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Guideline Summary
Guideline Title
Evaluation of patients for ventricular dysfunction and heart failure: HFSA 2010 comprehensive heart failure practice guideline.
Bibliographic Source(s)
Heart Failure Society of America, Lindenfeld J, Albert NM, Boehmer JP, Collins SP, Ezekowitz JA, Givertz MM, Katz SD, Klapholz M, Moser DK, Rogers JG, Starling RC, Stevenson WG, Tang WH, Teerlink JR, Walsh MN. Evaluation of patients for ventricular dysfunction and heart failure: HFSA 2010 comprehensive heart failure practice guideline. J Card Fail. 2010 Jun;16(6):e44-56. [109 references]
Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: Heart Failure Society of America. Evaluation of patients for ventricular dysfunction and heart failure. J Card Fail 2006 Feb;12(1):e16-25.

Scope

Disease/Condition(s)
  • Heart failure
  • Ventricular dysfunction

Note: Heart failure is a syndrome caused by cardiac dysfunction, generally resulting from myocardial muscle dysfunction or loss and characterized by either left ventricular (LV) dilation or hypertrophy or both.

Guideline Category
Diagnosis
Evaluation
Risk Assessment
Screening
Clinical Specialty
Cardiology
Family Practice
Internal Medicine
Intended Users
Advanced Practice Nurses
Pharmacists
Physician Assistants
Physicians
Guideline Objective(s)
  • To provide recommendations for the evaluation of patients for ventricular dysfunction and heart failure (HF)
  • To update and expand the previous 2006 clinical practice guidelines
Target Population
  • Patients at risk of developing heart failure (HF)
  • Patients suspected of having HF based on signs and symptoms or incidental evidence of abnormal cardiac structure or function
  • Patients with established symptomatic heart failure
Interventions and Practices Considered

Evaluation/Diagnosis/Risk Assessment

  1. Routine history
  2. Physical examination with vital signs
  3. Echocardiography with Doppler
  4. Evaluation of symptoms
  5. Plasma B-type natriuretic peptide (BNP) or N-terminal (NT) pro-BNP concentration for patients suspected of having heart failure (HF) when the diagnosis is not certain
  6. Differential diagnosis
  7. Assessment of functional capacity/activity level assessed using New York Heart Association class or 6-minute walk test
  8. Assessment of volume status
  9. Standard and additional laboratory tests
  10. Electrocardiogram (ECG)
  11. Chest x-ray
  12. Evaluation of myocardial ischemia
  13. Exercise testing, as indicated
  14. Endomyocardial biopsy, as indicated
  15. Follow-up, including clinical evaluation and sign/symptom assessment
  16. Repeat measurement of ventricular volume and left ventricular ejection fraction under limited circumstances
  17. Re-evaluation of electrolytes and renal function
Major Outcomes Considered

Accuracy of tests and procedures

Methodology

Methods Used to Collect/Select the Evidence
Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence

A literature search with relevant key words and phrases for each guideline section were provided to members of the subcommittees and the full Guideline Committee. Members of each subcommittee were asked to review the search and identify any additional relevant medical evidence for each assigned section.

The following databases were searched:

  • Ovid Medline (1950 to the updated date when the search was conducted)
  • Ovid Medline In-Process and other Non-Indexed Citations
  • PubMed

The searches focused primarily on the period between the last guideline publication and current, although the authors went back to 2005 to account for publication lag between the completion of the guideline and its publication in 2006 (i.e., 2005–2010) in the event there was some information that should/could be added to the 2010 updated document. Generally only non-human studies and publications that were non-English were excluded.

The following search terms were used: Heart failure; risk factors; echocardiography; natriuretic peptide, brain; cardiomyopathies; coronary artery disease; myocardial infarction; hypertension; heart valve diseases; arrhythmias, cardiac; coronary angiography; exercise test.

