Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug 15;217(4):212-217.
doi: 10.5694/mja2.51656. Epub 2022 Jul 31.

Consensus statement on the current pharmacological prevention and management of heart failure

Andrew P Sindone  1   2 , Carmine De Pasquale  3   4 , John Amerena  5   6 , Christine Burdeniuk  3   4 , Alicia Chan  7   8 , Andrew Coats  6 , David L Hare  9 , Peter Macdonald  10   11 , Aaron Sverdlov  12   13 , John J Atherton  14   15
Affiliations

Consensus statement on the current pharmacological prevention and management of heart failure

Andrew P Sindone et al. Med J Aust. .

Abstract

Introduction: This consensus statement of Australian clinicians provides new recommendations for the pharmacological management of heart failure based on studies reported since the publication of the 2018 Australian heart failure guidelines.

Main recommendations: ▪Use of sodium-glucose cotransporter 2 (SGLT2) inhibitors to prevent hospitalisation for heart failure in type 2 diabetes mellitus can be extended to patients with multiple cardiovascular risk factors, albuminuric chronic kidney disease, or atherosclerotic cardiovascular disease. ▪New evidence supports the use of a mineralocorticoid receptor antagonist (finerenone) to prevent heart failure in type 2 diabetes mellitus associated with albuminuric chronic kidney disease. ▪In addition to renin angiotensin system inhibitors (angiotensin receptor neprilysin inhibitor preferred), beta blockers and mineralocorticoid receptor antagonists, an SGLT2 inhibitor (dapagliflozin or empagliflozin) is recommended in all patients with heart failure with reduced left ventricular ejection fraction (LVEF ≤ 40%) (HFrEF). Lower quality evidence supports these therapies in patients with heart failure with mildly reduced LVEF (41-49%) (HFmrEF). ▪A soluble guanylate cyclase stimulator (vericiguat), selective cardiac myosin activator (omecamtiv mecarbil) and, if iron deficient, intravenous iron (ferric carboxymaltose) provide additional benefits in persistent HFrEF. ▪An SGLT2 inhibitor (empagliflozin) should be considered in patients with heart failure with preserved LVEF (≥ 50%) (HFpEF). Key changes in management from this statement: This document broadens the scope of angiotensin receptor neprilysin inhibitor use in patients with HFrEF and HFmrEF. SGLT2 inhibitor use expands to become a cornerstone therapy in HFrEF, with increasing evidence to support its use in HFmrEF and HFpEF.

Keywords: Cardiomyopathies; Guidelines as topic; Heart failure.

PubMed Disclaimer

Conflict of interest statement

All authors were supported by the South Australian Health and Medical Research Institute for the initial heart failure consensus statement conference. We were offered an honorarium to attend the virtual meeting by the Evidence to Practice Group. No other funding was provided. Andrew Sindone reports consultancy fees, speaking honoraria or research support from Amgen, AstraZeneca, Bayer, Biotronik, Boehringer Ingelheim, Bristol Myers Squibb, Menarini, Merck Sharp and Dohm, Mylan, Novartis, Otsuka, Pfizer, Sanofi, Servier, and Vifor. Carmine De Pasquale reports consultancy fees, speaking honoraria or research support from AstraZeneca, Novartis, Vifor, Boehringer Ingelheim, Bayer, Lily, Roche Diagnostics, and American Regent. John Amerena reports consultancy fees, speaking honoraria, conference and research support from AstraZeneca, Novartis, Vifor, Boehringer Ingelheim, Bayer, Lilly, and Amgen. Christine Burdeniuk reports consultancy fees and speaking honoraria from AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, and Novartis. Alicia Chan reports speaking honoraria or research support from Novartis, AstraZeneca, Boehringer Ingelheim, Vifor, Medtronic, Biotronik, Abbott, and Boston Scientific. Andrew Coats reports consultancy fees, speaking honoraria or research support from AstraZeneca, Boehringer Ingelheim, Menarini, Novartis, Servier, Vifor, Abbott, Actimed, Arena, Cardiac Dimensions, Corvia, CVRx, Enopace, ESN Cleer, Faraday, Impulse Dynamics, Respicardia, and Viatris. David Hare reports research grants, consultancy fees and speaking honoraria from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Lundbeck, Menarini, Merck, Novartis, Pfizer, Sanofi, Servier, and Vifor. Peter Macdonald reports peer‐reviewed research funding from the National Health and Medical Research Council and NSW Health, industry‐supported research funding to his institution from Amgen and Novartis, and consultancy fees paid to him from AstraZeneca, Boehringer Ingelheim, and Novartis. Aaron Sverdlov is supported by National Heart Foundation of Australia Future Leader Fellowships (Award IDs 101918 and 106025) and reports research grants from the NSW Health, Hunter Medical Research Institute, Biotronik, RACE Oncology, Bristol Myer Squibb, Roche Diagnostics, and Vifor; and consultancy fees and speaking honoraria from Novartis, Bayer, Bristol Myer Squibb, AstraZeneca, and Boehringer Ingelheim. John Atherton reports consultancy fees, speaking honoraria or research support from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Lilly, and Novartis.

Figures

None
ACE = angiotensin‐converting enzyme; ARNI = angiotensin receptor neprilysin inhibitor; CRT = cardiac resynchronisation therapy; HFrEF = heart failure with reduced ejection fraction; ICD = implantable cardioverter defibrillator; LVEF = left ventricular ejection fraction; MRA = mineralocorticoid receptor antagonist; SGLT2 = sodium–glucose cotransporter 2; SR = sinus rhythm. The key overarching theme (green background) is to commence all patients on the four destination therapies of ARNI/ACE inhibitor*, beta blocker†, MRA and SGLT2 inhibitor‡ as soon as clinically possible, given their early morbidity and mortality benefit. * ARNI preferred. ACE inhibitor can be considered as an alternative if problematic hypotension, and consider switching to ARNI later. † Use beta blocker with outcome trial proven HFrEF efficacy (ie, carvedilol, bisoprolol, metoprolol succinate or nebivolol). ‡ Use SGLT2 inhibitor with outcome trial proven HFrEF efficacy (ie, dapagliflozin or empagliflozin).
See this image and copyright information in PMC

References

    1. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021; 42: 3599‐3726. - PubMed
    1. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 79: e263‐e421. - PubMed
    1. Atherton JJ, Sindone A, De Pasquale CG, et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of heart failure 2018. Med J Aust 2018; 209: 363‐369. https://www.mja.com.au/journal/2018/209/8/national‐heart‐foundation‐aust... - PubMed
    1. Atherton JJ, Sindone A, De Pasquale CG, et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: guidelines for the prevention, detection, and management of heart failure in Australia 2018. Heart Lung Circ 2018; 27: 1123‐1208. - PubMed
    1. Schünemann HBJ, Guyatt G, Oxman A, editors. Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach. Updated October 2013. https://gdt.gradepro.org/app/handbook/handbook.html (viewed Apr 2022).

MeSH terms