TreatHF App Review: The ACC Takes on Heart Failure at the Point of Care

Heart failure has quickly become one of the top causes of morbidity and mortality accounting for 1 in 9 deaths. As patients with coronary artery disease live longer, survive myocardial infarctions, and bypass surgery, more live with heart failure. The disease has a staggering mortality rate of over 50% within 5 years of diagnosis. The most recent American College of Cardiology (ACC) guideline revised the terminology from the old systolic and diastolic heart failure to heart failure with preserved (HfpEF) or reduced (HFrEF) ejection fraction. The etiology and treatment of HFpEF and HFrEF are significantly different and both patients and providers can become confused on how to treat each condition. In 2017, the ACC released new heart failure guidelines that incorporated the new terminology and recent practice-changing evidence such as the PARADIGM-HF trial which demonstrated significant mortality reduction via the novel neprilysin inhibitor (ARNI), sacubitril. Recent updates have further solidified the role of beta-blockers, aldosterone antagonists such as spironolactone, and use of more invasive devices including ICDs and LVADs. The bottom line is that the treatment with target doses of the proven medications saves lives in HFrEF.

The American College of Cardiology (ACC) has been producing some outstanding apps. Previously on iMedicalApps, we reviewed their outstanding ASCVD, Anticoag Evaluator, DAPT calculator, LDL Manager, and BridgeAnticoag apps. Their latest app, TreatHF combines their 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment and the 2017 ACC/AHA/HFSA Focused Update of their 2013 HF guideline into a handy point-of-care app for patients with stage C HFrEF. Providers input data on patient’s current use of standard medications and enter potential indications/contraindications to other medications or treatments. The app provides tailored advice for titrating current medications as well as additional medications and/or other specific evidence-based treatments for the patient. Providers can email themselves a summary and reference more detailed information on all available treatments in the Therapy Reference section of the app.

Clinical Scenario

A 75-year-old male with a past medical history of myocardial infarction with a hx of HFrEF with a recent echo showing an EF of 38% presents for follow-up. He is already on lisinopril 20mg, atorvastatin 80mg and ASA 81mg. What other medications should he be taking? What if the EF was 25%? What additional recommendations would you consider?

Video Review

Evidence-based medicine

The ACC’s TreatHF app attempts to combine their latest HFrEF guideline and the latest medical evidence into an app for providers to use at the point of care. The app contains evidence from the 2014 PARADIGM-HF study and the ACC’s most recent guidelines for patients with stage C HFrEF. The app helps to ensure providers are prescribing evidence-based medications such as ACEI/ARB/ARNI, B-blockers, aldosterone antagonists, ICD’s, etc. This is accomplished via specific patient demographic/medication input by the app end user. Some of the recommendations are based on expert consensus.

What providers would benefit from this app?

Students, residents, mid-levels, family medicine, internal medicine, emergency medicine, cardiology providers. Any provider who treats or manages patients with HFrEF.

Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.