Number of Source Documents

Not stated

Methods Used to Assess the Quality and Strength of the Evidence
Weighting According to a Rating Scheme (Scheme Given)
Rating Scheme for the Strength of the Evidence
Hierarchy of Types of Evidence
Level A Randomized, Controlled, Clinical Trials
May be assigned based on results of a single methodologically rigorous trial
Level B Cohort and Case-Control Studies
Post hoc, subgroup analysis, and meta-analysis
Prospective observational studies or registries
Level C Expert Opinion
Observational studies – epidemiologic findings
Safety reporting from large-scale use in practice
Methods Used to Analyze the Evidence
Review of Published Meta-Analyses
Systematic Review
Description of the Methods Used to Analyze the Evidence

Heart Failure Society of America (HFSA) Guideline Approach to Medical Evidence

Two considerations are critical in the development of practice guidelines: assessing strength of evidence and determining strength of recommendation. Strength of evidence is determined both by the type of evidence available and the assessment of validity, applicability, and certainty of a specific type of evidence. Following the lead of previous guidelines, strength of evidence in this guideline is heavily dependent on the source or type of evidence used. The HFSA guideline process has used three grades (A, B, or C) to characterize the type of evidence available to support specific recommendations (see Table 1.2 in the original guideline document).

HFSA Guideline Approach to Strength of Recommendation

Determining Strength. Although level of evidence is important, the strength given to specific recommendations is critical. The process used to determine the strength of individual recommendations is complex. The goal of guideline development is to achieve the best recommendations for evaluation and management, considering not only efficacy, but the cost, convenience, side effect profile, and safety of various therapeutic approaches. The HFSA guideline committee often determined the strength of a recommendation by the "totality of evidence," which is a synthesis of all types of available data, pro and con, about a particular therapeutic option. The HFSA guideline employs the categorization for strength of recommendation outlined in Table 1.3 in the original guideline document.

Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations

Process of Guideline Development

Key steps in the development of this guideline are listed in Table 1.4 in the original guideline document. Having determined the broad scope of the current guideline, subcommittees of the guideline committee were formed for each section of the guideline. A literature search with relevant key words and phrases for each guideline section were provided to members of the subcommittees and the full Guideline Committee. Members of each subcommittee were asked to review the search and identify any additional relevant medical evidence for each assigned section. Changes in recommendation and background were carried out by each subcommittee with conference calls directed by the Guideline Committee chair. Each section was presented for comments and consensus approval to the Guideline Committee. Once subsections were complete, the Executive Council reviewed and commented on each section and these comments were returned to the Guideline Committee for changes and once complete, for final approval by the Executive Council.

Consensus

The Heart Failure Society of America (HFSA) Guideline Committee sought resolution of difficult cases through consensus building. An open, dynamic discussion meant that no single voice was allowed to dominate. Written documents were essential to this process, because they provided the opportunity for feedback from all members of the group. On occasion, consensus of opinion was sufficient to override positive or negative results of almost any form of evidence. The HFSA process had a strong commitment to recommendations based on objective evidence rigorously reviewed by a panel of experts. Issues that caused difficulty for the HFSA guideline process were some of the more important ones faced by the committee, because they mirrored those that are often most challenging to clinicians in day-to-day practice. The foundation of the HFSA guideline process was the belief that the careful judgment of recognized opinion leaders in these controversial areas is more likely to be correct than ad hoc decisions made "on the spot" by physicians in practice.

Rating Scheme for the Strength of the Recommendations

Classifying the Strength of the Recommendations

"Is recommended" Part of routine care
Exceptions to therapy should be minimized.
"Should be considered" Majority of patients should receive the intervention.
Some discretion in application to individual patients should be allowed.
"May be considered" Individualization of therapy is indicated.
"Is not recommended" Therapeutic intervention should not be used
Cost Analysis

The developer reviewed published cost analyses.

