View source for Congestive heart failure treatment of patients at high risk for developing heart failure (Stage A)

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{{Congestive heart failure}}
{{CMG}}; {{AOEIC}} Saleh El Dassouki, M.D. [mailto:seldassouki@hotmail.com]; {{LG}}{{MS}},{{MehdiP}}, [[User:Edzelco|Edzel Lorraine Co, D.M.D., M.D.]] [Mailto:efco@alum.up.edu.ph] 


==Overview==
Early detection and mitigation of risk factors associated with the subsequent development of [[heart failure]] may have a tremendous impact on public and individual health.

==Treatment of Hypertension==
Controlling both systolic and diastolic hypertension has been associated with a significant reduction in the risk of subsequent HF.<ref name="pmid9218667">{{cite journal |author=Kostis JB, Davis BR, Cutler J, Grimm RH, Berge KG, Cohen JD, Lacy CR, Perry HM, Blaufox MD, Wassertheil-Smoller S, Black HR, Schron E, Berkson DM, Curb JD, Smith WM, McDonald R, Applegate WB |title=Prevention of heart failure by antihypertensive drug treatment in older persons with isolated systolic hypertension. SHEP Cooperative Research Group |journal=[[JAMA : the Journal of the American Medical Association]] |volume=278 |issue=3 |pages=212–6 |year=1997 |month=July |pmid=9218667 |doi= |url= |accessdate=2011-03-28}}</ref> Control of [[systolic blood pressure]] is consistently associated with a 50% reduction in new [[heart failure]].  Other complications of [[hypertension]] include [[left ventricular hypertrophy]] ([[LVH]]), [[MI]], [[stroke]] and [[sudden death]].<ref name="pmid20424973">{{cite journal |author=Swamy RS, Lang RM |title=Echocardiographic quantification of left ventricular mass: prognostic implications |journal=[[Current Cardiology Reports]] |volume=12 |issue=3 |pages=277–82 |year=2010 |month=May |pmid=20424973 |doi=10.1007/s11886-010-0104-y |url=http://dx.doi.org/10.1007/s11886-010-0104-y |accessdate=2011-03-28}}</ref>In the Framingham heart study, [[hypertension]] was present in 39% of men and in 59% of women with [[heart failure]]. These numbers emphasize the importance of managing hypertension at an early stage to avoid complications such as heart failure.

Lowering both systolic and [[diastolic blood pressure]] in accordance with the recommendations provided in published guidelines has proven its effectiveness in lowering [[systemic vascular resistance]], improving [[ventricular remodeling]] and decreasing hemodynamic load on the failing ventricle in patients with established [[heart failure]]. The treatment of [[hypertension]] in patients with HF should take into consideration the type of heart failure that is present: In [[systolic dysfunction]] the biggest problem is the impaired contractility whereas in [[diastolic dysfunction]], the main issue is the limitation of diastolic filling and therefore abnormal forward [[cardiac output]] due to increased ventricular stiffness.

When any anti-hypertensive regimen is prescribed, an important aspect to keep in mind is the presence of concomitant medical problems as CAD, diabetes, renal disease, pulmonary disease in many patients suffering from HF, which requires the health care providers to keep in mind the priority of lowering blood pressure while trying not to affect the treatment of those diseases.

Diuretic-based antihypertensive therapy has repeatedly been shown to prevent HF in a wide range of target populations.<ref name="pmid12777939">{{cite journal |author=Staessen JA, Wang JG, Thijs L |title=Cardiovascular prevention and blood pressure reduction: a quantitative overview updated until 1 March 2003 |journal=[[Journal of Hypertension]] |volume=21 |issue=6 |pages=1055–76 |year=2003 |month=June |pmid=12777939 |doi=10.1097/01.hjh.0000059044.65882.db |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0263-6352&volume=21&issue=6&spage=1055 |accessdate=2011-03-28}}</ref>Patients may also benefit from the usage of [[ACE inhibitors]]([[ACEIs]]) and [[beta blockers]], which are proven to be effective in preventing HF in hypertensive individuals. However, ACEIs and beta blockers, as single therapies, are not superior to other antihypertensive drug classes in the reduction of all cardiovascular outcomes.

