Patients With Heart Failure Who Have Concomitant Disorders

CLASS I
(1) All other recommendations should apply to patients with concomitant disorders unless there are specific exceptions.

(2) Physicians should control systolic and diastolic hypertension and diabetes mellitus in patients with HF in accordance with recommended guidelines.

(3) Physicians should use nitrates and beta blockers for the treatment of angina in patients with HF.

(4) Physicians should recommend coronary revascularization according to recommended guidelines in patients who have both HF and angina.

(5) Physicians should prescribe anticoagulants in patients with HF who have paroxysmal or persistent atrial fibrillation or a previous thromboembolic event.

(6) Physicians should control the ventricular response rate in patients with HF and atrial fibrillation with a beta blocker (or amiodarone, if the beta blocker is contraindicated or not tolerated).

(7) Patients with coronary artery disease and HF should be treated in accordance with recommended guidelines for chronic stable angina.

(8) Physicians should prescribe antiplatelet agents for prevention of MI and death in patients with HF who have underlying coronary artery disease.

CLASS IIa
(1) It is reasonable to prescribe digitalis to control the ventricular response rate in patients with HF and atrial fibrillation.

(2) It is reasonable to prescribe amiodarone to decrease recurrence of atrial arrhythmias and to decrease recurrence of ICD discharge for ventricular arrhythmias.

CLASS IIb
(1) The usefulness of current strategies to restore and maintain sinus rhythm in patients with HF and atrial fibrillation is not well established.

(2) The usefulness of anticoagulation is not well established in patients with HF who do not have atrial fibrillation or a previous thromboembolic event.

(3) The benefit of enhancing erythropoiesis in patients with HF and anemia is not established.

CLASS III
(1) Class I or III antiarrhythmic drugs are not recommended in patients with HF for the prevention of ventricular arrhythmias.

(2) The use of antiarrhythmic medication is not indicated as primary treatment for asymptomatic ventricular arrhythmias or to improve survival in patients with HF.


JACC. 2009; 53; e1-e90