/jama.2018.18077 | pmc=6583475 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30512100  }} </ref><ref name="pmid25788231">{{cite journal| author=Kapadia SR, Leon MB, Makkar RR, Tuzcu EM, Svensson LG, Kodali S | display-authors=etal| title=5-year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER 1): a randomised controlled trial. | journal=Lancet | year= 2015 | volume= 385 | issue= 9986 | pages= 2485-91 | pmid=25788231 | doi=10.1016/S0140-6736(15)60290-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25788231  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=26280438 Review in: Ann Intern Med. 2015 Aug 18;163(4):JC3]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=26280439 Review in: Ann Intern Med. 2015 Aug 18;163(4):JC4]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=26296815 Review in: Evid Based Med. 2015 Dec;20(6):212-3] </ref><ref name="pmid16192479">{{cite journal| author=Evangelista A, Tornos P, Sambola A, Permanyer-Miralda G, Soler-Soler J| title=Long-term vasodilator therapy in patients with severe aortic regurgitation. | journal=N Engl J Med | year= 2005 | volume= 353 | issue= 13 | pages= 1342-9 | pmid=16192479 | doi=10.1056/NEJMoa050666 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16192479  }} </ref><ref name="pmid17397676">{{cite journal| author=Bhudia SK, McCarthy PM, Kumpati GS, Helou J, Hoercher KJ, Rajeswaran J | display-authors=etal| title=Improved outcomes after aortic valve surgery for chronic aortic regurgitation with severe left ventricular dysfunction. | journal=J Am Coll Cardiol | year= 2007 | volume= 49 | issue= 13 | pages= 1465-71 | pmid=17397676 | doi=10.1016/j.jacc.2007.01.026 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17397676  }} </ref><ref name="pmid25788234">{{cite journal| author=Mack MJ, Leon MB, Smith CR, Miller DC, Moses JW, Tuzcu EM | display-authors=etal| title=5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. | journal=Lancet | year= 2015 | volume= 385 | issue= 9986 | pages= 2477-84 | pmid=25788234 | doi=10.1016/S0140-6736(15)60308-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25788234  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=26296815 Review in: Evid Based Med. 2015 Dec;20(6):212-3] </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>

|-
|bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' In [[patients]] with chronic severe secondary [[MR]] and [[HFrEF]], optimization of GDMT is recommended before any intervention for secondary [[MR]] related to [[LV dysfunction]]. <ref name="pmid10740140">{{cite journal| author=Capomolla S, Febo O, Gnemmi M, Riccardi G, Opasich C, Caporotondi A | display-authors=etal| title=Beta-blockade therapy in chronic heart failure: diastolic function and mitral regurgitation improvement by carvedilol. | journal=Am Heart J | year= 2000 | volume= 139 | issue= 4 | pages= 596-608 | pmid=10740140 | doi=10.1016/s0002-8703(00)90036-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10740140  }} </ref><ref name="pmid30586756">{{cite journal| author=Kang DH, Park SJ, Shin SH, Hong GR, Lee S, Kim MS | display-authors=etal| title=Angiotensin Receptor Neprilysin Inhibitor for Functional Mitral Regurgitation. | journal=Circulation | year= 2019 | volume= 139 | issue= 11 | pages= 1354-1365 | pmid=30586756 | doi=10.1161/CIRCULATIONAHA.118.037077 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30586756  }} </ref><ref name="pmid21810666">{{cite journal| author=van Bommel RJ, Marsan NA, Delgado V, Borleffs CJ, van Rijnsoever EP, Schalij MJ | display-authors=etal| title=Cardiac resynchronization therapy as a therapeutic option in patients with moderate-severe functional mitral regurgitation and high operative risk. | journal=Circulation | year= 2011 | volume= 124 | issue= 8 | pages= 912-9 | pmid=21810666 | doi=10.1161/CIRCULATIONAHA.110.009803 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21810666  }} </ref><ref name="pmid19398488">{{cite journal| author=Agricola E, Ielasi A, Oppizzi M, Faggiano P, Ferri L, Calabrese A | display-authors=etal| title=Long-term prognosis of medically treated patients with functional mitral regurgitation and left ventricular dysfunction. | journal=Eur J Heart Fail | year= 2009 | volume= 11 | issue= 6 | pages= 581-7 | pmid=19398488 | doi=10.1093/eurjhf/hfp051 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19398488  }} </ref><ref name="pmid26721652">{{cite journal| author=Karaca O, Omaygenc MO, Cakal B, Cakal SD, Gunes HM, Barutcu I | display-authors=etal| title=Effect of QRS Narrowing After Cardiac Resynchronization Therapy on Functional Mitral Regurgitation in Patients With Systolic Heart Failure. | journal=Am J Cardiol | year= 2016 | volume= 117 | issue= 3 | pages= 412-9 | pmid=26721652 | doi=10.1016/j.amjcard.2015.11.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26721652  }} </ref><ref name="pmid12668512">{{cite journal| author=St John Sutton MG, Plappert T, Abraham WT, Smith AL, DeLurgio DB, Leon AR | display-authors=etal| title=Effect of cardiac resynchronization therapy on left ventricular size and function in chronic heart failure. | journal=Circulation | year= 2003 | volume= 107 | issue= 15 | pages= 1985-90 | pmid=12668512 | doi=10.1161/01.CIR.0000065226.24159.E9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12668512  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])'' <nowiki>"</nowiki>