Nevertheless, among patients with diabetes and other cardiovascular complications, ACEIs have shown to reduce the onset of HF and progression of [[nephropathy]].<ref name="pmid13678872">{{cite journal |author=Fox KM |title=Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study) |journal=[[Lancet]] |volume=362 |issue=9386 |pages=782–8 |year=2003 |month=September |pmid=13678872 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0140673603142869 |accessdate=2011-03-28}}</ref>Another significant reduction of HF incidence in comparison to placebo in patients with type 2 diabetes mellitus and nephropathy has been achieved by the usage of ARB’s losartan and irbesartan.<ref name="pmid12667024">{{cite journal |author=Berl T, Hunsicker LG, Lewis JB, Pfeffer MA, Porush JG, Rouleau JL, Drury PL, Esmatjes E, Hricik D, Parikh CR, Raz I, Vanhille P, Wiegmann TB, Wolfe BM, Locatelli F, Goldhaber SZ, Lewis EJ |title=Cardiovascular outcomes in the Irbesartan Diabetic Nephropathy Trial of patients with type 2 diabetes and overt nephropathy |journal=[[Annals of Internal Medicine]] |volume=138 |issue=7 |pages=542–9 |year=2003 |month=April |pmid=12667024 |doi= |url=http://www.annals.org/cgi/pmidlookup?view=long&pmid=12667024 |accessdate=2011-03-28}}</ref>
As previously mentioned an ultimate and appropriate hypertensive treatment would take into consideration all the concomitant diseases in an HF patient, and would involve multiple drugs used in combination.

==Treatment of Diabetes Mellitus==
Diabetes increases the risk of HF in all patients groups whether [[coronary heart disease]] or [[hypertension]] is present and it may cause [[cardiomyopathy]].<ref name="pmid11940554">{{cite journal |author=Taegtmeyer H, McNulty P, Young ME |title=Adaptation and maladaptation of the heart in diabetes: Part I: general concepts |journal=[[Circulation]] |volume=105 |issue=14 |pages=1727–33 |year=2002 |month=April |pmid=11940554 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=11940554 |accessdate=2011-03-29}}</ref> A gender difference in terms of HF risk in diabetic patients is present, since the increase of HF for diabetic men is 3 times less than that for a diabetic woman.<ref name="pmid8622246">{{cite journal |author=Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK |title=The progression from hypertension to congestive heart failure |journal=[[JAMA : the Journal of the American Medical Association]] |volume=275 |issue=20 |pages=1557–62 |year=1996 |pmid=8622246 |doi= |url= |accessdate=2011-03-29}}</ref> In a study of patients with type 2 [[diabetes mellitus]] over 50 years old, with urinary [[albumin]] greater than 20 mg/l, 4% of patients developed HF over the study period, of whom 36 % died.<ref name="pmid12610049">{{cite journal |author=Vaur L, Gueret P, Lievre M, Chabaud S, Passa P |title=Development of congestive heart failure in type 2 diabetic patients with microalbuminuria or proteinuria: observations from the DIABHYCAR (type 2 DIABetes, Hypertension, CArdiovascular Events and Ramipril) study |journal=[[Diabetes Care]] |volume=26 |issue=3 |pages=855–60 |year=2003 |month=March |pmid=12610049 |doi= |url=http://care.diabetesjournals.org/cgi/pmidlookup?view=long&pmid=12610049 |accessdate=2011-03-29}}</ref> Health care providers should closely monitor [[hyperglycemia]] and target a certain blood glucose level to avoid end-organ complications in such patients since each 1% increase in [[(Hb)A1c]] is associated with an 8% increase risk of [[heart failure]], and an [[(Hb)A1c]] > 10 increases the risk of CHF by 1.56 compared to an [[(Hb)A1c]] less than 7 <ref name="pmid8416309">{{cite journal |author=Kasiske BL, Kalil RS, Ma JZ, Liao M, Keane WF |title=Effect of antihypertensive therapy on the kidney in patients with [[diabetes]]: a meta-regression analysis |journal=[[Annals of Internal Medicine]] |volume=118 |issue=2 |pages=129–38 |year=1993 |month=January |pmid=8416309 |doi= |url=http://www.annals.org/cgi/pmidlookup?view=long&pmid=8416309 |accessdate=2011-03-29}}</ref><ref name="pmid8413456">{{cite journal |author=Lewis EJ, Hunsicker LG, Bain RP, Rohde RD |title=The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. The Collaborative Study Group |journal=[[The New England Journal of Medicine]] |volume=329 |issue=20 |pages=1456–62 |year=1993 |month=November |pmid=8413456 |doi=10.1056/NEJM199311113292004 |url=http://dx.doi.org/10.1056/NEJM199311113292004 |accessdate=2011-03-29}}</ref>[[ACEIs]] and [[ARBs]] have been proven to reduce the development of end-organ disease and the occurrence of clinical events in diabetic patients even when [[hypertension]] is not present.  Long term treatment with ACEIs and ARBs has been shown to lower various dangerous complications in diabetic patients such as renal disease and prolonged treatment with ACEI [[ramipril]] has been shown to decrease the event of cardiovascular death, [[MI]], and [[CHF]]. Long term therapy with ARBs has also been proven to lower cardiovascular complication, decreasing the incidence of first HF hospitalization and improving renal function in diabetic patients.<ref name="pmid">{{cite journal |author=Fox KM |title=Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study) |journal=[[Lancet]] |volume=362 |issue=9386 |pages=782–8 |year=2003 |month=September |pmid= |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0140673603142869 |accessdate=2011-03-29}}</ref>

