Heart Failure Guidelines: Introduction to the New Agents

G. Blair Sarbacker, PharmD, BCACP; Alyson G. Wilder, PharmD, BCPS


US Pharmacist. 2018;43(2):22-26. 

In This Article

Updated Guidelines

In May 2016, the American College of Cardiology, the AHA, and the Heart Failure Society of America published a focused update on new pharmacologic therapy for HF. The update was spurred by recent evidence regarding HF, and the new drugs sacubitril/valsartan and ivabradine were included in the update. Because these two new agents have evidence only for stage C HFrEF, this was the only section of the guidelines to be updated; recommendations for the other stages of HF are unchanged. Accordingly, practitioners are using both the 2013 ACCF/AHA guideline for the management of HF and the new update.[5] To aid the reader's understanding of the management of stage C HFrEF, the treatment algorithm from the 2013 ACCF/AHA guideline for the management of HF has been updated here to include the 2016 recommendations (Figure 1).[5,8]

Figure 1.

Updated Treatment Algorithm Based on ACCF/AHA Guideline for Management of Heart Failure
ACEI: ACE inhibitor; ARB: angiotensin receptor blocker; ARNI: angiotensin receptor-neprilysin inhibitor; BB: beta-blocker; GDEM: guideline-directed evaluation and management; HRrEF: heart failure with reduced ejection fraction; K+: potassium; LVEF: left ventricular ejection fraction; max: maximum; NYHA: New York Heart Association; SCr: serum creatinine. Source: References 5, 8.