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In the article, “ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult—Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure),” by Hunt et al, which appeared in the September 20, 2005, issue of the journal (J Am Coll Cardiol 2005;46:1116–43), the following clarifications should be made:
1. In Figure 1,under therapy for Stage B, the following text should be added below the listings for Drugs: “DEVICES IN SELECTED PATIENTS: Implantable defibrillators.” See revised figure below.
2. In Table 2, the legend defining HF is incorrect. The words “and asymptomatic left ventricular dysfunction” should be deleted, leaving, “HF, heart failure.”
3. In Table 3, a dagger should be added after “Potassium-sparing diuretics.” In the legend, the following definition should be added: “†Eplerenone, although also a diuretic, is primarily used in chronic heart failure as a suppressor of the renin-angiotensin-aldosterone system.”
4. On page 1127, the following Class I recommendation should be added after recommendation 6: “7. Maximal exercise testing with or without measurement of respiratory gas exchange is recommended to facilitate the prescription of an appropriate exercise program for patients presenting with HF. (Level of Evidence: C)”
5. On pages 1127 and 1128, current recommendations 7, 8, 9, 10, 11, and 12 should be renumbered 8, 9, 10, 11, 12, and 13 to accommodate the new recommendation 7.
6. On page 1128, in current recommendation 11, 6th line, “0.12 ms” should be changed to “120 ms” to read, “Patients with LVEF less than or equal to 35%, sinus rhythm, and NYHA functional class III or ambulatory class IV symptoms despite recommended, optimal medical therapy and who have cardiac dyssynchrony, which is currently defined as a QRS duration greater than 120 ms, should receive cardiac resynchronization therapy unless contraindicated. (Level of Evidence: A)”
7. On page 1128, in current recommendation 12, first line, the word “reasonable” should be replaced with the word “recommended” to read, “Addition of an aldosterone antagonist is recommended in selected patients with moderately severe to severe symptoms of HF and reduced LVEF who can be carefully monitored for preserved renal function and normal potassium concentration. Creatinine should be less than or equal to 2.5 mg/dL in men or less than or equal to 2.0 mg/dL in women and potassium should be less than 5.0 mEq/l. (Under circumstances where monitoring for hyperkalemia or renal dysfunction is not anticipated to be feasible, the risks may outweigh the benefits of aldosterone antagonists.) (Level of Evidence: B)”
8. On page 1128, Class IIarecommendation 3, the level of evidence should be changed from A to B to read, “The addition of a combination of hydralazine and a nitrate is reasonable for patients with reduced LVEF who are already taking an ACEI and beta-blocker for symptomatic HF and who have persistent symptoms. (Level of Evidence: B)”
9. On page 1129, right column, second paragraph, third line, the word “small” should be deleted.
- American College of Cardiology Foundation