|}

===[[Heart Failure With Mildly Reduced EF]] ([[HFmrEF]]) and Improved EF ([[HFimpHF]])===

====[[HF With Mildly Reduced Ejection Fraction]]====

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]

|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' In [[patients]] with [[HFmrEF]], [[SGLT2i]] can be beneficial in decreasing [[HF]] [[hospitalizations]] and [[cardiovascular]] [[mortality]]. <ref name="pmid34449189">{{cite journal| author=Anker SD, Butler J, Filippatos G, Ferreira JP, Bocchi E, Böhm M | display-authors=etal| title=Empagliflozin in Heart Failure with a Preserved Ejection Fraction. | journal=N Engl J Med | year= 2021 | volume= 385 | issue= 16 | pages= 1451-1461 | pmid=34449189 | doi=10.1056/NEJMoa2107038 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34449189  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=34978853 Review in: Ann Intern Med. 2022 Jan;175(1):JC4] </ref>   ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>

|}

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]

|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Among [[patients]] with current or previous [[symptomatic]] [[HFmrEF]] ([[LVEF]], 41%-49%), use of evidence-based [[beta blockers]] for [[HFrEF]], [[ARNi]], [[ACEi]], or [[ARB]], and [[MRA]]s may be considered to reduce the risk of [[HF]] [[hospitalization]] and [[cardiovascular]] [[mortality]], particularly among [[patients]] with [[LVEF]] on the lower end of this spectrum. <ref name="pmid29040525">{{cite journal| author=Cleland JGF, Bunting KV, Flather MD, Altman DG, Holmes J, Coats AJS | display-authors=etal| title=Beta-blockers for heart failure with reduced, mid-range, and preserved ejection fraction: an individual patient-level analysis of double-blind randomized trials. | journal=Eur Heart J | year= 2018 | volume= 39 | issue= 1 | pages= 26-35 | pmid=29040525 | doi=10.1093/eurheartj/ehx564 | pmc=5837435 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29040525  }} </ref><ref name="pmid31475794">{{cite journal| author=Solomon SD, McMurray JJV, Anand IS, Ge J, Lam CSP, Maggioni AP | display-authors=etal| title=Angiotensin-Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction. | journal=N Engl J Med | year= 2019 | volume= 381 | issue= 17 | pages= 1609-1620 | pmid=31475794 | doi=10.1056/NEJMoa1908655 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31475794  }} </ref><ref name="pmid30429050">{{cite journal| author=Halliday BP, Wassall R, Lota AS, Khalique Z, Gregson J, Newsome S | display-authors=etal| title=Withdrawal of pharmacological treatment for heart failure in patients with recovered dilated cardiomyopathy (TRED-HF): an open-label, pilot, randomised trial. | journal=Lancet | year= 2019 | volume= 393 | issue= 10166 | pages= 61-73 | pmid=30429050 | doi=10.1016/S0140-6736(18)32484-X | pmc=6319251 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30429050  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=30884498 Review in: Ann Intern Med. 2019 Mar 19;170(6):JC28] </ref><ref name="pmid29096886">{{cite journal| author=Nilsson BB, Lunde P, Grøgaard HK, Holm I| title=Long-Term Results of High-Intensity Exercise-Based Cardiac Rehabilitation in Revascularized Patients for Symptomatic Coronary Artery Disease. | journal=Am J Cardiol | year= 2018 | volume= 121 | issue= 1 | pages= 21-26 | pmid=29096886 | doi=10.1016/j.amjcard.2017.09.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29096886  }} </ref><ref name="pmid26915374">{{cite journal| author=Solomon SD, Claggett B, Desai AS, Packer M, Zile M, Swedberg K | display-authors=etal| title=Influence of Ejection Fraction on Outcomes and Efficacy of Sacubitril/Valsartan (LCZ696) in Heart Failure with Reduced Ejection Fraction: The Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) Trial. | journal=Circ Heart Fail | year= 2016 | volume= 9 | issue= 3 | pages= e002744 | pmid=26915374 | doi=10.1161/CIRCHEARTFAILURE.115.002744 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26915374  }} </ref><ref name="pmid28370829">{{cite journal| author=Tsuji K, Sakata Y, Nochioka K, Miura M, Yamauchi T, Onose T | display-authors=etal| title=Characterization of heart failure patients with mid-range left ventricular ejection fraction-a report from the CHART-2 Study. | journal=Eur J Heart Fail | year= 2017 | volume= 19 | issue= 10 | pages= 1258-1269 | pmid=28370829 | doi=10.1002/ejhf.807 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28370829  }} </ref><ref name="pmid31736342">{{cite journal| author=Solomon SD, Vaduganathan M, L Claggett B, Packer M, Zile M, Swedberg K | display-authors=etal| title=Sacubitril/Valsartan Across the Spectrum of Ejection Fraction in Heart Failure. | journal=Circulation | year= 2020 | volume= 141 | issue= 5 | pages= 352-361 | pmid=31736342 | doi=10.1161/CIRCULATIONAHA.119.044586 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31736342  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=32539517 Review in: Ann Intern Med. 2020 Jun 16;172(12):JC65] </ref><ref name="pmid28780577">{{cite journal| author=Zheng SL, Chan FT, Nabeebaccus AA, Shah AM, McDonagh T, Okonko DO | display-authors=etal| title=Drug treatment effects on outcomes in heart failure with preserved ejection fraction: a systematic review and meta-analysis. | journal=Heart | year= 2018 | volume= 104 | issue= 5 | pages= 407-415 | pmid=28780577 | doi=10.1136/heartjnl-2017-311652 | pmc=5861385 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28780577  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=29255858 Review in: Ann Intern Med. 2017 Dec 19;167(12):JC68] </ref>   ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki>

