2022 | HFSA

Understanding new medication guidelines

Patient News Heart Failure Awareness 365

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Heart failure occurs when the heart can’t pump enough blood to keep up with the body’s need for blood and oxygen. This can lead to tiredness, shortness of breath, and generally not feeling well. Heart failure is a lifelong, progressive condition and although there is usually no cure, with your doctor’s management and appropriate treatment, many people live enjoyable lives. There are many possible treatments which might help patients with heart failure and for your doctor to choose the best options it is important that they are aware of all medications you take including vitamins, supplements, and those bought without a prescription. With certain treatments, those with heart failure and reduced ejection fraction (HFrEF)—which is one type of heart failure—may live longer and have fewer hospitalizations.

Earlier this year, the Heart Failure Society of America (HFSA), in partnership with the American College of Cardiology (ACC) and the American Heart Association (AHA), published the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. This comprehensive publication helps provide guidance to your doctor and the heart failure care team on the diagnosis, monitoring, and treatment of heart failure.

The new guidelines make several changes to the previous version. Regarding treatment of HFrEF, there are now four different classes of medications which are now classified as GDMT (guideline-directed medical therapy). Medications that fall into the GDMT category have been proven to help the heart work stronger and more efficiently and have been shown in clinical trials to reduce hospitalizations, death due to heart failure, or both and some GDMT may help patients feel better. The 2022 guideline update has made some additions to medications considered GDMT. In addition to earlier medications considered to be GDMT [beta blockers, ACE inhibitors or Angiotensin Receptor Blockers (ARB), and mineralocorticoid receptor antagonists (MRA)], newer medications such as Angiotensin Receptor-Neprilysin Inhibitor (ARNI) is now GDMT as an alternative to ACE inhibitors or ARB, and Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors are also now part of GDMT. Descriptions of GDMT are below:

Some of the main classes of GDMT to treat heart failure may help patients live longer with fewer hospitalizations include:

  • Beta Blockers – The drugs reduce the stress on the heart and reduce the heart rate, allowing the heart to pump more efficiently and to require less oxygen to do so. These drugs are cornerstones in our treatment of heart failure.
  • ACE Inhibitors or Angiotensin Receptor Blockers (ARB) – These help the blood flow by opening the blood vessels. Opening the blood vessels decreases the pressure the heart has to pump against. This increases the amount of oxygen which can be delivered to the body’s muscles and organs. They also help return the heart to more efficient functioning.
  • Mineralocorticoid Receptor Antagonist (MRA) – In addition to being mild diuretics, these medications work on the same system that ACE Inhibitors, ARBs, and ARNI work on. They ultimately work to block some of the adverse consequences of heart failure.
  • New to the list: ARNI – This medication is a combination of an ARB (with its benefit) and a neprilysin inhibitor which helps to eliminate extra sodium and water from the body as well as augment the kidney function.
  • New to the list: SGLT2 Inhibitors – These have been used for years to help lower blood sugar in individuals with diabetes. Recently, they were found to be beneficial among patients with heart failure (even in individuals without diabetes). How they work in HFrEF is not completely understood.

In addition to GDMT, your health care provider may choose other medications which have not been proven to reduce the risk of death but may help treat symptoms or reduce hospitalizations. While the updated guidelines provide general treatment recommendations, it is important to remember that not all heart failure patients are the same and your doctor and health care team know which medications are best for your treatment. While some patients may feel better while on therapy, it is important to take your medications exactly as they are prescribed and to not stop taking them without discussing with your health care team. Discuss any new medications, including over the counter medications, vitamins, or supplements with your heart care provider before you start them.  Some may worsen heart failure symptoms. 



Helpful Resources

Visit the HFSA Patient Hub to explore tools and resources to help patients stay healthy while living with heart failure. 

View Heart Failure Awareness 365 activities to stay up-to-date on tips for healthy living for people living with heart failure.