Method of Guideline Validation
Internal Peer Review
Description of Method of Guideline Validation

Each section was presented for comments and consensus approval to the Guideline Committee. Once subsections were complete, the Executive Council reviewed and commented on each section and these comments were returned to the Guideline Committee for changes and once complete, for final approval by the Executive Council.

Recommendations

Major Recommendations

The strength of evidence (A, B, C) and strength of recommendations are defined at the end of the "Major Recommendations" field.

Evaluation of Patients at Risk

  1. Evaluation for clinical manifestations of heart failure (HF) with a routine history and physical examination is recommended in patients with the medical conditions or test findings listed in the Table below. (Strength of Evidence = B)

    Table: Indications for Evaluation of Clinical Manifestations of HF

    Conditions Hypertension
    Diabetes
    Obesity
    Coronary artery disease (e.g., after myocardial infarction [MI], revascularization)
    Peripheral arterial disease or cerebrovascular disease
    Valvular heart disease
    Family history of cardiomyopathy in a first-degree relative
    History of exposure to cardiac toxins
    Sleep-disordered breathing
    Test Findings Sustained arrhythmias
    Abnormal electrocardiogram (ECG) (e.g., left ventricular hypertrophy [LVH], left bundle branch block, pathologic Q waves)
    Cardiomegaly on chest x-ray
  1. Assessment of Cardiac Structure and Function. Echocardiography with Doppler is recommended to determine cardiac structure and function in asymptomatic patients with disorders of findings listed in the Table below. (Strength of Evidence = B)

    Table: Assess Cardiac Structure and Function in Patients with the Following Disorders or Findings

    • Coronary artery disease (e.g., after myocardial infarction [MI], revascularization)
    • Valvular heart disease
    • Family history of cardiomyopathy in a first-degree relative
    • Atrial fibrillation or flutter
    • Electrocardiographic evidence of left ventricular hypertrophy (LVH), left bundle branch block, or pathologic Q waves
    • Complex ventricular arrhythmia
    • Cardiomegaly
  1. Routine determination of plasma B-type natriuretic peptide (BNP) or N-terminal (NT) pro-BNP (NT-proBNP) concentration as part of a screening evaluation for structural heart disease in asymptomatic patients is not recommended. (Strength of Evidence = B)

Evaluation of Patients Suspected of Having HF

  1. Symptoms Consistent with HF. The symptoms listed in the Table below suggest the diagnosis of HF. It is recommended that each of these symptoms be elicited in all patients in whom the diagnosis of HF is being considered. (Strength of Evidence = B)

    Table: Symptoms Suggesting the Diagnosis of HF

    Symptoms
    • Dyspnea at rest or on exertion
    • Reduction in exercise capacity
    • Orthopnea
    • Paroxysmal nocturnal dyspnea (PND) or nocturnal cough
    • Edema
    • Ascites or scrotal edema
    Less specific presentations of HF
    • Early satiety, nausea and vomiting, abdominal discomfort
    • Wheezing or cough
    • Unexplained fatigue
    • Confusion/delirium
    • Depression/weakness (especially in the elderly)
  1. Physical Examination. It is recommended that patients suspected of having HF undergo careful physical examination with determination of vital signs and careful evaluation for signs shown in the Table below. (Strength of Evidence = B)

    Table: Signs to Evaluate in Patients Suspected of Having HF

    Elevated cardiac filling pressures and fluid overload Elevated jugular venous pressure
    S3 gallop
    Rales
    Hepatojugular reflux
    Ascites
    Edema
    Cardiac enlargement Laterally displaced or prominent apical impulse
    Murmurs suggesting valvular dysfunction
    Reduced cardiac output Narrow pulse pressure
    Cool extremities
    Tachycardia with pulsus alternans
    Arrhythmia Irregular pulse suggestive of atrial fibrillation or frequent ectopy
  1. It is recommended that BNP or NT-proBNP levels be assessed in all patients suspected of having HF, especially when the diagnosis is not certain. (Strength of Evidence = A)
  2. Differential Diagnosis. The differential diagnoses in the Table below, should be considered as alternative explanations for signs and symptoms consistent with HF. (Strength of Evidence = B)

