Korean Society of Heart Failure Guidelines for the Management of Heart Failure: Treatment

Abstract

The Korean Society of Heart Failure (KSHF) guidelines aim to provide physicians with evidence-based recommendations for the management of patients with heart failure (HF). After the first introduction of the KSHF guidelines in 2016, newer therapies for HF with reduced ejection fraction, HF with mildly reduced ejection fraction, and HF with preserved ejection fraction have since emerged. The current version has been updated based on international guidelines and research data on Korean patients with HF. Herein, we present Part II of these guidelines, which comprises treatment strategies to improve the outcomes of patients with HF.

Keywords: Guideline; Heart failure; Pharmacotherapy; Treatment.

Figure 1. Therapeutic algorithm for HFrEF.

ACEI = angiotensin converting enzyme inhibitors; AF = atrial fibrillation; ARB = angiotensin receptor blocker; ARNI = angiotensin receptor-neprilysin inhibitors; CRT = cardiac resynchronization therapy; D/P = defibrillator/pacemaker; GDMT = guideline directed medical therapy; HR = heart rate; HF = heart failure; HFrEF = heart failure with reduced ejection fraction; ICD = implantable cardioverter-defibrillator; LVAD = left ventricular assist device; LVEF = left ventricular ejection fraction; MRA = mineralocorticoid receptor antagonists; NSR = normal sinus rhythm; NYHA = New York Heart Association; SGLT2 = sodium-glucose co-transporter 2; SR = sinus rhythm. ^*If patients with chronic HFrEF are intolerant to ACEI because of cough or angioedema and when the use of ARNI is not feasible, the use of ARB is recommended to reduce morbidity and mortality.

Figure 2. Indications for cardiac resynchronization therapy.

AF = atrial fibrillation; AV = atrioventricular; HF = heart failure; HFmrEF = heart failure with mildly reduced ejection fraction; HFpEF = heart failure with preserved ejection fraction; HFrEF = heart failure with reduced ejection fraction; HR = heart rate; GDMT = guideline directed medical therapy; LBBB = left bundle branch block; LVEF = left ventricular ejection fraction; SR = sinus rhythm.

Figure 3. Diagnostic algorithm for cardiac amyloidosis.

AL = light chain immunoglobulin; ATTR = transthyretin amyloidosis; CMR = cardiovascular magnetic resonance; H/CL = heart-to-contralateral lung; HF = heart failure; Tc-DPD = technetium 3,3-diphospho-1,2-propanodicarboxylic acid; Tc-HMDP = technetium-hydroxymethylene diphosphonate; Tc-PYP = technetium pyrophosphate; TTR = transthyretin. ^*Consider cardiac biopsy if clinical suspicion is high.

Figure 4. Risk-based approach for acute myocarditis.

AHF = acute heart failure; AV = atrioventricular; CMR = cardiovascular magnetic resonance; LVEF = left ventricular ejection fraction; VF = ventricular fibrillation; VT = ventricular tachycardia.

Figure 5. Assessment and treatment of right HF.

ARVD = arrhythmogenic right ventricular dysplasia; AV = atrioventricular; BP = blood pressure; CI = cardiac index; CO = cardiac output; CVP = central venous pressure; CVVH = continuous veno-venous hemofiltration; DCCV = direct current cardioversion; HF = heart failure; IV = intravenous; MAP = mean arterial pressure; MPAP = mean pulmonary artery pressure; PA = pulmonary artery; PADP = pulmonary artery diastolic pressure; PAH = pulmonary arterial hypertension; PASP = pulmonary artery systolic pressure; PCWP = pulmonary capillary wedge pressure; PVR = pulmonary vascular resistance; RAP = right atrial pressure; RV = right ventricle; SV = stroke volume; SVI = stroke volume index; UO = urine output; PTE = pulmonary thromboembolism; TR = tricuspid regurgitation.