==Management of Metabolic Syndrome==
The [[metabolic syndrome]] or [[syndrome X]] is mainly linked to [[obesity]] (mainly abdominal obesity), [[insulin resistance]], [[hypertriglyceridemia]], [[HDL|low HDL]], [[hypertension]] and [[fasting hyperglycemia]]. Those combined metabolic risks promotes vascular [[endothelial dysfunction]], vascular inflammation and thus, the development of [[atherosclerotic cardiovascular disease]].<ref name="pmid14504251">{{cite journal |author=Wilson PW, Grundy SM |title=The metabolic syndrome: practical guide to origins and treatment: Part I |journal=[[Circulation]] |volume=108 |issue=12 |pages=1422–4 |year=2003 |month=September |pmid=14504251 |doi=10.1161/01.CIR.0000089505.34741.E5 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=14504251 |accessdate=2011-03-30}}</ref> The major complication of metabolic syndrome is [[coronary artery disease]] which in turn increases the incidence of [[congestive heart failure]] in the general population;<ref name="pmid15358046">{{cite journal |author=Grundy SM, Cleeman JI, Merz CN, Brewer HB, Clark LT, Hunninghake DB, Pasternak RC, Smith SC, Stone NJ |title=Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines |journal=[[Journal of the American College of Cardiology]] |volume=44 |issue=3 |pages=720–32 |year=2004 |month=August |pmid=15358046 |doi=10.1016/j.jacc.2004.07.001 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109704013312 |accessdate=2011-03-30}}</ref> For this reason, the appropriate management of [[hypertension]], [[diabetes mellitus]], and [[dyslipedemia]] can significantly reduce the risk of developing CHF.

==Management of Anemia==
Routine baseline assessment of all patients with HF includes an evaluation for anemia in addition to other baseline laboratory measurements. [[Anemia]] is independently associated with HF disease severity, and iron deficiency appears to be uniquely associated with reduced exercise capacity. When iron deficiency is diagnosed and after full evaluation for cause, [[intravenous]] repletion of iron, especially in the setting of concomitant [[hepcidin]] deficiency in HF, may improve exercise capacity and quality of life.

