2024 ACC Expert Consensus Decision Pathway for Treatment of HFrEF

This set of vocabulary flashcards covers essential terminology, medication classes, and clinical assessment criteria from the 2024 ACC Expert Consensus Decision Pathway for the treatment of HFrEF.

HFrEF

Heart failure with reduced ejection fraction, defined as clinical heart failure and a left ventricular ejection fraction ($LVEF$) of $\leq 40\%$.

GDMT

Guideline-directed medical therapy, representing treatment options supported for use by clinical practice guidelines.

NYHA Functional Classification

A four-class system categorizing heart failure based on physical activity limitations, ranging from Class I (no limitation) to Class IV (symptoms at rest).

Stage C Heart Failure

Structural heart disease with prior or current symptoms of heart failure.

Stage D Heart Failure

Marked heart failure symptoms that interfere with daily life, involving recurrent hospitalizations despite attempts to optimize GDMT.

The '4 Pillars' of GDMT

The core therapeutic regimen for HFrEF consisting of an ARNI (or ACE inhibitor/ARB), an evidence-based beta-blocker, a mineralocorticoid antagonist (MRA), and an SGLT inhibitor.

ARNI

Angiotensin receptor/neprilysin inhibitor, specifically sacubitril/valsartan, which is the preferred renin-angiotensin system inhibitor for HFrEF.

SGLT Inhibitors

Sodium-glucose cotransporter inhibitors (e.g., dapagliflozin, empagliflozin, or sotagliflozin) used to reduce the risk of HF hospitalization and cardiovascular mortality regardless of diabetes status.

Ivabradine

A medication that inhibits the $I_f$ current in the sinoatrial node to reduce heart rate in patients in sinus rhythm with a resting heart rate $\geq 70\,\text{beats/min}$.

Vericiguat

An oral soluble guanylyl cyclase stimulator indicated for select high-risk patients with HFrEF and recent worsening heart failure.

Neprilysin

A zinc-dependent metalloprotease that inactivates several vasoactive peptides, including natriuretic peptides, adrenomedullin, and bradykinin.

Target Dose

The specific dose of a medication that was targeted in clinical trials to achieve optimal therapeutic benefit.

Euvolemia

A state of normal body fluid volume (being 'dry'), which is a critical clinical goal before initiating or titrating certain GDMT like beta-blockers.

Transcatheter Mitral Valve Repair

A percutaneous procedure used to treat severe functional mitral regurgitation in symptomatic heart failure patients whose symptoms persist despite optimized GDMT.

NT-proBNP

N-terminal pro–B-type natriuretic peptide; a biomarker used to support heart failure diagnosis, assess severity, establish prognosis, and monitor response to therapy.

I NEED HELP

A mnemonic used to identify high-risk heart failure features (e.g., Inotropes, NYHA class, Edema, Effusion) that should trigger referral to an advanced heart failure specialist.

Social Determinants of Health (SDOH)

The conditions in which people are born, grow, live, work, and age that drive HFrEF outcomes and contribute to health disparities.

Financial Toxicity

The economic burden of heart failure treatment, particularly regarding the high cost of newer medications, which can lead to nonadherence.

Frailty

A pathophysiological entity amplifying muscle wasting and neurological decline that increases morbidity and mortality in heart failure patients.

Optimal Therapy

GDMT provided at either the target dose or the highest-tolerated dose for a given patient.

Hyperkalemia

An elevated serum potassium level (typically $> 5.0\,\text{mEq/L}$) that may necessitate dose reduction of renin-angiotensin-aldosterone system inhibitors like MRAs.