Focused Update of 2016 Korean Society of Heart Failure Guidelines for the Management of Chronic Heart Failure

Abstract

The incidence of heart failure (HF) is increasing in South Korea and devising the optimal care plan is crucial to promote appropriate and effective treatment of HF. To this end, the first Korean guideline for management of chronic HF was published in 2016 by the HF research group under the Korean Society of Cardiology (KSC). After this publication, considerable data have been accumulated and a new guideline for the management of HF was published in Europe, and an update regarding pharmacological therapy was published in the United States, which made it warrant to update the Korean guideline. Under this premise, The Clinical Practice Guidelines Committee under the Korean Society of Heart Failure (KSHF) founded in 2018 decided to publish a focused update management guideline for chronic HF and selected 15 topics that need an update regarding the diagnosis, definition, diagnostic algorithm, monitoring, novel biomarkers, drug therapy related to non-vitamin K antagonist oral anticoagulants and angiotensin receptor neprilysin inhibitors, and with respect to comorbidities changes in the guidelines of relevant institutions, such as new guidelines for the management of hypertension, a procedure used to treat severe aortic stenosis, information on sodium glucose co-transporter-2 inhibitor, and that about sleep apnea. Among nonpharmacological therapies, changes to the recommendations for implantable cardioverter defibrillator, cardiac resynchronization therapy, and cardiac rehabilitation were updated. Subsequent and continuous updates based on additional clinical research findings, with continual supervision by the KSHF will be needed.

Keywords: Comorbidity; Diagnosis; Guideline; Heart failure; Treatment.

Figure 1. Survival curves of patients with HFrEF, HFpEF, and HFmrEF (analyzed with KorAHF data). (A) Kaplan-Meier survival curve with reference to time of discharge. (B) Landmark Kaplan-Meier survival curve with reference to 3 months after discharge.

HFmrEF = heart failure with mid-range ejection fraction; HFpEF = heart failure with preserved ejection fraction; HFrEF = heart failure with reduced ejection fraction; KorAHF = Korean Acute Heart Failure.

Figure 2. Diagnostic algorithm for a diagnosis of HF of non-acute onset.

“Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016;37:2129-200, DOI: 10.1093/eurheartj/ehw128.” reproduced by permission of the European Society of Cardiology. BNP = B-type natriuretic peptide; CAD = coronary artery disease; ECG = electrocardiogram; HF = heart failure; MI = myocardial infarction; NT-proBNP = N-terminal pro-B-type natriuretic peptide.

Figure 3. Diagnostic algorithm for a diagnosis and initial management of a patient with AHF.

“Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016;37:2129-200, DOI: 10.1093/eurheartj/ehw128.” reproduced by permission of the European Society of Cardiology. AHF = acute heart failure; BiPAP = bilevel positive airway pressure; CCU = coronary care unit; CPAP = continuous positive airway pressure; ICU = intensive care unit. *Mechanical complications of acute myocardial infarction (acute mitral regurgitation, acute myocardial rupture, interventricular septal defect), chest trauma, acute valve failure caused by infectious endocarditis (native/prosthetic), aortic dissection.

Figure 4

Algorithm of indications for cardiac resynchronization therapy. “Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;62:e147-239, DOI: 10.1016/j.jacc.2013.05.019.” reproduced by permission of the Journal of the American College of Cardiology. CRT = cardiac resynchronization therapy; GDMT = guideline-directed medical therapy; LBBB = left bundle-branch block; LVEF = left ventricular ejection fraction; MI = myocardial infarction; NYHA = New York Heart Association. ^*Updated based on Ruschitzka et al. and Steffel et al.