HF: Introduction (2017)

Guideline Overview

Guideline Title

Heart Failure (2017) Evidence-Based Nutrition Practice Guideline

Guideline Narrative Overview

The focus of this guideline is on the treatment of adults with heart failure (NYHA Classes I - IV/AHA Stages B, C and D).

Guideline Development and Contributors

This guideline outlines the most current information on heart failure. The recommendations developed in this guideline were based upon a systematic review of the literature in multiple practice areas, the American College of Cardiology / American Heart Association Task Force 2013 and 2016 Guidelines, and the European Society of Cardiology 2016 Guidelines.

A summary of the evidence analysis is below. Topics include:

Medical Nutrition Therapy
Energy
Protein
Sodium and Fluid
Nutrient Intake and Supplementation (Coenzyme Q10, Iron, Omega-3 Fatty Acids, Thiamin and Vitamin D)

The number of supporting documents for these topics is below:

Recommendations: 17
Conclusion Statements: 46
Evidence Summaries: 20
Article worksheets: 17

Additional conclusion statements and evidence summaries supporting the recommendations are located in the American College of Cardiology / American Heart Association Task Force 2013 and 2016 Guidelines, and the European Society of Cardiology 2016 Guidelines.

To view the guideline development and review process, click here.

Contributors

Expand the Project Team to see the list of expert workgroup members, analysts and contributors for this project.

Revision

Academy guidelines are revisited every five years. An expert workgroup will be convened by the Evidence-based Practice Committee to determine the need for new and revised recommendations based on the available science. The process includes:

Literature searches to identify new research published since the previous searches were completed. Updated inclusion/exclusion criteria and search terms may be warranted.
Review to determine if the update will include modification to all, some or no recommendations compared to the earlier version(s) of the guideline, or development of new recommendations.
Creation of a table comparing the new guideline and the older version of the guideline. The document will indicate which recommendations remained unchanged; updated; new; or not reviewed.

Using the Academy's EAL Methodology, an unbiased and transparent systematic review will be completed and the updated guidelines published on the EAL.

Medical Nutrition Therapy and Heart Failure

The registered dietitian nutritionist (RDN) plays an integral role in the interdisciplinary healthcare team by designing the optimal nutrition prescription that complements drug therapy, physical activity, and behavioral therapy. Based on the client’s treatment plan and comorbid conditions, other nutrition practice guidelines may be needed in order to provide optimal treatment.

Populations to Whom This Guideline May Apply

This guideline applies to adults with heart failure (NYHA Classes I - IV/AHA Stages B, C and D).

Comparison of ACCF/AHA Stages of Heart Failure (HF) and New York Heart Association (NYHA) Functional Classifications

ACCF/AHA Stage		NYHA Functional Classification
Stage A	At high risk for HF but without structural heart disease or symptoms of HF	None
Stage B	Structural heart disease but without signs or symptoms of HF	Class I	No limitation of physical activity. Ordinary physical activity does not cause symptoms of HF.
Stage C	Structural heart disease with prior or current symptoms of HF	Class I	No limitation of physical activity. Ordinary physical activity does not cause symptoms of HF.
		Class II	Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in symptoms of HF.
		Class III	Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes symptoms of HF.
		Class IV	Unable to carry on any physical activity without symptoms of HF, or symptoms of HF at rest.
Stage D	Refractory HF requiring specialized interventions	Class IV	Unable to carry on any physical activity without symptoms of HF, or symptoms of HF at rest.

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