Saudi Heart Association (SHA) guidelines for the management of heart failure

Abstract

Heart failure (HF) is the leading cause of morbidity and mortality worldwide and negatively impacts quality of life, healthcare costs, and longevity. Although data on HF in the Arab population are scarce, recently developed regional registries are a step forward to evaluating the quality of current patient care and providing an overview of the clinical picture. Despite the burden of HF in Saudi Arabia, there are currently no standardized protocols or guidelines for the management of patients with acute or chronic heart failure. Therefore, the Heart Failure Expert Committee, comprising 13 local specialists representing both public and private sectors, has developed guidelines to address the needs and challenges for the diagnosis and treatment of HF in Saudi Arabia. The ultimate aim of these guidelines is to assist healthcare professionals in delivering optimal care and standardized clinical practice across Saudi Arabia.

Keywords: Acute heart failure; Chronic heart failure; Heart failure recommendations; Multidisciplinary management; Saudi Arabia.

Fig. 1

Overview of medical therapy following diagnosis of patients with (A) acute heart failure (AHF) and (B) chronic heart failure (CHF) in the heart function assessment registry trial in Saudi Arabia (HEARTS) registry . ACE-I = angiotensin-converting enzyme inhibitor; ARB = angiotensin II receptor blocker. Note.Fig. 1A and B are taken from AlHabib KF, Elasfar AA, AlBackr H, AlFaleh H, Hersi A, AlShaer F, et al. Design and preliminary results of the heart function assessment registry trial in Saudi Arabia (HEARTS) in patients with acute and chronic heart failure. Eur J Heart Fail 2011;13:1178–84. Reproduced with permission from Wiley.

Fig. 2

Diagram summarizing the etiology of heart failure . ARVC = arrhythmogenic right ventricular cardiomyopathy; CAD = coronary artery disease; EMF = endomyocardial fibrosis; GH = growth hormone; HCM = hypertrophic cardiomyopathy; HES = hypereosinophilic syndrome. Note. Figure is based on content from .

Fig. 3

Clinical signs and symptoms typical of heart failure (HF) .

Fig. 4

Algorithm for the diagnosis of heart failure. BNP = B-type natriuretic peptide; CAD = coronary artery disease; CBC = complete blood count; ECG = electrocardiogram; Hb = hemoglobin; HF = heart failure; MI = myocardial infarction; NT-proBNP = N-terminal pro B-type natriuretic peptide.

Fig. 5

Criteria for diagnosis of HFpEF . CHF = chronic heart failure; EF = ejection fraction; HF = heart failure; HFpEF = heart failure with preserved ejection fraction; LV = left ventricle.

Fig. 6

Algorithm for pharmacological treatment of HFrEF. ACE-I = angiotensin-converting enzyme inhibitor; AF = atrial fibrillation; ARB = angiotensin II receptor blocker; ARNI = angiotensin receptor/neprilysin inhibitor; BB = beta-blocker; HF = heart failure; HFrEF = heart failure with reduced ejection fraction; HR = heart rate; MRA = mineralocorticoid antagonist.

Fig. 7

(A) Relative risk for mortality and HF hospitalization categorized by treatment group . (B) Relative risk for all-cause mortality categorized by treatment group . ACE-I = angiotensin-converting enzyme inhibitor; ARA = aldosterone receptor antagonist; ARB = angiotensin II receptor blocker; ARNI = angiotensin receptor/neprilysin inhibitor; BB = beta-blocker; HF = heart failure; CRT = cardiac resynchronization therapy; ICD = implantable cardioverter defibrillator; MRA = mineralocorticoid receptor antagonist.

Fig. 8

Algorithm for the management of acute heart failure. IV = intravenous; SBP = systolic blood pressure.

Fig. 9

Patient management pathway for HF. HF = heart failure; ICD = implantable cardioverter defibrillator.