Congestive heart failure implantation of intracardiac defibrillator

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Obstructive Sleep Apnea in the Patient with CHF
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Editor(s)-In-Chief: James Chang, M.D., Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School [1] and C. Michael Gibson, M.S., M.D. [2], Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [3] Edzel Lorraine Co, DMD, MD[4]

Overview

Fifty percent of patients with heart failure die of sudden cardiac death. ICDs are indicated for patients with previous myocardial infarction and an LVEF <30%, sustained ventricular tachycardia, inducible ventricular tachycardia. The morbidity and mortality benefit of ICD placement compared with anti-arrhythmic drug therapy is controversial.

Indications for an Intracardiac Defibrillator

1. The left ventricular ejection fraction (LVEF) is ≤ 35% [1]

and

2. NYHA class II/III

OR

1. The left ventricular ejection fraction (LVEF) is ≤ 30%

and

2. There is a prior history of myocardial infarction (MI) [2]

Background

  • ICD implantation has NOT been demonstrated to prolong life in patients who are severely symptomatic or otherwise profoundly debilitated (NYHA class IV).

2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) [3]

ICDs and CRTs

Class I
"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. [4][5][6][7][8][9][10][1][11](Level of Evidence: A) "
Value Statement:High Value
"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. [12][13][14][15][16][17] (Level of Evidence: A) "
Class I
"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. [2] (Level of Evidence: B-R) "
"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.[18][19][20][21][22][23] (Level of Evidence: B-R) "
Value Statement:High Value
"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. [24][25][26][27][28][29] (Level of Evidence: B-NR) "
Class IIa
"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. [18][19][20][21][22][23][30][31][32][33][34][35] (Level of Evidence: B-R) "
"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. [36][37] (Level of Evidence: B-R) "
"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. [18][19][20][21][22][23][30][31][32][33][34][35] (Level of Evidence: B-NR) "
"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. [18][19][20][21][22][23][30][31][32][33][34][35] (Level of Evidence: B-NR) "
"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. [18][19][20][21][22][23][30][31][32][33][34][35] (Level of Evidence: B-NR) "
"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. [38][39](Level of Evidence: B-NR) "
Class IIb
"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. [18][19][20][21][22][23][30][31][32][33][34][35] (Level of Evidence: B-R) "
"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. [18][19][20][21][22][23][30][31][32][33][34][35] (Level of Evidence: B-R) "
Class III (No Benefit)
"14. In patients with QRS duration < 120 ms, CRT is not recommended. [38][39][40][41][42][43](Level of Evidence: B-R) "
"15. For patients with NYHA class I or II symptoms and non-LBBB pattern with QRS durati150 ms, CRT is not recommended.[18][19][20][21][22][23][30][31][32][33][34][5][6][7][8][9][10][1][11][18][19][20][21][22][23] (Level of Evidence: C-LD) "

