*This is an archive page. The links are no longer being updated. 1994.06.28 : Heart Failure Guidelines Contact: AHCPR Public Affairs Tuesday, June 28, 1994 (301) 594-1364 Bob Isquith ext. 173 Bob Griffin ext. 169 Valna Montgomery ext. 170 Paula Zeller ext. 148 Millions of Americans now suffering from heart failure -- a debilitating, potentially fatal condition -- could lead longer, more active lives under new guidelines released today by the U.S. Public Health Service's Agency for Health Care Policy and Research. The guidelines, which are based on the results of the latest clinical trials and outcomes research, call for wider use of medications proven capable of preventing heart failure in some high- risk patients, and improving comfort and longevity in patients with established heart failure. "These guidelines are a timely and necessary step to improve quality of life for Americans," said HHS Assistant Secretary for Health Philip R. Lee, M.D., who directs the Public Health Service. "Heart failure is a treatable illness that can be managed. Most persons with heart failure can adjust to the limitations imposed by the condition and continue to lead active and rewarding lives," said Dr. Lee. The guidelines address several problems, said Dr. Lee. "One problem is that doctors often underuse or prescribe too little of the medicines that help control heart failure symptoms and prolong life," he said. "A second problem is that patients don't always understand how important it is to follow their treatment regimens conscientiously," Dr. Lee said. "Patients and their physicians and other health care providers need to work as partners in making treatment decisions. Once these decisions are made, patients must literally `take to heart' the vital importance of following recommendations on medicines, diet and exercise." Heart failure occurs when the heart fails to pump enough blood to meet the body's demands. Symptoms can include shortness of breath, fatigue, frequent coughing, or swelling of the feet, ankles and legs. More than 2 million Americans have heart failure, and about 400,000 new cases are diagnosed each year. Heart failure contributes to over 200,000 deaths annually. The death rate attributed to heart failure rose by 64 percent from 1970 to 1990. In 1990, the estimated cost of treating heart failure surpassed $10 billion, which included $7 billion for hospitalizations. - More - - 2 - The guidelines, which are for left-ventricular systolic dysfunction, the most common type of heart failure, recommend use of sophisticated imaging technologies for making initial diagnoses, while generally relying on observation of patients' symptoms and physical signs to monitor treatment progress. The guidelines urge better patient education and compliance, and call for the use of bypass surgery or angioplasty in selected instances. The heart failure guidelines were developed through an AHCPR contract with RAND (a non-profit, public policy and research organization), which convened a 16-member, private-sector panel of experts and consumers. Recommendations include expanding use of currently underutilized ACE (angiotensin-converting enzyme) inhibitors, which relax blood vessels, allowing the heart to pump blood more easily and prevent the heart from deteriorating. ACE inhibitors can sometimes prevent heart failure symptoms from developing in people who have reduced heart function but who do not yet experience symptoms. The guidelines also recommend prescribing diuretics to reduce swelling, and using digoxin to strengthen heartbeat in patients with moderate to severe heart failure or when symptoms persist despite use of ACE inhibitors and diuretics. The guidelines take a systematic approach to determining optimal use of invasive interventions, such as heart bypass surgery or angioplasty. Imaging technologies, including echocardiography and radionuclide ventriculography, are recommended to diagnose heart failure correctly; however, the guidelines stress that using these tests repeatedly to assess patients' response to therapy is inappropriate, and that it usually is more useful for clinicians to monitor response to therapy by questioning patients about their symptoms and their ability to carry out everyday activities, such as climbing stairs or walking. Because patient noncompliance with medication, diet and exercise instructions for heart failure is widespread and a major cause of hospital readmissions, the guidelines call for increased patient education and better monitoring of patient compliance. Acting AHCPR Administrator Linda K. Demlo, Ph.D., said that the new guidelines put the diagnosis and treatment of heart failure on their most solid scientific foundation to date. According to Marvin A. Konstam, M.D., director of the Heart Failure and Cardiac Transplant Center of Boston's New England Medical Center Hospitals, and co-chair of the heart failure panel, the guidelines will help physicians to manage heart failure more effectively. "These guidelines apply to outpatient as well as inpatient care; family doctors and other primary care providers have a key role in heart failure management," said Dr. Konstam, who added that the input of specialists is often valuable and that difficult or complicated cases should be referred to them. - More - - 3 - Panel co-chair Kathleen Dracup, D.N.Sc., R.N., professor at the School of Nursing at the University of California, Los Angeles, said the patient and his or her family play a critical role in managing heart failure and need to be active in evaluating and clarifying treatment decisions. Dr. Dracup said, "No therapy can be effective unless the patient follows instructions. To prevent hospital readmissions, patients must take medications as prescribed, follow a low-salt diet, check their weight daily and adhere to activity and exercise recommendations." Dr. Dracup also said that patients and family members need to be educated about what to do in the face of worsening symptoms. RAND project director David C. Hadorn, M.D., said the panel based its recommendations on research findings obtained from reviewing more than 1,000 published articles, and on expert judgment in areas where scientific evidence was lacking. The AHCPR-supported panel included experts in cardiology, cardiac surgery, pulmonology, internal medicine, family practice, geriatrics, nursing and pharmacy, and consumer representatives. The heart failure guidelines are the 11th published by AHCPR. Free copies of Heart Failure: Management of Patients with Left- Ventricular Systolic Dysfunction, the guidelines' quick reference guide for clinicians and the patient guide Living with Heart Disease: Is It Heart Failure? (available in English and Spanish) may be obtained by calling 800/358-9295 or writing: AHCPR Publications Clearinghouse, P.O. Box 8547, Silver Spring, Md. 20907. Single free copies of the clinical practice guideline Heart Failure: Evaluation and Care of Patients with Left-Ventricular Systolic Dysfunction also are available from the Clearinghouse, but on a limited basis. After supplies are exhausted, the clinical practice guideline may be purchased through the Government Printing Office. Persons with telephone-equipped facsimile machines can obtain the quick reference guide and consumer booklet, and an overview of the guidelines by calling AHCPR Instant Fax (tel: 301/594-2800) at any time, pressing "1" to get the menu, and then selecting the materials desired.