The Immediate Impact of the 2022 Heart Failure Guidelines

The American College of Cardiology (ACC) 2022 Scientific Sessions in Washington, DC, kicked off its meeting Friday with the release of new multi-organization guidelines for the prevention and management of heart failure.

Headlining the new recommendations was the addition of SGLT-2 inhibitors as a primary option for patients at varying stages or severity of heart failure, regardless of diabetes status. Experts celebrated the new guideline as vindication of game-changing clinical developments in the assessment of the drug class and its potential in mitigating the national impact of heart failure. But how do the new recommendations immediately change care strategies?

In an interview with HCPLive during ACC 2022, Larry Allen, MD, medical director of heart failure at University of Colorado Anschutz School of Medicine, discussed the first update to heart failure treatment recommendations since 2017—and namely how SGLT-2 inhibitors have become the “fourth pillar” of standard heart failure care, joining beta blockers, sacubitril valsartan, and eplenerone/sprionolactone.

“And I think there’s a real focus on trying to make sure patients with reduced ejection fraction really get an opportunity to be on those 4 drugs,” Allen said.

Allen additionally discussed the recommendations for treating patients with higher, or preserved, ejection fraction (EF) with SGLT-2 inhibitors. “So not only have we expanded the benefits of guideline-directed therapy for low EF patients, now we’ve actually got additional therapy for preserved or higher EF group of patients for whom we did not have many as many therapies historically,” he explained.

Though the guideline recommendations for SGLT-2 inhibitors in preserved ejection fraction are less significant because of lesser available data, Allen said it’s nonetheless “fairly strong” for the in-need heart failure patient population with greater ejection fraction.

“I think the guidelines aren’t quite as strong because the data aren’t quite as strong,” Allen said. “But I think you’re getting a two-way recommendation, which is that once you get through the class I recommendations—for which there aren’t as many in that group—then you move to the next level at class IIA.”

Lastly, Allen discussed the importance of the refined stages and classifications of heart failure set in the guideline—factors that reflect the very heterogenous nature of the disease.

“There’s a lot of discussion in the guidelines about not just definitions and classifications, but understanding the various ways that an individual patient may experience their heart failure,” Allen said. “And then that relates to how you evaluate and then manage them.”