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External Links

References

  1. ↑ 1.0 1.1 1.2 Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, Domanski M, Troutman C, Anderson J, Johnson G, McNulty SE, Clapp-Channing N, Davidson-Ray LD, Fraulo ES, Fishbein DP, Luceri RM, Ip JH (2005). "Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure". The New England Journal of Medicine. 352 (3): 225–37. doi:10.1056/NEJMoa043399. PMID 15659722. Retrieved 2012-04-03. Unknown parameter |month= ignored (help)
  2. ↑ 2.0 2.1 Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW, Andrews ML (2002). "Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction". The New England Journal of Medicine. 346 (12): 877–83. doi:10.1056/NEJMoa013474. PMID 11907286. Retrieved 2012-04-03. Unknown parameter |month= ignored (help)
  3. ↑ Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM; et al. (2022). "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". Circulation. 145 (18): e876–e894. doi:10.1161/CIR.0000000000001062. PMID 35363500 Check |pmid= value (help).
  4. ↑ Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators (1997). "A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias". N Engl J Med. 337 (22): 1576–83. doi:10.1056/NEJM199711273372202. PMID 9411221.
  5. ↑ 5.0 5.1 Kuck KH, Cappato R, Siebels J, Rüppel R (2000). "Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest : the Cardiac Arrest Study Hamburg (CASH)". Circulation. 102 (7): 748–54. doi:10.1161/01.cir.102.7.748. PMID 10942742.
  6. ↑ 6.0 6.1 Connolly SJ, Gent M, Roberts RS, Dorian P, Roy D, Sheldon RS; et al. (2000). "Canadian implantable defibrillator study (CIDS) : a randomized trial of the implantable cardioverter defibrillator against amiodarone". Circulation. 101 (11): 1297–302. doi:10.1161/01.cir.101.11.1297. PMID 10725290.
  7. ↑ 7.0 7.1 Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H; et al. (1996). "Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators". N Engl J Med. 335 (26): 1933–40. doi:10.1056/NEJM199612263352601. PMID 8960472.
  8. ↑ 8.0 8.1 Buxton AE, Lee KL, Fisher JD, Josephson ME, Prystowsky EN, Hafley G (1999). "A randomized study of the prevention of sudden death in patients with coronary artery disease. Multicenter Unsustained Tachycardia Trial Investigators". N Engl J Med. 341 (25): 1882–90. doi:10.1056/NEJM199912163412503. PMID 10601507.
  9. ↑ 9.0 9.1 Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS; et al. (2002). "Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction". N Engl J Med. 346 (12): 877–83. doi:10.1056/NEJMoa013474. PMID 11907286 : 11907286 Check |pmid= value (help). Review in: ACP J Club. 2002 Nov-Dec;137(3):81
  10. ↑ 10.0 10.1 Kadish A, Dyer A, Daubert JP, Quigg R, Estes NA, Anderson KP; et al. (2004). "Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy". N Engl J Med. 350 (21): 2151–8. doi:10.1056/NEJMoa033088. PMID 15152060. Review in: ACP J Club. 2004 Nov-Dec;141(3):61
  11. ↑ 11.0 11.1 Køber L, Thune JJ, Nielsen JC, Haarbo J, Videbæk L, Korup E; et al. (2016). "Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure". N Engl J Med. 375 (13): 1221–30. doi:10.1056/NEJMoa1608029. PMID 27571011. Review in: Ann Intern Med. 2016 Nov 15;165(10 ):JC55
  12. ↑ Al-Khatib SM, Anstrom KJ, Eisenstein EL, Peterson ED, Jollis JG, Mark DB; et al. (2005). "Clinical and economic implications of the Multicenter Automatic Defibrillator Implantation Trial-II". Ann Intern Med. 142 (8): 593–600. doi:10.7326/0003-4819-142-8-200504190-00007. PMID 15838065.
  13. ↑ Cowie MR, Marshall D, Drummond M, Ferko N, Maschio M, Ekman M; et al. (2009). "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". Europace. 11 (6): 716–26. doi:10.1093/europace/eup068. PMID 19359333.
  14. ↑ Mark DB, Nelson CL, Anstrom KJ, Al-Khatib SM, Tsiatis AA, Cowper PA; et al. (2006). "Cost-effectiveness of defibrillator therapy or amiodarone in chronic stable heart failure: results from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT)". Circulation. 114 (2): 135–42. doi:10.1161/CIRCULATIONAHA.105.581884. PMID 16818817.
  15. ↑ Mushlin AI, Hall WJ, Zwanziger J, Gajary E, Andrews M, Marron R; et al. (1998). "The cost-effectiveness of automatic implantable cardiac defibrillators: results from MADIT. Multicenter Automatic Defibrillator Implantation Trial". Circulation. 97 (21): 2129–35. doi:10.1161/01.cir.97.21.2129. PMID 9626173.