    Table: Differential Diagnosis for HF Symptoms and Signs

    • Myocardial ischemia
    • Pulmonary disease (pneumonia, asthma, chronic obstructive pulmonary disease, pulmonary embolus, primary pulmonary hypertension)
    • Sleep-disordered breathing
    • Obesity
    • Deconditioning
    • Malnutrition
    • Anemia
    • Hepatic failure
    • Chronic kidney disease
    • Hypoalbuminemia
    • Venous stasis
    • Depression
    • Anxiety and hyperventilation syndromes
    • Hyper or hypo-thyroidism
  1. It is recommended that patients with a diagnosis of HF undergo evaluation as outlined in the Table below. (Strength of Evidence = C)

    Table: Initial Evaluation of Patients with a Diagnosis of HF

    • Assess clinical severity of HF by history and physical examination
    • Assess cardiac structure and function
    • Determine the etiology of HF, with particular attention to reversible causes
    • Evaluate for coronary disease and myocardial ischemia
    • Evaluate the risk of life-threatening arrhythmia
    • Identify any exacerbating factors for HF
    • Identify comorbidities which influence therapy
    • Identify barriers to adherence
  1. Symptoms. In addition to symptoms characteristic of HF (dyspnea, fatigue, decreased exercise tolerance, fluid retention), evaluation of the following symptoms should be considered in the diagnosis of HF:
    • Angina
    • Symptoms suggestive of embolic events
    • Symptoms suggestive of sleep-disordered breathing
    • Symptoms suggestive of arrhythmias, including palpitations
    • Symptoms of possible cerebral hypoperfusion, including syncope, presyncope, or lightheadedness (Strength of Evidence = B)
  1. Functional Capacity/Activity Level. It is recommended that the severity of clinical disease and functional limitation be evaluated and recorded and the ability to perform typical daily activities be determined. This evaluation may be graded by metrics such as New York Heart Association (NYHA) functional class (Table 4.7 in the original guideline document) (Strength of Evidence = A) or by the 6-minute walk test. (Strength of Evidence = C)
  2. Volume Status. The degree of volume excess is a key consideration during treatment. It is recommended that it be routinely assessed by determining:
    • Presence of paroxysmal nocturnal dyspnea or orthopnea
    • Presence of dyspnea on exertion
    • Daily weights and vital signs with assessment for orthostatic changes
    • Presence and degree of rales, S3 gallop, jugular venous pressure elevation, hepatic enlargement and tenderness, positive hepatojugular reflux, edema, and ascites (Strength of Evidence = B)
  1. Standard Laboratory Tests. It is recommended that the following laboratory tests be obtained routinely in patients being evaluated for HF: serum electrolytes, blood urea nitrogen, creatinine, glucose, calcium, magnesium, fasting lipid profile (low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides), complete blood count, serum albumin, uric acid, liver function tests, urinalysis, and thyroid function. (Strength of Evidence = B)
  2. Electrocardiogram. It is recommended that all patients with HF have an electrocardiogram performed to:
    • Assess cardiac rhythm and conduction (in some cases, using Holter monitoring or event monitors)
    • Assess electrical dyssynchrony (wide QRS or bundle branch block), especially when left ventricular ejection fraction (LVEF) <35%
    • Detect LV hypertrophy or other chamber enlargement
    • Detect evidence of myocardial infarction (MI) or ischemia
    • Assess QTc interval, especially with drugs that prolong QT intervals (Strength of Evidence = B)
  1. Chest X-Ray. It is recommended that all patients with HF have a postero-anterior and lateral chest X-ray examination for determination of heart size, evidence of fluid overload, detection of pulmonary and other diseases, and appropriate placement of implanted cardiac devices. (Strength of Evidence = B)
  2. Additional Laboratory Tests. It is recommended that patients with no apparent etiology of HF or no specific clinical features suggesting unusual etiologies undergo additional directed blood and laboratory studies to determine the cause of HF. (Strength of Evidence = B)
  3. Evaluation of myocardial ischemia is recommended in those who develop new-onset LV systolic dysfunction especially in the setting of suspected myocardial ischemia or worsening symptoms with pre-existing coronary artery disease (CAD). The choice of testing modality should depend on the clinical suspicion and underlying cardiac risk factors. Coronary angiography should be considered when pre-test probability of underlying ischemic cardiomyopathy is high and an invasive coronary intervention may be considered. (See the National Guideline Clearinghouse (NGC) summary of the Heart Failure Society of American (HFSA) guideline Evaluation and Therapy for Heart Failure in the Setting of Ischemic Heart Disease for specific clinical situations and Strength of Evidence).
  4. Exercise testing for functional capacity is not recommended as part of routine evaluation in patients with HF. Specific circumstances in which maximal exercise testing with measurement of expired gases should be considered include:
    • Assessing disparity between symptomatic limitation and objective indicators of disease severity
    • Distinguishing non HF-related causes of functional limitation, specifically cardiac versus pulmonary
    • Considering candidacy for cardiac transplantation or mechanical circulatory support
    • Determining the prescription for cardiac rehabilitation
    • Addressing specific employment capabilities (Strength of Evidence = C)