|}

====[[HF]] With Improved [[Ejection Fraction]]====

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]

|-
|bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In [[patients]] with [[HFimpEF]] after [[treatment]], GDMT should be continued to prevent relapse of [[HF]] and [[LV dysfunction]], even in [[patients]] who may become [[asymptomatic]]. <ref name="pmid30429050">{{cite journal| author=Halliday BP, Wassall R, Lota AS, Khalique Z, Gregson J, Newsome S | display-authors=etal| title=Withdrawal of pharmacological treatment for heart failure in patients with recovered dilated cardiomyopathy (TRED-HF): an open-label, pilot, randomised trial. | journal=Lancet | year= 2019 | volume= 393 | issue= 10166 | pages= 61-73 | pmid=30429050 | doi=10.1016/S0140-6736(18)32484-X | pmc=6319251 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30429050  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=30884498 Review in: Ann Intern Med. 2019 Mar 19;170(6):JC28] </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>

|}

===[[Treatment]] of [[Patients]] with [[HF]] and preserved ejection fraction [[diastolic dysfunction|HFpEF]] (DO NOT EDIT) <ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref>===

====[[HF]] With Preserved [[Ejection Fraction]]====

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]

|-
|bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[Patients]] with [[HFpEF]] and [[hypertension]] should have [[medication]] titrated to attain [[blood pressure]] targets in accordance with published [[clinical practice guidelines]] to prevent [[morbidity]]. <ref name="pmid27454050">{{cite journal| author=Thomopoulos C, Parati G, Zanchetti A| title=Effects of blood-pressure-lowering treatment in hypertension: 9. Discontinuations for adverse events attributed to different classes of antihypertensive drugs: meta-analyses of randomized trials. | journal=J Hypertens | year= 2016 | volume= 34 | issue= 10 | pages= 1921-32 | pmid=27454050 | doi=10.1097/HJH.0000000000001052 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27454050  }} </ref><ref name="pmid27195814">{{cite journal| author=Williamson JD, Supiano MA, Applegate WB, Berlowitz DR, Campbell RC, Chertow GM | display-authors=etal| title=Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial. | journal=JAMA | year= 2016 | volume= 315 | issue= 24 | pages= 2673-82 | pmid=27195814 | doi=10.1001/jama.2016.7050 | pmc=4988796 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27195814  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=27538175 Review in: Ann Intern Med. 2016 Aug 16;165(4):JC14]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=27872159 Review in: Evid Based Med. 2017 Mar;22(1):30] </ref><ref name="pmid26551272">{{cite journal| author=SPRINT Research Group. Wright JT, Williamson JD, Whelton PK, Snyder JK, Sink KM | display-authors=etal| title=A Randomized Trial of Intensive versus Standard Blood-Pressure Control. | journal=N Engl J Med | year= 2015 | volume= 373 | issue= 22 | pages= 2103-16 | pmid=26551272 | doi=10.1056/NEJMoa1511939 | pmc=4689591 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26551272  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=26882300 Review in: Ann Intern Med. 2016 Feb 16;164(4):JC15]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=27008978 Review in: Evid Based Med. 2016 Jun;21(3):101] </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])'' <nowiki>"</nowiki>

|}

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]