  16. ↑ Sanders GD, Hlatky MA, Owens DK (2005). "Cost-effectiveness of implantable cardioverter-defibrillators". N Engl J Med. 353 (14): 1471–80. doi:10.1056/NEJMsa051989. PMID 16207849. Review in: ACP J Club. 2006 Mar-Apr;144(2):52
  17. ↑ Zwanziger J, Hall WJ, Dick AW, Zhao H, Mushlin AI, Hahn RM; et al. (2006). "The cost effectiveness of implantable cardioverter-defibrillators: results from the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II". J Am Coll Cardiol. 47 (11): 2310–8. doi:10.1016/j.jacc.2006.03.032. PMID 16750701.
  18. ↑ 18.0 18.1 18.2 18.3 18.4 18.5 18.6 18.7 18.8 Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E; et al. (2002). "Cardiac resynchronization in chronic heart failure". N Engl J Med. 346 (24): 1845–53. doi:10.1056/NEJMoa013168. PMID 12063368. Review in: ACP J Club. 2002 Nov-Dec;137(3):82
  19. ↑ 19.0 19.1 19.2 19.3 19.4 19.5 19.6 19.7 19.8 Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T; et al. (2004). "Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure". N Engl J Med. 350 (21): 2140–50. doi:10.1056/NEJMoa032423. PMID 15152059. Review in: ACP J Club. 2004 Nov-Dec;141(3):60
  20. ↑ 20.0 20.1 20.2 20.3 20.4 20.5 20.6 20.7 20.8 Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L; et al. (2005). "The effect of cardiac resynchronization on morbidity and mortality in heart failure". N Engl J Med. 352 (15): 1539–49. doi:10.1056/NEJMoa050496. PMID 15753115. Review in: ACP J Club. 2005 Sep-Oct;143(2):29
  21. ↑ 21.0 21.1 21.2 21.3 21.4 21.5 21.6 21.7 21.8 Linde C, Abraham WT, Gold MR, St John Sutton M, Ghio S, Daubert C; et al. (2008). "Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms". J Am Coll Cardiol. 52 (23): 1834–1843. doi:10.1016/j.jacc.2008.08.027. PMID 19038680.
  22. ↑ 22.0 22.1 22.2 22.3 22.4 22.5 22.6 22.7 22.8 Goldenberg I, Kutyifa V, Klein HU, Cannom DS, Brown MW, Dan A; et al. (2014). "Survival with cardiac-resynchronization therapy in mild heart failure". N Engl J Med. 370 (18): 1694–701. doi:10.1056/NEJMoa1401426. PMID 24678999.
  23. ↑ 23.0 23.1 23.2 23.3 23.4 23.5 23.6 23.7 23.8 Tang AS, Wells GA, Talajic M, Arnold MO, Sheldon R, Connolly S; et al. (2010). "Cardiac-resynchronization therapy for mild-to-moderate heart failure". N Engl J Med. 363 (25): 2385–95. doi:10.1056/NEJMoa1009540. PMID 21073365. Review in: Evid Based Med. 2011 Oct;16(5):138-9
  24. ↑ Feldman AM, de Lissovoy G, Bristow MR, Saxon LA, De Marco T, Kass DA; et al. (2005). "Cost effectiveness of cardiac resynchronization therapy in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) trial". J Am Coll Cardiol. 46 (12): 2311–21. doi:10.1016/j.jacc.2005.08.033. PMID 16360064.
  25. ↑ Gold MR, Padhiar A, Mealing S, Sidhu MK, Tsintzos SI, Abraham WT (2017). "Economic Value and Cost-Effectiveness of Cardiac Resynchronization Therapy Among Patients With Mild Heart Failure: Projections From the REVERSE Long-Term Follow-Up". JACC Heart Fail. 5 (3): 204–212. doi:10.1016/j.jchf.2016.10.014. PMID 28254126.
  26. ↑ Heerey A, Lauer M, Alsolaiman F, Czerr J, James K (2006). "Cost effectiveness of biventricular pacemakers in heart failure patients". Am J Cardiovasc Drugs. 6 (2): 129–37. doi:10.2165/00129784-200606020-00007. PMID 16555866.
  27. ↑ Nichol G, Kaul P, Huszti E, Bridges JF (2004). "Cost-effectiveness of cardiac resynchronization therapy in patients with symptomatic heart failure". Ann Intern Med. 141 (5): 343–51. doi:10.7326/0003-4819-141-5-200409070-00102. PMID 15353425.
  28. ↑ Noyes K, Veazie P, Hall WJ, Zhao H, Buttaccio A, Thevenet-Morrison K; et al. (2013). "Cost-effectiveness of cardiac resynchronization therapy in the MADIT-CRT trial". J Cardiovasc Electrophysiol. 24 (1): 66–74. doi:10.1111/j.1540-8167.2012.02413.x. PMC 3711178. PMID 22913474.
  29. ↑ Woo CY, Strandberg EJ, Schmiegelow MD, Pitt AL, Hlatky MA, Owens DK; et al. (2015). "Cost-Effectiveness of Adding Cardiac Resynchronization Therapy to an Implantable Cardioverter-Defibrillator Among Patients With Mild Heart Failure". Ann Intern Med. 163 (6): 417–26. doi:10.7326/M14-1804. PMC 8105088 Check |pmc= value (help). PMID 26301323. Review in: Evid Based Med. 2016 Jun;21(3):88
