2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure
The US guideline shares the four foundational HFrEF drug classes with the ESC but frames them differently: it adopts the universal definition with stages A–D ('at risk', 'pre-HF'), introduces HF with improved ejection fraction (HFimpEF), and — unusually for a guideline — attaches explicit cost-effectiveness value statements to each therapy. Two substantive differences from the ESC 2021 text: SGLT2 inhibitors are recommended across HFmrEF and HFpEF (Class 2a, on EMPEROR-Preserved), which the ESC only caught up with in its 2023 Focused Update; and the primary-prevention ICD keeps a Class 1 recommendation irrespective of aetiology, whereas the ESC downgraded non-ischaemic dilated cardiomyopathy to Class IIa after DANISH. The register's heart-failure trials are grouped below.
This guideline cites 26 of the 199 landmark trials in our Cardiology register.
Foundational HFrEF therapy (four pillars)12
- 2020EMPEROR-ReducedCardiology · HF · SGLT2 inhibitorsEmpagliflozin Outcome Trial in Chronic Heart Failure With Reduced EF
- 2019DAPA-HFCardiology · HF · SGLT2 inhibitorsDapagliflozin and Prevention of Adverse outcomes in Heart Failure
- 2019PIONEER-HFCardiology · HF · ARNIComparison of Sacubitril/Valsartan versus Enalapril on Effect on NT-proBNP in Patients Stabilized from an Acute Heart Failure Episode
- 2014PARADIGM-HFCardiology · HF · ARNIProspective comparison of ARNI with ACEI to Determine Impact on Global Mortality
- 2011EMPHASIS-HFCardiology · HF · MRAEplerenone in Mild Patients Hospitalisation and Survival Study in Heart Failure
- 2004A-HeFTCardiology · HF · hydralazine/nitrateAfrican-American Heart Failure Trial
- 2003CHARMCardiology · HF · ARBCandesartan in Heart failure: Assessment of Reduction in Mortality and morbidity — Overall Programme
- 2001COPERNICUSCardiology · HF · beta-blockerCarvedilol Prospective Randomized Cumulative Survival Study
- 1999RALESCardiology · HF · MRARandomized Aldactone Evaluation Study
- 1999MERIT-HFCardiology · HF · Beta-blockadeMetoprolol CR/XL Randomized Intervention Trial in Heart Failure
- 1991SOLVDCardiology · HF · ACE inhibitorStudies of Left Ventricular Dysfunction — Treatment Trial
- 1987CONSENSUSCardiology · HF · RAAS inhibitionCooperative North Scandinavian Enalapril Survival Study
HFmrEF & HFpEF2
- 2021EMPEROR-PreservedCardiology · HF · SGLT2 inhibitorsEmpagliflozin Outcome Trial in Patients With Chronic Heart Failure With Preserved EF
- 2014TOPCATCardiology · HF · MRATreatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist
Adjunctive therapy, exercise & advanced HF4
- 2020VICTORIACardiology · HF · sGC stimulatorVericiguat Global Study in Subjects with Heart Failure with Reduced Ejection Fraction
- 2016STICHCardiology · HF · CABGSurgical Treatment for Ischemic Heart Failure — Extension Study (STICHES, 10-year follow-up)
- 2010SHIFTCardiology · HF · If-channel inhibitorSystolic Heart failure treatment with the If inhibitor ivabradine Trial
- 2009HF-ACTIONCardiology · HF · Exercise trainingHeart Failure: A Controlled Trial Investigating Outcomes of Exercise Training
Cardiac amyloidosis (ATTR)1
- 2018ATTR-ACTCardiology · HF · CardiomyopathyTafamidis in Transthyretin Amyloid Cardiomyopathy
Device therapy — ICD & CRT7
- 2016DANISHCardiology · Arrhythmia · ICDDanish Study to Assess the Efficacy of ICDs in Non-Ischaemic Systolic Heart Failure
- 2010RAFTCardiology · Arrhythmia · CRTResynchronization-Defibrillation for Ambulatory Heart Failure Trial
- 2009MADIT-CRTCardiology · Arrhythmia · CRTMulticenter Automatic Defibrillator Implantation Trial with CRT
- 2005SCD-HeFTCardiology · Arrhythmia · ICDSudden Cardiac Death in Heart Failure Trial
- 2005CARE-HFCardiology · Arrhythmia · CRTCardiac Resynchronisation in Heart Failure
- 2004COMPANIONCardiology · Arrhythmia · CRTComparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure
- 2002MADIT-IICardiology · Arrhythmia · ICDMulticenter Automatic Defibrillator Implantation Trial II
Published since the guideline6
- 2025SUMMITCardiology · Cardiometabolic · Obesity & HFpEFTirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity
- 2024FINEARTS-HFCardiology · HF · MRAFinerenone in Heart Failure with Mildly Reduced or Preserved Ejection Fraction
- 2024ATTRibute-CMCardiology · HF · TTR stabiliserEfficacy and Safety of Acoramidis (AG10) in Subjects With Transthyretin Amyloid Cardiomyopathy
- 2023STEP-HFpEFCardiology · HF · GLP-1 RASemaglutide Treatment Effect in People with obesity and HFpEF
- 2022DELIVERCardiology · HF · SGLT2 inhibitorsDapagliflozin Evaluation to Improve the Lives of Patients with Preserved-EF Heart Failure
- 2022STRONG-HFCardiology · HF · GDMT up-titrationSafety, Tolerability and Efficacy of Rapid Optimization, helped by NT-proBNP testinG, of Heart Failure therapies