==Management of Atherosclerotic Disease==
Atherosclerotic diseases (eg., of the coronary, cerebral, peripheral blood vessels) are an important risk factor in the development of [[CHF]].<ref name="pmid11571256">{{cite journal |author=Smith SC, Blair SN, Bonow RO, Brass LM, Cerqueira MD, Dracup K, Fuster V, Gotto A, Grundy SM, Miller NH, Jacobs A, Jones D, Krauss RM, Mosca L, Ockene I, Pasternak RC, Pearson T, Pfeffer MA, Starke RD, Taubert KA |title=AHA/ACC Scientific Statement: AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 update: A statement for healthcare professionals from the American Heart Association and the American College of Cardiology |journal=[[Circulation]] |volume=104 |issue=13 |pages=1577–9 |year=2001 |month=September |pmid=11571256 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=11571256 |accessdate=2011-03-30}}</ref> A series of different large scale studies involving the long term usage of ACEIs, produced mixed data and recommendations.<ref name="pmid10639539">{{cite journal |author=Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G |title=Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators |journal=[[The New England Journal of Medicine]] |volume=342 |issue=3 |pages=145–53 |year=2000 |month=January |pmid=10639539 |doi=10.1056/NEJM200001203420301 |url=http://dx.doi.org/10.1056/NEJM200001203420301 |accessdate=2011-03-30}}</ref> In one study, the treatment with ACEIs proved to decrease the risk of the primary endpoint of cardiovascular death, [[MI]] and [[stroke]] in patients with previous vascular disease who were without evidence of HF or reduced [[LVEF]] at the time of randomization, but the incidence of HF was not a primary or secondary endpoint, although it was improved.<ref name="pmid13678872">{{cite journal |author=Fox KM |title=Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study) |journal=[[Lancet]] |volume=362 |issue=9386 |pages=782–8 |year=2003 |month=September |pmid=13678872 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0140673603142869 |accessdate=2011-03-30}}</ref> A more recent trial of ACEIs versus placebo didn’t prove to be effective in reducing the primary composite endpoint, although a post hoc analysis did show a decrease in HF hospitalization.

