Clinical Guidelines for Heart Failure
To receive the best care for heart failure, talking frankly with your healthcare team is a good place to start. It’s also helpful to know about a resource published by health experts that outlines treatment plans recommended for patients with chronic heart failure.
Since 1980, the American College of Cardiology and the American Heart Association have jointly published clinical guidelines to help healthcare providers create good care plans for their patients. The guidelines are based on scientific research and medical evidence. One set of guidelines, published in 2013, is the 2013 ACCF/AHA Guideline for the Management of Heart Failure.
The guidelines are written for medical people, so the language is technical and focuses on clinical information. As a patient, understanding the basics of the guidelines can help you take a more active role in your treatment. You’ll also be able to ask questions that can help you receive the best care.
The guidelines offer information for healthcare providers on performing a thorough checkup to detect heart failure and to evaluate how serious it is. They guide the healthcare provider in what symptoms to look for and what screenings may be needed (such as lab or exercise tests) to gather more information.
According to the guidelines, a person who is at risk for or who has heart failure falls into one of the following stages of the disease:
Stage A: A person who is at high risk for heart failure, but has no problem with his or her heart structure and does not have symptoms of heart failure
Stage B: A person who has a problem with his or her heart structure, but does not have symptoms of heart failure
Stage C: A person who already has, or who has had in the past, heart failure symptoms, which have to do with structural heart disease
Stage D: A person who has end-stage heart disease; this is the most serious stage
Only people in stages C and D are already in heart failure. There is an additional set of categories for the management of these people. This is called the New York Heart Association functional classification. Do not confuse this with the ACCF/AHA staging method.
The guidelines suggest specific treatments and actions for each stage. Once you know the stage you are in, you can learn which treatments the guidelines suggest. For example, for people in Stage A, suggested actions focus on treating risk factors. These include high blood pressure, smoking, and drinking. For all stages, the guidelines suggest specific medicines and certain medical tests or procedures.
The guidelines also advise healthcare providers to take a “multidisciplinary approach” to your care. This means that, rather than working alone to treat you, your healthcare provider teams up with other healthcare specialists, such as nurses, exercise physiologists, and smoking-cessation experts. Your healthcare team may suggest that you participate in support groups or visit certain specialists to help you make lifestyle changes to manage heart disease.
Take a proactive role
The guidelines are designed to apply to most patients in most cases. They give healthcare providers a range of treatment choices. The ultimate decisions rest with the healthcare provider and with you. Remember that you are the most important member of your healthcare team. Asking questions about your treatment is smart and responsible. It’s your right to know your healthcare team’s goals for you and how clinical guidelines compare with your care plan. It's important that you understand the approach to your care plan and that you arrive at it together with your healthcare provider.
March 21, 2017
2013 ACCF/AHA Guideline for the Management of Heart Failure. Circulation (2013); 128 (16); pp. e240-e327.
Fetterman, Anne, RN, BSN,Gandelman, Glenn, MD, MPH