Common Errors in Initial Assessment

  1. Routine endomyocardial biopsy is not recommended in cases of new-onset HF. Endomyocardial biopsy should be considered in patients with rapidly progressive clinical HF or ventricular dysfunction, despite appropriate medical therapy. Endomyocardial biopsy also should be considered in patients suspected of having myocardial infiltrative processes, such as sarcoidosis or amyloidosis, or in patients with malignant arrhythmias out of proportion to LV dysfunction, where sarcoidosis and giant cell myocarditis are considerations. (Strength of Evidence = C)

Follow-up Evaluation

  1. It is recommended that clinical evaluation at each follow-up visit include determination of the elements listed in the Table below. (Strength of Evidence = B)

    These assessments should include the same symptoms and signs assessed during the initial evaluation. (Strength of Evidence = B)

    Table: Elements to Determine at Follow-Up Visits of HF Patients

    • Functional capacity and activity level
    • Changes in body weight
    • Patient understanding of and adherence with dietary sodium restriction
    • Patient understanding of and adherence with medical regimen
    • History of arrhythmia, syncope, presyncope, palpitation or implantable cardioverter defibrillator (ICD) discharge
    • Adherence and response to therapeutic interventions
    • The presence or absence of exacerbating factors for HF, including worsening ischemic heart disease, hypertension, and new or worsening valvular disease
  1. In the absence of deteriorating clinical presentation, repeat measurements of ventricular volume and LVEF should be considered in these limited circumstances:
    • When a prophylactic implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy device and defibrillator (CRT-D) placement is being considered in order to determine that LVEF criteria for device placement are still met after medical therapy (Strength of Evidence = B)
    • When patients show substantial clinical improvement (for example, in response to beta blocker treatment or following pregnancy in patients with peripartum cardiomyopathy). Such change may denote improved prognosis, although it does not in itself mandate alteration or discontinuation of specific treatments (See the NGC summary of the HFSA guideline Heart Failure in Patients with Reduced Ejection Fraction) (Strength of Evidence = C)
    • In alcohol and cardiotoxic substance abusers who have discontinued the abused substance. (Strength of Evidence = C)
    • In patients receiving cardiotoxic chemotherapy. (Strength of Evidence = B)

    Repeat determination of LVEF is usually unnecessary in patients with previously documented LV dilatation and low LVEF who manifest worsening signs or symptoms of HF, unless the information is needed to justify a change in patient management (such as surgery or device implantation). (Strength of Evidence = C)

  1. It is recommended that reevaluation of electrolytes and renal function occur at least every 6 months in clinically stable patients and more frequently following changes in therapy or with evidence of change in volume status. More frequent assessment of electrolytes and renal function is recommended in patients with severe HF, those receiving high doses of diuretics, those on aldosterone antagonists, and those who are clinically unstable. (Strength of Evidence = C)

    See the NGC summary of the HFSA guideline Heart Failure in Patients with Reduced Ejection Fraction for recommendations for patients on an angiotensin receptor blocker.

