Source: ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2005 ;112(12):e154-235. Epub 2005

New heart failure guidelines have two ultimate goals: improve quality of life for survivors and help prolong life for survivors, according to the panel responsible for developing the guidance.

Major new developments in the guidelines include an expanded indication for use of beta blockers in treatment of heart failure; new indications for a combination of nitroglycerin and hydrolazine specific to the African American population; and, most significantly, the use of device therapies. These developments are all addressed in the American College of Cardiology/ American Heart Association 2005 Guideline Update.

Since the last ACC/AHA guidelines were published in 2001, there have been many new developments in the treatment of heart failure. The latest were updated to keep up with the current state of knowledge, according to William T. Abraham, MD, professor of medicine and chief, division of cardiovascular medicine, The Ohio State University, Columbus.

In terms of prevention or delay of heart failure, the guidelines emphasize early awareness and treatment of coronary artery disease, other heart diseases, hypertension, elevated blood pressure, and diabetes.

The updated guidelines highlight how new indications have shown that angiotensin receptor blockers (ARBs) are nearly as dependable as ACE inhibitors, and either can be used as first-line therapy, according to Dr. Abraham. But what Abraham views as "truly revolutionary" to the guidelines are use of device therapies—ventricular pacing or cardiac resynchronization therapy and use of implantable defibrillators. "Such therapies are now recommended routinely for eligible patients," he said. "Device therapies are brand new—these weren't even anticipated four years ago."

He said the update also highlights the strengthening of recommendation for exercise for heart failure patients, which has evolved in the last decade.

"We used to ask our heart failure patients to decrease their exercise or activity, and now we actually encourage them to exercise, because of studies that show benefit to the heart. This updated exercise recommendation holds true in the elderly population—even those in their 80s or even 90s. It's never too late to start exercising," Dr. Abraham said. The recommendations promote aerobic exercises, including brisk walking, riding a bicycle outdoors or a stationary bicycle.

"Little by little" physicians are beginning to support the heart failure guidance, Dr. Abraham said. "However, there are a lot of old biases or myths about heart failure, which need to be dispelled, such as that heart patients should become sedentary. The recommendations are really creating awareness about new information and guidelines to improve the standard of care," he said. "This guideline update is perhaps one of the most important guidelines that a physician taking care of an elderly population can read, because about one in 10 people over age 65 will have heart failure."

A decade ago, heart failure was viewed as a relentlessly progressive disease associated with substantial disability and early death for most people, Dr. Abraham said. "Now, we view it as a manageable chronic disease syndrome, associated with good quality of life and improved survival for most people."

Although heart failure can strike at any age, its prevalence is greatest in those over age 65 —two-thirds of heart failure patients in the United States are older than 65.

"In a way, heart failure is a disease syndrome associated with aging," Dr. Abraham noted.

To put the guidelines into practice, Dr. Abraham advises a "straightforward evidence-based approach. All patients who can tolerate them should be treated with an ACE inhibitor and a beta blocker. Then, if appropriate, based on specific recommendations in the guidelines, consideration might be given to device therapy."

Editor's note: Cardiologist Wilbert S. Aronow, MD, will review specifics of this guideline in more detail in our March 2005 issue of GERIATRICS.