Those various findings led the AHA to change the level of recommendation for the use of ACEIs for stage A patients from Class 1 to Class 2a<ref name="pmid15531767">{{cite journal |author=Braunwald E, Domanski MJ, Fowler SE, Geller NL, Gersh BJ, Hsia J, Pfeffer MA, Rice MM, Rosenberg YD, Rouleau JL |title=Angiotensin-converting-enzyme inhibition in stable coronary artery disease |journal=[[The New England Journal of Medicine]] |volume=351 |issue=20 |pages=2058–68 |year=2004 |month=November |pmid=15531767 |pmc=2556374 |doi=10.1056/NEJMoa042739 |url=http://dx.doi.org/10.1056/NEJMoa042739 |accessdate=2011-03-30}}</ref>. Treatment of [[hyperlipidemia]] has also been shown to reduce the risk of death and of HF in patients with a history of [[MI]].
==Sleep Disordered Breathing==
Sleep disorders are common in patients with HF. A study of adults with chronic HF treated with evidence-based therapies found that 61% had either central or obstructive sleep apnea. It is clinically important to distinguish obstructive sleep apnea from central sleep apnea, given the different responses to treatment. Adaptive servo-ventilation for central sleep apnea is associated with harm. Continuous positive airway pressure (CPAP) for obstructive sleep apnea improves sleep quality, reduces the apnea-hypopnea index, and improves nocturnal oxygenation.<ref name="pmid17562959">{{cite journal |vauthors=Arzt M, Floras JS, Logan AG, Kimoff RJ, Series F, Morrison D, Ferguson K, Belenkie I, Pfeifer M, Fleetham J, Hanly P, Smilovitch M, Ryan C, Tomlinson G, Bradley TD |title=Suppression of central sleep apnea by continuous positive airway pressure and transplant-free survival in heart failure: a post hoc analysis of the Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure Trial (CANPAP) |journal=Circulation |volume=115 |issue=25 |pages=3173–80 |year=2007 |pmid=17562959 |doi=10.1161/CIRCULATIONAHA.106.683482 |url=}}</ref><ref name="pmid16282183">{{cite journal |vauthors=Somers VK |title=Sleep--a new cardiovascular frontier |journal=N. Engl. J. Med. |volume=353 |issue=19 |pages=2070–3 |year=2005 |pmid=16282183 |doi=10.1056/NEJMe058229 |url=}}</ref> 
==Control of Conditions That May Cause Heart Failure==
Cardiotoxic effect of various agents and substances should be closely controlled, especially in patients at higher risk of developing HF. [[Smoking]], [[alcohol]], [[amphetamines]], [[cocaine]] and other illicit drugs are some of the most common substances that patients should be advised about. Several HF programs limit alcoholic beverage consumption to no more than one alcoholic beverage a day for all the patients with LV dysfunction, regardless of cause<ref name="pmid11308433">{{cite journal |author=Abramson JL, Williams SA, Krumholz HM, Vaccarino V |title=Moderate alcohol consumption and risk of heart failure among older persons |journal=[[JAMA : the Journal of the American Medical Association]] |volume=285 |issue=15 |pages=1971–7 |year=2001 |month=April |pmid=11308433 |doi= |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=11308433 |accessdate=2011-04-01}}</ref>. Cardiac injuries could be sustained from other causes and interventions, such as ionizing radiation involving the mediastinum, [[chemotherapeutic agents]] such as [[anthracyclines]], immunotherapy such as [[trastuzumab]], or high dose-[[cyclophosphamide]].<ref name="pmid11301371">{{cite journal |author=Sparano JA |title=Cardiac toxicity of trastuzumab (Herceptin): implications for the design of adjuvant trials |journal=[[Seminars in Oncology]] |volume=28 |issue=1 Suppl 3 |pages=20–7 |year=2001 |month=February |pmid=11301371 |doi= |url= |accessdate=2011-04-01}}</ref> Trastuzumab in particular when combined with [[anthracyclines]] increase the risk of HF and may occur years after the initial exposure.

==2022 AHA/ACC/HFSA Heart Failure Guideline/ 2013 ACC/AHA Guideline/ 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure/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>==


===[[Patients]] at High Risk of [[HF]] (Stage A: [[Primary Prevention]]) (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>===