|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' In [[patients]] with [[HFpEF]], [[SGLT2i]] can be beneficial in decreasing [[HF]] [[hospitalizations]] and [[cardiovascular]] [[mortality]]. <ref name="pmid34449189">{{cite journal| author=Anker SD, Butler J, Filippatos G, Ferreira JP, Bocchi E, Böhm M | display-authors=etal| title=Empagliflozin in Heart Failure with a Preserved Ejection Fraction. | journal=N Engl J Med | year= 2021 | volume= 385 | issue= 16 | pages= 1451-1461 | pmid=34449189 | doi=10.1056/NEJMoa2107038 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34449189  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=34978853 Review in: Ann Intern Med. 2022 Jan;175(1):JC4] </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B-R]])'' <nowiki>"</nowiki>

|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' In [[patients]] with [[HFpEF]], [[management]] of [[AF]] can be useful to improve [[symptoms]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-EO]])'' <nowiki>"</nowiki>

|}

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]

|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' In selected [[patients]] with [[HFpEF]], [[MRA]]s may be considered to decrease [[hospitalizations]], particularly among [[patients]] with [[LVEF]] on the lower end of this spectrum. <ref name="pmid24716680">{{cite journal| author=Pitt B, Pfeffer MA, Assmann SF, Boineau R, Anand IS, Claggett B | display-authors=etal| title=Spironolactone for heart failure with preserved ejection fraction. | journal=N Engl J Med | year= 2014 | volume= 370 | issue= 15 | pages= 1383-92 | pmid=24716680 | doi=10.1056/NEJMoa1313731 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24716680  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=25329223 Review in: Ann Intern Med. 2014 Oct 21;161(8):JC6] </ref><ref name="pmid25406305">{{cite journal| author=Pfeffer MA, Claggett B, Assmann SF, Boineau R, Anand IS, Clausell N | display-authors=etal| title=Regional variation in patients and outcomes in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial. | journal=Circulation | year= 2015 | volume= 131 | issue= 1 | pages= 34-42 | pmid=25406305 | doi=10.1161/CIRCULATIONAHA.114.013255 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25406305  }} </ref><ref name="pmid26915374">{{cite journal| author=Solomon SD, Claggett B, Desai AS, Packer M, Zile M, Swedberg K | display-authors=etal| title=Influence of Ejection Fraction on Outcomes and Efficacy of Sacubitril/Valsartan (LCZ696) in Heart Failure with Reduced Ejection Fraction: The Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) Trial. | journal=Circ Heart Fail | year= 2016 | volume= 9 | issue= 3 | pages= e002744 | pmid=26915374 | doi=10.1161/CIRCHEARTFAILURE.115.002744 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26915374  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B-R]])'' <nowiki>"</nowiki>

|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.''' In selected [[patients]] with [[HFpEF]], the use of [[ARB]] may be considered to decrease [[hospitalizations]], particularly among [[patients]] with [[LVEF]] on the lower end of this spectrum. <ref name="pmid13678871">{{cite journal| author=Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ | display-authors=etal| title=Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. | journal=Lancet | year= 2003 | volume= 362 | issue= 9386 | pages= 777-81 | pmid=13678871 | doi=10.1016/S0140-6736(03)14285-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13678871  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=15122853 Review in: ACP J Club. 2004 Mar-Apr;140(2):32-3] </ref><ref name="pmid29431256">{{cite journal| author=Lund LH, Claggett B, Liu J, Lam CS, Jhund PS, Rosano GM | display-authors=etal| title=Heart failure with mid-range ejection fraction in CHARM: characteristics, outcomes and effect of candesartan across the entire ejection fraction spectrum. | journal=Eur J Heart Fail | year= 2018 | volume= 20 | issue= 8 | pages= 1230-1239 | pmid=29431256 | doi=10.1002/ejhf.1149 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29431256  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>

