Heart failure with reduced ejection fraction

Also known as: CHF · HFrEF · systolic heart failure

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United StatesACC/AHA

Current

2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure

ACC/AHA/HFSA · 2022

The current US heart-failure guideline. It replaced the 2013 ACCF/AHA guideline and its 2017 focused update and established guideline-directed medical therapy across HF stages.

Establishes four foundational drug classes ('pillars') of guideline-directed medical therapy for HFrEF. source
Introduces universal definitions and revised HF stages and ejection-fraction categories. source

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EuropeESC

Current

2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

ESC (HFA) · 2023 · 2023 Focused Update of 2021

The current European heart-failure guidance — a 2023 focused update of the 2021 ESC guideline, revised after major new trials.

Gives a Class I recommendation for SGLT2 inhibitors in HFmrEF and HFpEF to reduce HF hospitalisation and cardiovascular death. source
Recommends intravenous iron for iron-deficient patients with HFrEF or HFmrEF to improve symptoms and quality of life. source

Verify against original ↗

US vs EU key differences

The two guidelines are broadly aligned on guideline-directed medical therapy, including the four foundational drug classes for HFrEF. source
The European guidance is more recent by way of its 2023 focused update, which strengthened SGLT2-inhibitor recommendations for HFmrEF/HFpEF. source

What changed recently

EU2021 → 2023 Focused Update of 20212023-08-25
The 2023 focused update strengthens intravenous iron repletion with ferric carboxymaltose or ferric derisomaltose for iron-deficient patients with reduced or mildly reduced ejection fraction to reduce heart failure hospitalisation, and adds guidance on comorbidities such as chronic kidney disease and diabetes on top of the 2021 four-pillar therapy.
source ↗curation confidence 90%
US2013 (with 2017 Focused Update) → 20222022-04-01
The 2022 guideline replaces the 2013 ACCF/AHA heart failure guideline and its 2017 focused update, and expands guideline-directed medical therapy for reduced ejection fraction to four drug classes by adding SGLT2 inhibitors alongside renin-angiotensin system inhibition or ARNI, beta blockers and mineralocorticoid receptor antagonists.
source ↗curation confidence 90%

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