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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In [[patients]] with [[hypertension]], [[blood pressure]] should be controlled in accordance with GDMT for [[hypertension]] to prevent [[symptomatic]] [[HF]]. <ref name="pmid18378519">{{cite journal| author=Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D | display-authors=etal| title=Treatment of hypertension in patients 80 years of age or older. | journal=N Engl J Med | year= 2008 | volume= 358 | issue= 18 | pages= 1887-98 | pmid=18378519 | doi=10.1056/NEJMoa0801369 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18378519  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=18697287 Review in: J Fam Pract. 2008 Aug;57(8):506-7]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=18710183 Review in: ACP J Club. 2008 Aug 19;149(2):10]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=18836104 Review in: Evid Based Med. 2008 Oct;13(5):136] </ref><ref name="pmid26724178">{{cite journal| author=Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J | display-authors=etal| title=Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. | journal=Lancet | year= 2016 | volume= 387 | issue= 10022 | pages= 957-967 | pmid=26724178 | doi=10.1016/S0140-6736(15)01225-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26724178  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=27388797 Review in: Evid Based Med. 2016 Oct;21(5):172] </ref><ref name="pmid9218667">{{cite journal| author=Kostis JB, Davis BR, Cutler J, Grimm RH, Berge KG, Cohen JD | display-authors=etal| title=Prevention of heart failure by antihypertensive drug treatment in older persons with isolated systolic hypertension. SHEP Cooperative Research Group. | journal=JAMA | year= 1997 | volume= 278 | issue= 3 | pages= 212-6 | pmid=9218667 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9218667  }} </ref><ref name="pmid9297994">{{cite journal| author=Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, Birkenhäger WH | display-authors=etal| title=Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. | journal=Lancet | year= 1997 | volume= 350 | issue= 9080 | pages= 757-64 | pmid=9297994 | doi=10.1016/s0140-6736(97)05381-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9297994  }} </ref><ref name="pmid26780184">{{cite journal| author=Thomopoulos C, Parati G, Zanchetti A| title=Effects of blood pressure-lowering treatment. 6. Prevention of heart failure and new-onset heart failure--meta-analyses of randomized trials. | journal=J Hypertens | year= 2016 | volume= 34 | issue= 3 | pages= 373-84; discussion 384 | pmid=26780184 | doi=10.1097/HJH.0000000000000848 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26780184  }} </ref><ref name="pmid28364091">{{cite journal| author=Upadhya B, Rocco M, Lewis CE, Oparil S, Lovato LC, Cushman WC | display-authors=etal| title=Effect of Intensive Blood Pressure Treatment on Heart Failure Events in the Systolic Blood Pressure Reduction Intervention Trial. | journal=Circ Heart Fail | year= 2017 | volume= 10 | issue= 4 | pages=  | pmid=28364091 | doi=10.1161/CIRCHEARTFAILURE.116.003613 | pmc=5384646 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28364091  }} </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><ref name="pmid8622246">{{cite journal| author=Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK| title=The progression from hypertension to congestive heart failure. | journal=JAMA | year= 1996 | volume= 275 | issue= 20 | pages= 1557-62 | pmid=8622246 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8622246  }} </ref><ref name="pmid21636845">{{cite journal| author=Butler J, Kalogeropoulos AP, Georgiopoulou VV, Bibbins-Domingo K, Najjar SS, Sutton-Tyrrell KC | display-authors=etal| title=Systolic blood pressure and incident heart failure in the elderly. The Cardiovascular Health Study and the Health, Ageing and Body Composition Study. | journal=Heart | year= 2011 | volume= 97 | issue= 16 | pages= 1304-11 | pmid=21636845 | doi=10.1136/hrt.2011.225482 | pmc=3652313 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21636845  }} </ref> ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
|-
|bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' In [[patients]] with [[type 2 diabetes]] and either established [[CVD]] or at high [[cardiovascular]] risk, [[SGLT2i]] should be used to prevent [[hospitalization]] for [[HF]]. <ref name="pmid28605608">{{cite journal| author=Neal B, Perkovic V, Mahaffey KW, de Zeeuw D, Fulcher G, Erondu N | display-authors=etal| title=Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. | journal=N Engl J Med | year= 2017 | volume= 377 | issue= 7 | pages= 644-657 | pmid=28605608 | doi=10.1056/NEJMoa1611925 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28605608  }} </ref><ref name="pmid30415602">{{cite journal| author=Wiviott SD, Raz I, Bonaca MP, Mosenzon O, Kato ET, Cahn A | display-authors=etal| title=Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. | journal=N Engl J Med | year= 2019 | volume= 380 | issue= 4 | pages= 347-357 | pmid=30415602 | doi=10.1056/NEJMoa1812389 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30415602  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=31610556 Review in: Ann Intern Med. 2019 Oct 15;171(8):JC43] </ref><ref name="pmid26378978">{{cite journal| author=Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S | display-authors=etal| title=Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. | journal=N Engl J Med | year= 2015 | volume= 373 | issue= 22 | pages= 2117-28 | pmid=26378978 | doi=10.1056/NEJMoa1504720 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26378978  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=26784492 Review in: Ann Intern Med. 2016 Jan 19;164(2):JC2] </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>