|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''6.''' In selected [[patients]] with [[HFpEF]], [[ARNi]] may be considered to decrease [[hospitalizations]], particularly among [[patients]] with [[LVEF]] on the lower end of this spectrum. <ref name="pmid31475794">{{cite journal| author=Solomon SD, McMurray JJV, Anand IS, Ge J, Lam CSP, Maggioni AP | display-authors=etal| title=Angiotensin-Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction. | journal=N Engl J Med | year= 2019 | volume= 381 | issue= 17 | pages= 1609-1620 | pmid=31475794 | doi=10.1056/NEJMoa1908655 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31475794  }} </ref><ref name="pmid31736342">{{cite journal| author=Solomon SD, Vaduganathan M, L Claggett B, Packer M, Zile M, Swedberg K | display-authors=etal| title=Sacubitril/Valsartan Across the Spectrum of Ejection Fraction in Heart Failure. | journal=Circulation | year= 2020 | volume= 141 | issue= 5 | pages= 352-361 | pmid=31736342 | doi=10.1161/CIRCULATIONAHA.119.044586 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31736342  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=32539517 Review in: Ann Intern Med. 2020 Jun 16;172(12):JC65] </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>
|}

{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)

|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''7.''' In [[patients]] with [[HFpEF]], routine use of [[nitrates]] or [[phosphodiesterase-5 inhibitors]] to increase activity or [[QOL]] is ineffective. <ref name="pmid26549714">{{cite journal| author=Redfield MM, Anstrom KJ, Levine JA, Koepp GA, Borlaug BA, Chen HH | display-authors=etal| title=Isosorbide Mononitrate in Heart Failure with Preserved Ejection Fraction. | journal=N Engl J Med | year= 2015 | volume= 373 | issue= 24 | pages= 2314-24 | pmid=26549714 | doi=10.1056/NEJMoa1510774 | pmc=4712067 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26549714  }} </ref><ref name="pmid23478662">{{cite journal| author=Redfield MM, Chen HH, Borlaug BA, Semigran MJ, Lee KL, Lewis G | display-authors=etal| title=Effect of phosphodiesterase-5 inhibition on exercise capacity and clinical status in heart failure with preserved ejection fraction: a randomized clinical trial. | journal=JAMA | year= 2013 | volume= 309 | issue= 12 | pages= 1268-77 | pmid=23478662 | doi=10.1001/jama.2013.2024 | pmc=3835156 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23478662  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B-R]])'' <nowiki>"</nowiki>

|}

==Related Chapters==
* [[The Living Guidelines: Diagnosis and Management of Chronic Heart Failure | The CHF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]

==External Links==
*[https://www.ahajournals.org/doi/epub/10.1161/CIR.0000000000001063.full.pdf 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines]<ref name="pmid35363499">{{cite journal |vauthors=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW |title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines |journal=Circulation |volume=145 |issue=18 |pages=e895–e1032 |date=May 2022 |pmid=35363499 |doi=10.1161/CIR.0000000000001063 |url=}} </ref>

*[http://circ.ahajournals.org/content/early/2013/06/03/CIR.0b013e31829e8807.full.pdf 2013 ACCF/AHA Guideline for the Management of Heart Failure]<ref name="pmid23747642">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE et al.| title=2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 |volume=  | issue=  | pages=  | pmid=23747642 | doi=10.1016/j.jacc.2013.05.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23747642  }} </ref>

*[http://content.onlinejacc.org/cgi/reprint/53/15/1343.pdf 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation] <ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016.[http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>

*[http://circ.ahajournals.org/content/112/12/e154.full.pdf The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult] <ref name="pmid16160202">Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG et al. (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16160202 ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society.] ''Circulation'' 112 (12):e154-235. [http://dx.doi.org/10.1161/CIRCULATIONAHA.105.167586 DOI:10.1161/CIRCULATIONAHA.105.167586]PMID: [http://pubmed.gov/16160202 16160202]</ref>

==References==
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