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May 12, 2022 - The American Heart Association (AHA) recently published an update to its heart failure guidelines. The new guidelines replace the previous 2013 recommendations and the "2017 focused update." The guidelines include changes to the heart failure classification system, medication recommendations, and guidance on non-drug therapies. In regards to primary care, the guidelines only have a few major changes, which are outlined below.

  • Four heart failure classifications - the new guidelines divide heart failure into 4 subtypes, and treatment recommendations are based on these categories
    • Heart failure with reduced ejection fraction (LVEF ≤ 40%)
    • Heart failure with mildly reduced ejection fraction (LVEF 41 - 49%)
    • Heart failure with improved ejection fraction (past LVEF ≤ 40%, now > 40%)
    • Heart failure with preserved ejection fraction (LVEF ≥ 50%)

  • SGLT2 inhibitors - SGLT2 inhibitors are now considered a part of standard HFrEF therapy, along with RAAS inhibitors (ACE inhibitor, ARB, Entresto), beta blockers, aldosterone antagonists, and as-needed diuretics. In HFpEF, SGLT2 inhibitors are preferred over other drug classes.

  • Links to pertinent content


Coronary artery disease

Heart valve disease

SGLT2 inhibitors