|-
|bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' In the general [[population]], healthy lifestyle habits such as regular [[physical activity]], maintaining normal [[weight]], healthy [[dietary]] patterns, and avoiding [[smoking]] are helpful to reduce future risk of [[HF]].<ref name="pmid26160366">{{cite journal| author=Del Gobbo LC, Kalantarian S, Imamura F, Lemaitre R, Siscovick DS, Psaty BM | display-authors=etal| title=Contribution of Major Lifestyle Risk Factors for Incident Heart Failure in Older Adults: The Cardiovascular Health Study. | journal=JACC Heart Fail | year= 2015 | volume= 3 | issue= 7 | pages= 520-528 | pmid=26160366 | doi=10.1016/j.jchf.2015.02.009 | pmc=4508377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26160366  }} </ref><ref name="pmid21914814">{{cite journal| author=Wang Y, Tuomilehto J, Jousilahti P, Antikainen R, Mähönen M, Katzmarzyk PT | display-authors=etal| title=Lifestyle factors in relation to heart failure among Finnish men and women. | journal=Circ Heart Fail | year= 2011 | volume= 4 | issue= 5 | pages= 607-12 | pmid=21914814 | doi=10.1161/CIRCHEARTFAILURE.111.962589 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21914814  }} </ref><ref name="pmid24449810">{{cite journal| author=Young DR, Reynolds K, Sidell M, Brar S, Ghai NR, Sternfeld B | display-authors=etal| title=Effects of physical activity and sedentary time on the risk of heart failure. | journal=Circ Heart Fail | year= 2014 | volume= 7 | issue= 1 | pages= 21-7 | pmid=24449810 | doi=10.1161/CIRCHEARTFAILURE.113.000529 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24449810  }} </ref><ref name="pmid24449810">{{cite journal| author=Young DR, Reynolds K, Sidell M, Brar S, Ghai NR, Sternfeld B | display-authors=etal| title=Effects of physical activity and sedentary time on the risk of heart failure. | journal=Circ Heart Fail | year= 2014 | volume= 7 | issue= 1 | pages= 21-7 | pmid=24449810 | doi=10.1161/CIRCHEARTFAILURE.113.000529 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24449810  }} </ref><ref name="pmid20048205">{{cite journal| author=Hu G, Jousilahti P, Antikainen R, Katzmarzyk PT, Tuomilehto J| title=Joint effects of physical activity, body mass index, waist circumference, and waist-to-hip ratio on the risk of heart failure. | journal=Circulation | year= 2010 | volume= 121 | issue= 2 | pages= 237-44 | pmid=20048205 | doi=10.1161/CIRCULATIONAHA.109.887893 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20048205  }} </ref><ref name="pmid25908393">{{cite journal| author=Folsom AR, Shah AM, Lutsey PL, Roetker NS, Alonso A, Avery CL | display-authors=etal| title=American Heart Association's Life's Simple 7: Avoiding Heart Failure and Preserving Cardiac Structure and Function. | journal=Am J Med | year= 2015 | volume= 128 | issue= 9 | pages= 970-6.e2 | pmid=25908393 | doi=10.1016/j.amjmed.2015.03.027 | pmc=4554769 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25908393  }} </ref><ref name="pmid26781788">{{cite journal| author=Tektonidis TG, Åkesson A, Gigante B, Wolk A, Larsson SC| title=Adherence to a Mediterranean diet is associated with reduced risk of heart failure in men. | journal=Eur J Heart Fail | year= 2016 | volume= 18 | issue= 3 | pages= 253-9 | pmid=26781788 | doi=10.1002/ejhf.481 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26781788  }} </ref><ref name="pmid19433696">{{cite journal| author=Levitan EB, Wolk A, Mittleman MA| title=Consistency with the DASH diet and incidence of heart failure. | journal=Arch Intern Med | year= 2009 | volume= 169 | issue= 9 | pages= 851-7 | pmid=19433696 | doi=10.1001/archinternmed.2009.56 | pmc=2682222 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19433696  }} </ref><ref name="pmid19892061">{{cite journal| author=Levitan EB, Wolk A, Mittleman MA| title=Relation of consistency with the dietary approaches to stop hypertension diet and incidence of heart failure in men aged 45 to 79 years. | journal=Am J Cardiol | year= 2009 | volume= 104 | issue= 10 | pages= 1416-20 | pmid=19892061 | doi=10.1016/j.amjcard.2009.06.061 | pmc=2774905 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19892061  }} </ref><ref name="pmid31023426">{{cite journal| author=Lara KM, Levitan EB, Gutierrez OM, Shikany JM, Safford MM, Judd SE | display-authors=etal| title=Dietary Patterns and Incident Heart Failure in U.S. Adults Without Known Coronary Disease. | journal=J Am Coll Cardiol | year= 2019 | volume= 73 | issue= 16 | pages= 2036-2045 | pmid=31023426 | doi=10.1016/j.jacc.2019.01.067 | pmc=6501554 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31023426  }} </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>'''4.''' For [[patients]] at risk of developing [[HF]], [[natriuretic peptide]] [[biomarker]]-based screening followed by team-based [[care]], including a [[cardiovascular]] specialist optimizing GDMT, can be useful to prevent the development of [[LV]] dysfunction (systolic or diastolic) or new-onset [[HF]].<ref name="pmid23821090">{{cite journal| author=Ledwidge M, Gallagher J, Conlon C, Tallon E, O'Connell E, Dawkins I | display-authors=etal| title=Natriuretic peptide-based screening and collaborative care for heart failure: the STOP-HF randomized trial. | journal=JAMA | year= 2013 | volume= 310 | issue= 1 | pages= 66-74 | pmid=23821090 | doi=10.1001/jama.2013.7588 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23821090  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=24368334 Review in: Evid Based Med. 2014 Jun;19(3):107] </ref><ref name="pmid23810874">{{cite journal| author=Huelsmann M, Neuhold S, Resl M, Strunk G, Brath H, Francesconi C | display-authors=etal| title=PONTIAC (NT-proBNP selected prevention of cardiac events in a population of diabetic patients without a history of cardiac disease): a prospective randomized controlled trial. | journal=J Am Coll Cardiol | year= 2013 | volume= 62 | issue= 15 | pages= 1365-72 | pmid=23810874 | doi=10.1016/j.jacc.2013.05.069 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23810874  }} </ref> ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>