Definitions:

Strength of Evidence

Hierarchy of Types of Evidence
Level A Randomized, Controlled, Clinical Trials
May be assigned based on results of a single methodologically rigorous trial
Level B Cohort and Case-Control Studies
Post hoc, subgroup analysis, and meta-analysis
Prospective observational studies or registries
Level C Expert Opinion
Observational studies – epidemiologic findings
Safety reporting from large-scale use in practice

Strength of Recommendations

"Is recommended" Part of routine care
Exceptions to therapy should be minimized.
"Should be considered" Majority of patients should receive the intervention.
Some discretion in application to individual patients should be allowed.
"May be considered" Individualization of therapy is indicated.
"Is not recommended" Therapeutic intervention should not be used
Clinical Algorithm(s)

None provided

Evidence Supporting the Recommendations

Type of Evidence Supporting the Recommendations

The type of supporting evidence is identified and graded for each recommendation (see the "Major Recommendations").

Benefits/Harms of Implementing the Guideline Recommendations

Potential Benefits

Appropriate evaluation for ventricular dysfunction and heart failure in symptomatic and asymptomatic patients

Potential Harms

Some interventions require appropriate patient selection and monitoring to minimize potential harms, and these are specified within the recommendations and accompanying text of the original guideline document.

Contraindications

Contraindications

Some interventions carry relative or absolute contraindications. These contraindications vary according to the specific intervention and are described in the recommendations and accompanying text of the original guideline document.

Qualifying Statements

Qualifying Statements

It must be recognized that the evidence supporting recommendations is based largely on population responses that may not always apply to individuals within the population. Therefore, data may support overall benefit of one treatment over another but cannot exclude that some individuals within the population may respond better to the other treatment. Thus, guidelines can best serve as evidence-based recommendations for management, not as mandates for management in every patient. Furthermore, it must be recognized that trial data on which recommendations are based have often been carried out with background therapy not comparable to therapy in current use. Therefore, physician decisions regarding the management of individual patients may not always precisely match the recommendations. A knowledgeable physician who integrates the guidelines with pharmacologic and physiologic insight and knowledge of the individual being treated should provide the best patient management.

Implementation of the Guideline

Description of Implementation Strategy

The value of a practice guideline is significantly influenced by the scope of its dissemination. The first and second Heart Failure Society of America guidelines were available on the Internet, and thousands of copies were downloaded. The current document will be implemented on the Internet both for file transfer and as a hypertext source of detailed knowledge concerning heart failure.

Implementation Tools
Quick Reference Guides/Physician Guides
Slide Presentation
For information about availability, see the Availability of Companion Documents and Patient Resources fields below.

Institute of Medicine (IOM) National Healthcare Quality Report Categories

IOM Care Need
Staying Healthy
IOM Domain
Effectiveness

Identifying Information and Availability

Bibliographic Source(s)
Heart Failure Society of America, Lindenfeld J, Albert NM, Boehmer JP, Collins SP, Ezekowitz JA, Givertz MM, Katz SD, Klapholz M, Moser DK, Rogers JG, Starling RC, Stevenson WG, Tang WH, Teerlink JR, Walsh MN. Evaluation of patients for ventricular dysfunction and heart failure: HFSA 2010 comprehensive heart failure practice guideline. J Card Fail. 2010 Jun;16(6):e44-56. [109 references]
Adaptation

Not applicable: The guideline was not adapted from another source.

