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New guidelines from the American College of Cardiology (ACC) outline management of heart failure with reduced ejection fraction (HFrEF) in light of new therapies, and with considerations for specific groups.

"With recent changes in available diagnostics and therapeutics for HFrEF along with evolution in recommended management strategies for affected patients, many questions have emerged regarding optimal deployment of these newer approaches to patient care," wrote Clyde Yancy, MD, MSc, of Chicago's Northwestern University Feinberg School of Medicine, and colleagues on the ACC's Heart Failure Pathway Writing Committee.

The document was published online in the . It gives guidance on 10 areas of interest to heart failure clinicians:

• How to initiate, add, or switch therapy to new evidence-based guideline-directed treatments for HFrEF.
• How to achieve optimal therapy given multiple drugs for heart failure.
• When to refer to a heart failure specialist.
• How to address challenges of care coordination.
• How to improve adherence to therapies.
• What is needed in specific patient cohorts: African Americans, the frail, and older adults.
• How to manage patients' cost of care for heart failure.
• How to manage the increasing complexity of heart failure.
• How to manage common comorbidities.
• How to integrate palliative care and transition to hospice care.

"The purpose of this document is to complement the 2017 ACC/AHA/HFSA Focused Update of the 2013 ACC/AHA Guideline for the Management of Heart Failure by addressing new medical therapies, prevention, and comorbidities relevant to HFrEF for which data are available," the authors commented.

Paul Hauptman, MD, of Saint Louis University Hospital in Missouri, called the guidelines "practical" for the practicing clinician.

"Each one of the ten 'principles for successful treatment of heart failure' is covered in a comprehensive manner and at the same time provides a framework for 'in the trenches' care of patients," he told MedPage Today."Overall, a very impressive document which takes guidelines to the clinic, for the first time."

Generally not included in guidelines, but outlined here, are the suggestions for cost containment and navigation of pre-authorizations, Hauptman said. He added that the listing of "triggers for referral to a specialist helps to formalize a process that has been somewhat random, at times to the detriment of patients."

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