JAMA: 心衰的治疗

Guideline title 2022 American College of Cardiology (ACC)/American Heart Association AHA)/Heart Failure Society of America (HFSA) Guidelines for the Management of Heart Failure

Release date April 1, 2022

Prior versions 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure and 2013 ACCF/AHA Guideline for the Management of Heart Failure

Developer and Funding Source ACC/AHA Joint Committee on Clinical Practice Guidelines

Target population Adult patients with a diagnosis of or at risk for heart failure (HF)

Major recommendations

1、Classifications for HF are separated into 4 categories based on ejection fraction (EF) and disease history: HF with reduced EF (EF ≤40%), HF with mildly reduced EF (EF 41%-49%), HF with preserved EF (EF ≥50%), and HF with improved EF (EF previously ≤40% with improvement to >40%). 根据射血分数 (EF) 和病史，将 HF 的主要推荐分类分为4类：EF降低的HF(EF≤40%)、EF轻度降低的HF(EF 41%-49%)、EF保留的HF(EF≥50%) 和 EF 改善的HF（EF既往≤40%，改善至 > 40%）。

2、In patients with chronic HF with reduced EF, angiotensin receptor–neprilysin inhibitors (ARNIs) are preferred over angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs). If ARNI use is not feasible, ACEIs are preferred over ARBs, unless there is significant cough or angioedema (class 1, level of evidence [LOE] A).在 EF 降低的慢性 HF 患者中，血管紧张素受体-脑啡肽酶抑制剂 (ARNIs) 优于血管紧张素转换酶抑制剂 (ACEI) 和血管紧张素 II 受体阻滞剂 (ARB)。如果使用 ARNI 不可行，ACEI优于ARB，除非有明显咳嗽或血管性水肿（1类，证据等级 [LOE]A）。

3、Sodium-glucose cotransporter 2 (SGLT2) inhibitors should be included across all HF categories (symptomatic HF with reduced EF [class 1, LOE A]; HF with mildly reduced EF and HF with preserved EF [class 2a, LOE B-R]).钠-葡萄糖协同转运蛋白 2(SGLT2) 抑制剂应包括在所有 HF 类别中（症状性 HF 伴 EF 降低 [1类，LOE A]；HF伴 EF 轻度降低和 HF 伴 EF 保留 [2a 类，LOE B-R]）

4、Patients with HF with improved EF should continue to receive medical therapy originally indicated for HF with reduced EF (class 1, LOE B-R).EF 改善的 HF 患者应继续接受最初适用于 EF 降低的HF（1类，LOE B-R）的药物治疗。

5、Evidence-based treatment of HF with preserved EF includes blood pressure control (class 1, LOE C-LD), SGLT2 inhibitors (class 2a, LOE B-R), mineralocorticoid antagonists, ARBs, and ARNIs (class 2b, LOE B-R).EF 保留型 HF 的循证治疗包括血压控制（1类，LOE C-LD）、SGLT2抑制剂（2a类，LOE B-R）、盐皮质激素拮抗剂、ARB和ARNI（2b类，LOE B-R）。