Date Released
1999 (revised 2010 Jun)
Guideline Developer(s)
Heart Failure Society of America, Inc - Disease Specific Society
Source(s) of Funding

Heart Failure Society of America, Inc

Guideline Committee

Heart Failure Society of America Guideline Committee

Composition of Group That Authored the Guideline

Guideline Committee Members: JoAnn Lindenfeld, MD (Chair); Nancy M. Albert, RN, PhD; John P. Boehmer, MD; Sean P. Collins, MD, MSc; Justin A. Ezekowitz, MBBCh; Michael M. Givertz, MD; Stuart D. Katz, MD; Marc Klapholz, MD; Debra K. Moser, RN, DNSc; Joseph G. Rogers, MD; Randall C. Starling, MD, MPH; William G. Stevenson, MD; W.H. Wilson Tang, MD; John R. Teerlink, MD; Mary N. Walsh, MD

Executive Council: Douglas L. Mann, MD, President; Inder S. Anand, MD; J. Malcolm O. Arnold, MD; John C. Burnett, Jr., MD; John Chin, MD; Jay N. Cohn, MD; Thomas Force, MD; Barry H. Greenberg, MD; Steven R. Houser, PhD; Mariell L. Jessup, MD; Barry M. Massie, MD; Mandeep R. Mehra, MD; Mariann R. Piano, RN, PhD; Clyde W. Yancy, MD; Michael R. Zile, MD

Financial Disclosures/Conflicts of Interest

Committee members and reviewers from the Executive Council received no direct financial support from the Heart Failure Society of America (HFSA) or any other source for the development of the guideline. Support was provided by the HFSA administrative staff, but the writing of the document was performed on a volunteer basis primarily by the Committee. Financial relationships that might represent conflicts of interest were collected annually from all members of the Guideline Committee and the Executive Council. Current relationships are shown in Appendix C of the "2010 HFSA Guideline Executive Summary" companion document (see the "Availability of Companion Documents" field).

Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: Heart Failure Society of America. Evaluation of patients for ventricular dysfunction and heart failure. J Card Fail 2006 Feb;12(1):e16-25.

Guideline Availability

Electronic copies: Available from the Heart Failure Society of America, Inc. Web site External Web Site Policy.

Print copies: Available from the Heart Failure Society of America, Inc., Court International - Suite 240 S, 2550 University Avenue West, Saint Paul, Minnesota 55114; Phone: (651) 642-1633

Availability of Companion Documents

The following are available:

  • Heart Failure Society of America. Executive summary: The 2010 HFSA comprehensive heart failure practice guideline. J Card Fail 2010 Jun. Electronic copies: Available from the Journal of Cardiac Failure Web site External Web Site Policy.
  • Heart Failure Society of America. Development and implementation of a comprehensive heart failure practice guideline. J Card Fail 2010 Jun;16(6):e3-6. Electronic copies: Available from the Journal of Cardiac Failure Web site External Web Site Policy.
  • Heart Failure Society of America. Conceptualization and working definition of heart failure. J Card Fail 2010 Jun;16(6):e34-7. Electronic copies: Available from the Journal of Cardiac Failure Web site External Web Site Policy.
  • PowerPoint slides. HFSA 2010 comprehensive heart failure guideline. Electronic copies: Available from the Heart Failure Society of America, Inc. Web site External Web Site Policy.

Print copies: Available from the Heart Failure Society of America, Inc., Court International - Suite 240 South, 2550 University Avenue West, Saint Paul, Minnesota 55114; Phone: (651) 642-1633

Patient Resources

None available

NGC Status

This NGC summary was completed by ECRI on July 31, 2006. The information was verified by the guideline developer on August 10, 2006. This NGC summary was updated by ECRI Institute on October 12, 2010. The updated information was verified by the guideline developer on November 23, 2010.

Copyright Statement

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. Please direct inquiries to info@hfsa.org.

Disclaimer

NGC Disclaimer

The National Guideline Clearinghouseâ„¢ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site.

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