Compensated Heart Failure Management

Multidisciplinary Collaboration

The European Society of Cardiology recommends a dedicated multidisciplinary team for heart failure management, which is associated with improved outcomes 2
The American College of Cardiology, American Heart Association, and Heart Failure Society of America emphasize the importance of multidisciplinary collaboration in complex patient cases, such as those with compensated heart failure 4
A core team should include a cardiologist with heart failure expertise, nephrologist, hepatologist or gastroenterologist, and radiation oncologist, as well as allied health professionals like physiotherapists and occupational therapists 1, 2

The European Society of Cardiology recommends hemodynamic profile assessment, including clinical congestion and perfusion adequacy, for patients with suspected heart failure 4
Natriuretic peptide measurement, such as NT-proBNP or BNP, is essential for diagnosis, with age-adjusted thresholds (>300 pg/mL for NT-proBNP in patients >75 years) 6
Echocardiographic evaluation, including left ventricular ejection fraction, diastolic function parameters, and stroke volume index confirmation, is mandatory for heart failure diagnosis 2

The American College of Cardiology recommends initiating SGLT2 inhibitor (dapagliflozin or empagliflozin) as first-line disease-modifying therapy for HFpEF, provided eGFR >30 mL/min/1.73m² for dapagliflozin 5
The European Society of Cardiology recommends optimizing diuretic therapy with loop diuretics at the lowest effective dose to manage congestion 6
The American Heart Association recommends considering mineralocorticoid receptor antagonist (spironolactone) for patients with HFpEF, particularly if LVEF is in the lower preserved range (40-50%) 5

Regular assessment of volume status, renal function, and electrolytes is necessary, especially with diuretic and MRA therapy 5
Serial natriuretic peptide measurements can guide therapy optimization, though interpretation may be complicated by CKD 6
Functional capacity assessment through 6-minute walk test can objectively evaluate both pulmonary and cardiac capacity 3