The AHA Guidelines and Scientific Statements Handbook

Chapter 13 Heart Failure

Class III
1 Digoxin should not be used in patients with low
EF, sinus rhythm, and no history of HF symptoms,
because in this population, the risk of harm is
not balanced by any known benefi t. (Level of Evi-
dence: C)
2 Use of nutritional supplements to treat structural
heart disease or to prevent the development of
symptoms of HF is not recommended. (Level of Evi-
dence: C)
3 Calcium channel blockers with negative inotropic
effects may be harmful in asymptomatic patients
with low LVEF and no symptoms of HF after MI
(see text in Stage C). (Level of Evidence: C)

Stage C – patients with current or prior
symptoms of HF
Recommendations for patients with
reduced LVEF
Class I
1 Measures listed as Class I recommendations for
patients in stages A and B are also appropriate for
patients in Stage C. (Levels of Evidence: A, B, and C
as appropriate)
2 Diuretics and salt restriction are indicated in
patients with current or prior symptoms of HF and
reduced LVEF who have evidence of fl uid retention
(see Table 13.4). (Level of Evidence: C)

3 Angiotensin converting enzyme inhibitors are

recommended for all patients with current or prior

symptoms of HF and reduced LVEF, unless contra-

indicated (see Table 13.3 and text). (Level of Evi-

dence: A)

4 Beta-blockers (using one of the three proven to

reduce mortality, i.e., bisoprolol, carvedilol, and sus-

tained release metoprolol succinate) are recommended

for all stable patients with current or prior symptoms

of HF and reduced LVEF, unless contraindicated (see

Table 13.3 and text). (Level of Evidence: A)

5 Angiotensin II receptor blockers approved for the

treatment of HF (see Table 13.3) are recommended

in patients with current or prior symptoms of HF

and reduced LVEF who are ACEI-intolerant (see

text for information regarding patients with angio-

edema). (Level of Evidence: A)

6 Drugs known to adversely affect the clinical status

of patients with current or prior symptoms of

HF and reduced LVEF should be avoided or with-

drawn whenever possible (e.g., nonsteroidal anti-

infl ammatory drugs, most antiarrhythmic drugs,

and most calcium channel blocking drugs; see text).

(Level of Evidence: B)

7 Exercise training is benefi cial as an adjunctive

approach to improve clinical status in ambulatory

patients with current or prior symptoms of HF and

reduced LVEF. (Level of Evidence: B)

Table 13.4 ACC/AHA Heart Failure Performance Measures: inpatient measure descriptions

Performance measure name Measure description

1. Evaluation of left ventricular systolic (LVS) function Heart failure patients with documentation in the hospital record that LVS function
   was assessed before arrival, during hospitalization, or is planned after discharge.


2. ACE inhibitor (ACEI), or angiotensin receptor blocker
   (ARB) for LVSD

Heart failure patients with LVSD and without both ACEI and ARB

contraindications who are prescribed an ACEI or ARB at hospital discharge.

3. Anticoagulant at discharge for HF patients with atrial
   fi brillation (AF)

Heart failure patients with chronic/recurrent AF and without warfarin

contraindications who are prescribed warfarin at discharge.

4. Discharge instructions Heart failure patients discharged home with written instructions or educational
   material given to patient or caregiver at discharge or during the hospital stay
   addressing all of the following: activity level, diet, discharge medications, follow-
   up appointment, weight monitoring, and what to do if symptoms worsen.


5. Adult smoking cessation advice/counseling Heart failure patients with a history of smoking cigarettes, who are given smoking
   cessation advice or counseling during hospital stay.