Updated heart failure and atrial fibrillation guidelines

New guidelines on heart failure and atrial fibrillation have been released, including new pharmacological recommendations.

Released by the National Heart Foundation of Australia (NHF) in collaboration with the Cardiac Society of Australia and New Zealand (CSANZ), the guidelines were written for practising clinicians across all disciplines.

Revised guidelines for the prevention, detection and management of adults with heart failure include a focus on managing co-morbidities and other conditions in the treatment of patients with heart failure, including those at risk of cardiotoxicity associated with certain chemotherapy treatments. The guidelines for the diagnosis and management of adult patients with atrial fibrillation are a new addition to the clinical scope of practice for atrial fibrillation, which have been specifically developed for the Australian population.

In a media release circulated by the NHF ahead of the report launch, Heart Foundation Chief Medical Advisor Professor Garry Jennings said the guidelines – updated for the first time in seven years – assist the prevention of heart failure by including new advice on targets for type 2 diabetes medications and improvements in the criteria to diagnose heart failure.¹

‘The guidelines provide new advice on the better management of people living with heart failure through new evidence on medications, implantable cardioverter defibrillators, cardiotoxicity advice, and atrial fibrillation ablation techniques,’ Prof Jennings said.

Research published in The New England Journal of Medicine in 2015 – the EMPA-REG OUTCOME trial – found the addition of an SGLT2 inhibitor (empagliflozin) to the treatment of patients with type 2 diabetes and established cardiovascular disease reduced their relative risks of cardiovascular death by 38% (3.7%, vs. 5.9% in the placebo group; 38% relative risk reduction) and hospitalisation from heart failure by 35% (2.7% and 4.1%, respectively; 35% relative risk reduction).²

The authors of the NHF and CSANZ guidelines for the prevention, detection, and management of heart failure recommend the use of an SGLT2 inhibitor in patients with type 2 diabetes associated with cardiovascular disease and insufficient glycaemic control despite metformin, to decrease the risk of cardiovascular events and decrease the risk of hospitalisation for heart failure.¹

‘There is also new advice on non-pharmacological care for heart failure patients, including telephone support, nurse-led care, exercise, and palliative care,’ Prof Jennings said.

‘The number of people being diagnosed and living longer with heart failure is increasing. So is the number of heart failure patients with one or more co-morbidities, such as atrial fibrillation, which lead to an increased risk of death and a reduced quality of life.’

Other comorbidities addressed in the guidelines on heart failure include hypertension, coronary artery disease and angina, diabetes, chronic kidney disease, obesity, airways disease (chronic obstructive pulmonary disease and asthma), gout, arthritis, depression, and anaemia.

‘By improving outcomes for heart failure patients with co-morbidities, we aim to reduce hospital re-admissions. Avoiding these crises will help patient survival and quality of life,’ Prof Jennings said.

In 2014, an estimated 480,000 people in Australia aged 18 years or over had heart failure, which contributed to one in eight deaths in 2016.1,3 According to the NHF, the most common causes of heart failure include coronary heart disease, previous heart attack, high blood pressure and cardiomyopathy.³

Rates of survival for heart failure are poor and can vary depending on the type of heart failure. Only 50% of patients diagnosed with chronic heart failure are alive in five years.³

For advice on conducting cardiovascular health checks in the pharmacy, see how to run a CVD screening and risk assessment.

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1. 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. At: https://www.heartfoundation.org.au/for-professionals/clinical-information/heart-failure

2. Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 2015;373(22):2117-28.

3. National Heart Foundation of Australia. New guidelines for growing number of Australians with heart failure. Aug 2018 At: www.heartfoundation.org.au/news/new-guidelines-for-growing-number-of-australians-with-heart-failure