The American Heart Association (AHA) and the American College of Cardiology (ACC) are well known for excellent and frequent publication of guidelines and scientific statements. Three important documents from these organizations are now in the scientific literature, with publication in Circulation.

The two Scientific Statements from AHA concern complementary and alternative medicine (CAM) in heart failure (HF), and the management of acute coronary syndrome (ACS). The joint AHA/ACC guideline addresses aortic disease.

 

Scientific Statement on CAM for HF 

 

Use of CAM is increasing across the US, and it is estimated that more than 30% of patients with HF use CAM therapies. These therapies are usually purchased by patients without consultation with an HCP—and patients rarely disclose CAM therapies when being seen by their HCP, even when they have a serious condition such as HF. 

Some CAM therapies have been studied and shown to possibly provide clinical benefit in HF, but others could worsen HF or interact with HF medications.

The AHA’s Scientific Statement, titled “Complementary and Alternative Medicines in the Management of Heart Failure,” aims to help HCPs elicit information from their patients with HF and communicate with them to promote transparency and improve outcomes.

As Sheryl L. Chow, PharmD, lead author and chair of the Statement Writing Committee said in a press release, “These products are not federally regulated, and they are available to consumers without having to demonstrate efficacy or safety to meet the same standards as prescription medications.”

Some benefits, potential risks with alternative medicines for heart failure. American Heart Association. December 8, 2022.

 

The Scientific Statement advises HCPs to ask patients with HF at every health care visit about their use of CAM therapies and to inform them of potential medication interactions and side effects, as well as which ones have been shown to benefit HF patients. 

The Statement reviews 27 different CAM agents that patients may be using for HF and groups them into three categories: potentially harmful, uncertain safety, and potentially beneficial. Some potentially beneficial therapies include CoQ10, omega 3 fatty acids, yoga, and tai chi. Potentially harmful therapies include blue cohosh and lily of the valley supplements. 

 

Scientific Statement on ACS

 

 

Do you have older patients who might be at risk for ACS? The AHA’s Scientific Statement on ACS, titled “Management of Acute Coronary Syndrome in the Older Adult Population,” includes recommendations on optimization of ACS identification and referrals.

Damluji AA, Forman DE, Wang TY, et al. Management of acute coronary syndrome in the older adult population: a Scientific Statement from the American Heart Association. Circulation. 2023;147(3):e32-e62.

 

 

 

The Statement proposes an approach that integrates specific geriatric risks into ACS management. 

The AHA reports that more than 720,000 people annually in the US experience an acute myocardial infarction or death related to coronary artery disease. Adults older than age 75  account for 30% to 40% of all hospitalized patients with ACS, as well as the majority of ACS-related deaths. Topics covered in the Statement include diagnosis, pharmacotherapy, revascularization strategies, and prevention of adverse events. 

Since this patient group has significant physiologic vulnerability, the Statement covers the many multimorbidity factors that negatively affect ACS outcomes in older patients:

• Polypharmacy

• Frailty

• Nutritional deficiencies

• Renal aging 

• Sensory loss 

• Cognitive impairment

• Delirium 

ACS management strategies include the following:

• Appropriate use of ECG, cardiac biomarkers, and imaging

• Pharmacologic management 

• Surgical risk management, including percutaneous revascularization

• Dosing adjustments for antiplatelet and anticoagulant therapy

• Transition of care 

• Use of cardiac rehabilitation

• Palliative care services 

• Holistic approaches 

The Statement was developed because these factors are not addressed by other current tools, and because the older age group has distinct phenotypes of ACS. Care for older patients with HF should be individualized and patient-centric. In addition, management should be instituted by a multidisciplinary team, involving an outpatient cardiologist, primary care clinician, and geriatrician, and a cardiac rehabilitation referral. 

 

Clinical Guideline for Aortic Disease 

 

The joint “2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease” updates previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease.

Isselbacher EM, Preventza O, Hamilton Black J, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022;146(24):e334-e482.

 

 

It provides HCPs with recommendations on diagnosis, genetic evaluation, medical therapy, surgical treatment, and long-term surveillance. In addition, it addresses multiple clinical presentations, including asymptomatic, stable symptomatic, and acute aortic syndromes.

Also emphasized is the importance of an institution’s volume of interventional procedures, as well as the expertise of the multidisciplinary aortic team, in the care of patients with aortic disease. The guideline makes a strong recommendation for using a multidisciplinary aortic team to determine the scope and timing of interventions needed. 

Outcomes at centers with these teams are enhanced due to the extensive experience of the practitioners and the overall capabilities of the center.  

Other features related to the disease that are discussed in the guideline are patient height, and the rate of aortic aneurysm growth. There is an in-depth review of normal aortic anatomy that can help HCPs orient to abnormal presentations.