The American College of Cardiology (ACC) has published an expert consensus decision pathway for the optimization of treatment for patients with heart failure with reduced ejection fraction (HFrEF).

The new document complements the 2017 ACC/AHA/HFSA Focused Update of the 2013 ACC/AHA Guideline for the Management of Heart Failure by addressing new medical therapies, prevention and comorbidities relevant to heart failure with reduced ejection fraction for which data are available.

Published online in the Journal of the American College of Cardiology, the statement addresses 10 key issues (as below) encountered in the management of these patients and thus provides a framework for the decision pathway in these areas.

1. How to initiate, add, or switch to new evidence-based guideline-directed therapy for HFrEF 
2. How to achieve optimal therapy given multiple drugs for HF including augmented clinical assessment that may trigger additional changes in GDMT (e.g., imaging data, biomarkers, and filling pressures) 
3. When to refer to an HF Specialist 
4. How to address challenges of care coordination 
5. How to improve adherence 
6. What is needed in specific patient cohorts: African Americans, the frail, and older adults 
7. How to manage your patients’ cost of care for HF 
8. How to manage the increasing complexity of HF 
9. How to manage common comorbidities 
10. How to integrate palliative care and transition to hospice care 

(Source: ACC News Release, December 22, 2017)