  30. ↑ 30.0 30.1 30.2 30.3 30.4 30.5 30.6 Sipahi I, Chou JC, Hyden M, Rowland DY, Simon DI, Fang JC (2012). "Effect of QRS morphology on clinical event reduction with cardiac resynchronization therapy: meta-analysis of randomized controlled trials". Am Heart J. 163 (2): 260–7.e3. doi:10.1016/j.ahj.2011.11.014. PMC 4113034. PMID 22305845.
  31. ↑ 31.0 31.1 31.2 31.3 31.4 31.5 31.6 Gervais R, Leclercq C, Shankar A, Jacobs S, Eiskjaer H, Johannessen A; et al. (2009). "Surface electrocardiogram to predict outcome in candidates for cardiac resynchronization therapy: a sub-analysis of the CARE-HF trial". Eur J Heart Fail. 11 (7): 699–705. doi:10.1093/eurjhf/hfp074. PMID 19505883.
  32. ↑ 32.0 32.1 32.2 32.3 32.4 32.5 32.6 Zareba W, Klein H, Cygankiewicz I, Hall WJ, McNitt S, Brown M; et al. (2011). "Effectiveness of Cardiac Resynchronization Therapy by QRS Morphology in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT)". Circulation. 123 (10): 1061–72. doi:10.1161/CIRCULATIONAHA.110.960898. PMID 21357819.
  33. ↑ 33.0 33.1 33.2 33.3 33.4 33.5 33.6 Gold MR, Thébault C, Linde C, Abraham WT, Gerritse B, Ghio S; et al. (2012). "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". Circulation. 126 (7): 822–9. doi:10.1161/CIRCULATIONAHA.112.097709. PMID 22781424.
  34. ↑ 34.0 34.1 34.2 34.3 34.4 34.5 34.6 Birnie DH, Ha A, Higginson L, Sidhu K, Green M, Philippon F; et al. (2013). "Impact of QRS morphology and duration on outcomes after cardiac resynchronization therapy: Results from the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT)". Circ Heart Fail. 6 (6): 1190–8. doi:10.1161/CIRCHEARTFAILURE.113.000380. PMID 23995437.
  35. ↑ 35.0 35.1 35.2 35.3 35.4 35.5 Nery PB, Ha AC, Keren A, Birnie DH (2011). "Cardiac resynchronization therapy in patients with left ventricular systolic dysfunction and right bundle branch block: a systematic review". Heart Rhythm. 8 (7): 1083–7. doi:10.1016/j.hrthm.2011.01.041. PMID 21300176.
  36. ↑ Curtis AB (2013). "Biventricular pacing for atrioventricular block and systolic dysfunction". N Engl J Med. 369 (6): 579. doi:10.1056/NEJMc1306998. PMID 23924013.
  37. ↑ Doshi RN, Daoud EG, Fellows C, Turk K, Duran A, Hamdan MH; et al. (2005). "Left ventricular-based cardiac stimulation post AV nodal ablation evaluation (the PAVE study)". J Cardiovasc Electrophysiol. 16 (11): 1160–5. doi:10.1111/j.1540-8167.2005.50062.x. PMID 16302897.
  38. ↑ 38.0 38.1 Pugh TJ, Kelly MA, Gowrisankar S, Hynes E, Seidman MA, Baxter SM; et al. (2014). "The landscape of genetic variation in dilated cardiomyopathy as surveyed by clinical DNA sequencing". Genet Med. 16 (8): 601–8. doi:10.1038/gim.2013.204. PMID 24503780.
  39. ↑ 39.0 39.1 Gigli M, Merlo M, Graw SL, Barbati G, Rowland TJ, Slavov DB; et al. (2019). "Genetic Risk of Arrhythmic Phenotypes in Patients With Dilated Cardiomyopathy". J Am Coll Cardiol. 74 (11): 1480–1490. doi:10.1016/j.jacc.2019.06.072. PMC 6750731 Check |pmc= value (help). PMID 31514951.
  40. ↑ Towbin JA, McKenna WJ, Abrams DJ, Ackerman MJ, Calkins H, Darrieux FCC; et al. (2019). "2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy". Heart Rhythm. 16 (11): e301–e372. doi:10.1016/j.hrthm.2019.05.007. PMID 31078652.
  41. ↑ Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP; et al. (2009). "Cardiac-resynchronization therapy for the prevention of heart-failure events". N Engl J Med. 361 (14): 1329–38. doi:10.1056/NEJMoa0906431. PMID 19723701.
  42. ↑ Beshai JF, Grimm RA, Nagueh SF, Baker JH, Beau SL, Greenberg SM; et al. (2007). "Cardiac-resynchronization therapy in heart failure with narrow QRS complexes". N Engl J Med. 357 (24): 2461–71. doi:10.1056/NEJMoa0706695. PMID 17986493.
  43. ↑ Ruschitzka F, Abraham WT, Singh JP, Bax JJ, Borer JS, Brugada J; et al. (2013). "Cardiac-resynchronization therapy in heart failure with a narrow QRS complex". N Engl J Med. 369 (15): 1395–405. doi:10.1056/NEJMoa1306687. PMID 23998714.
  44. ↑ 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
  45. ↑ Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) 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. DOI:10.1161/CIRCULATIONAHA.109.192064 PMID: 19324967

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