Guidelines for the diagnosis and management of heart failure with level of evidence
| Quality indicator | Guideline | Level of evidence (ACC)* | |
|---|---|---|---|
| ACEI = angiotensin converting enzyme inhibitor; LVSD = left ventricular systolic dysfunction; HF = heart failure; AF = atrial fibrillation; INR = international normalisation ratio. | |||
| *ACC = American College of Cardiology rating system; class I: conditions for which there is evidence and/or general agreement that a given procedure/therapy is useful and effective; class II: conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of performing the procedure/therapy; class III: conditions for which there is evidence and/or general agreement that a procedure/therapy is not useful/effective and in some cases may be harmful; level A: data derived from multiple randomised clinical trials; level B: data derived from a single randomised trial or non-randomised studies; level C: when consensus opinion of experts was the primary source of recommendation.14 | |||
| **Anticoagulation for atrial fibrillation not discussed in ACC heart failure guidelines but in ACC guidelines for the management and treatment of patients with atrial fibrillation.34 | |||
| 1 | Determination of left ventricular function | Patients with suspected HF should undergo echocardiography or radionuclide ventriculography to measure the ejection fraction (if information about ventricular function is not available from previous tests). | Class I, level C |
| 2 | Use and dosing of ACEI in patients with LVSD | Patients with LVSD should be given trial of ACEIs unless contraindicated. Doses of ACEIs should be titrated upwards to the doses shown to decrease mortality in large randomised controlled trials. | Class I, level A |
| 3 | Use of β blocker in patients with LVSD* | Patients with stable NYHA class II and III HF due to LVSD should receive a β blocker unless contraindicated. | Class I, level A |
| 4 | Use of warfarin in patients with HF and AF** | HF patients with a history of systemic or pulmonary embolism, recent AF, or mobile left ventricular thrombi should be anticoagulated to a prothrombin time ratio of 1.2–1.8 times each individual laboratory control time (INR 2.0–3.0). | Class I, level A |