The American Heart Association/American College of Cardiology/Heart Failure Society of America (AHA/ACC/HFSA) 2022 guidelines have been issued to prevent, diagnose, and manage heart failure patients. These novel guidelines offer valuable suggestions on the basis of contemporary evidence and aim to yield patient-centered suggestions for clinicians to combat heart failure.

The guideline was harmonized with other American Heart Association/American College of Cardiology guidelines and has substituted the the “2017 ACC/AHA/HFSA Focused Update of the 2013 American College of Cardiology Foundation/American Heart Association (ACCF/AHA) Guideline for the Management of Heart Failure” and  “2013 ACCF/AHA Guideline for the Management of Heart Failure”.

The EMBASE, Agency for Healthcare Research and Quality, the Cochrane Collaboration, MEDLINE (PubMed), and other relevant databases were searched. With the intention of enhancing the quality of care, many suggestions from the previous heart failure guidelines have been modified with novel valuable evidences. Additionally, many novel suggestions have been advocated when supported by published data, as depicted below:

• For patients with heart failure with reduced ejection fraction (HfrEF), the guideline-directed medical therapy now incorporates 4 classes of medicines that include sodium-glucose cotransporter-2 inhibitors (SGLT2i).
• In patients having heart failure with mildly reduced ejection fraction (HfmrEF), SGLT2i were found to show Class of Recommendation 2a. In this population, weaker suggestions (Class of Recommendation 2b) have been indicated for beta-blockers, angiotensin receptor-neprilysin inhibitors (ARNi), mineralocorticoid receptor antagonists (MRA), angiotensin-converting enzyme inhibitors (ACEi), and angiotensin (II) receptor blockers (ARBs).
• Improved left ventricular ejection fraction is used to refer to those people having previous HFrEF who now have a left ventricular ejection fraction >40%. HFrEF therapy should be continued in such people.
• Novel suggestions for HFpEF alleviation have been made for ARNi (Class of Recommendation 2b), MRAs (Class of Recommendation 2b), and SGLT2i (Class of Recommendation 2a).
• Numerous previous suggestions have been amended including avoiding routine usage of phosphodiesterase-5 inhibitors or nitrates (Class of Recommendation 3: No Benefit), management of hypertension (Class of Recommendation 1), management of atrial fibrillation (Class of Recommendation 2a), and ARBs usage (Class of Recommendation 2b).
• For certain suggestions where cost-effectiveness, high-quality studies of the intervention have been issued, value statements were made.
• The amyloid heart disease has novel suggestions for management including screening for urine and serum monoclonal light chains, anticoagulation, bone scintigraphy, tetramer stabilizer therapy, and genetic sequencing.
• If the left ventricular ejection fraction is >40%, evidence supporting elevated filling pressures is pivotal for diagnosing heart failure
• The evidence for elevated filling pressures can be procured from  invasive testing (like hemodynamic estimation) or noninvasive testing (like natriuretic peptide, diastolic function on imaging).
• Suggestions have been offered for select people suffering from heart failure and iron deficiency anemia, type 2 diabetes, hypertension, sleep disorders, malignancy, atrial fibrillation, and coronary artery disease.
•  A team specializing in heart failure should examine individuals suffering from advanced heart failure who desire to extend survival.  This team examines heart failure treatment, determines suitability for advanced heart failure treatments and utilizes palliative care that includes palliative inotropes.
• For people at risk for heart failure (stage A) or pre-heart failure (stage B), primary prevention is crucial. Revision of heart failure stages was done to highlight the novel terminologies of “at risk” for heart failure for stage A and pre-heart failure for stage B.

In summary, the novel AHA/ACC/HFSA heart failure guidelines endorse the novel definition of heart failure, emphasize novel directions in prevention, emphasize the potential of quadruple therapy for HFrEF, and trumpet first-ever truly efficacious therapies for HfpEF management. The novel recommendations for amyloid heart disease, HfmrEF, and HfpEF offered pivotal updates on state-of-the-art clinical practice.