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©2013 UpToDate ® Print Email ACC/AHA guideline summary: Management of concomitant diseases in patients with heart failure (HF) Class I - There is evidence and/or general agreement that the following approaches are effective for the management of concomitant diseases in patients with HF. • All recommendations for HF therapy should apply to patients with concomitant disorders unless there are specific exceptions. • Treatment of concomitant diseases: 1. Control of systolic and diastolic hypertension according to current guidelines. 2. Control of diabetes mellitus according to current guidelines. 3. Nitrates and beta blockers for the treatment of angina. 4. Coronary revascularization for angina according to current guidelines. 5. Anticoagulation for paroxysmal or persistent atrial fibrillation or a previous thromboembolic event. 6. Control of the ventricular response in patients with atrial fibrillation with a beta blocker (or amiodarone if the beta-blocker is contraindicated or not tolerated). 7. Treatment of coronary artery disease according to current guidelines. 8. Antiplatelet agents for prevention of MI and death in patients with coronary artery disease. Class IIa - The weight of evidence or opinion is in favor of the usefulness of the following approaches for the management of concomitant diseases in patients with HF • Control the ventricular response in patients with atrial fibrillation with digitalis. • Amiodarone to decrease recurrence of atrial arrhythmias and recurrence of implantable cardioverter-defibrillator discharge for ventricular arrhythmias. Class IIb - The weight of evidence or opinion is less well established for the usefulness of the following approaches for the management of concomitant diseases in patients with HF • Restoration and maintenance of sinus rhythm in patients with atrial fibrillation. • Anticoagulation in the absence of atrial fibrillation or a previous thromboembolic events. • Enhancing erythropoiesis in patients with anemia. Class III - There is evidence and/or general agreement that the following approaches are not useful or may be harmful for the management of concomitant diseases in patients with HF • Class I or III antiarrhythmic drugs to prevent ventricular arrhythmias. • Antiarrhythmic drugs as primary treatment of asymptomatic ventricular arrhythmias or to improve survival.

Class III - There is evidence and/or general agreement that the following approaches are not useful or may be harmful for the management of concomitant diseases in patients with HF • Class I or III antiarrhythmic drugs to prevent ventricular arrhythmias. • Antiarrhythmic drugs as primary treatment of asymptomatic ventricular arrhythmias or to improve survival. Data from Hunt SA, Abraham WT, Chin MH, et al. 2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 2009; 119:e391.