|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.''' In the general [[population]], validated multivariable risk scores can be useful to estimate subsequent risk of incident [[HF]].<ref name="pmid10371227">{{cite journal| author=Kannel WB, D'Agostino RB, Silbershatz H, Belanger AJ, Wilson PW, Levy D| title=Profile for estimating risk of heart failure. | journal=Arch Intern Med | year= 1999 | volume= 159 | issue= 11 | pages= 1197-204 | pmid=10371227 | doi=10.1001/archinte.159.11.1197 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10371227  }} </ref><ref name="pmid19777072">{{cite journal| author=Butler J, Kalogeropoulos A, Georgiopoulou V, Belue R, Rodondi N, Garcia M | display-authors=etal| title=Incident heart failure prediction in the elderly: the health ABC heart failure score. | journal=Circ Heart Fail | year= 2008 | volume= 1 | issue= 2 | pages= 125-33 | pmid=19777072 | doi=10.1161/CIRCHEARTFAILURE.108.768457 | pmc=2748334 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19777072  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
|}
[[File:Stage A and Stage B recommendations for HF. Adapted from 2022 AHA-ACC-HFSA Guideline for the Management of Heart Failure.png|alt=Stage A and Stage B recommendations for HF. Adapted from 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure|thumb|Stage A and Stage B recommendations for HF. Adapted from 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure]]


==Vote on and Suggest Revisions to the Current Guidelines==
*[[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/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="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>

*[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/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>

==References==
{{Reflist|2}}
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