Heart failure

JACC VOL. 79, NO. 17, 2022 Heidenreich et al e413 MAY 3, 2022:e263–e421 2022 AHA/ACC/HFSA Heart Failure Guideline APPENDIX 1. CONTINUED Institutional, Ownership/ Organizational, or Speakers Partnership/ Committee Personal Other Financial Expert Member Bureau Principal Research Mark S. Link Employment Consultant Benefit Witness Salary None Carmelo A. UT Southwestern Medical Center, Dallas— None None None None None None Milano Professor of Medicine and Director, Cardiac Electrophysiology; Laurence and Susan Hirsch/Centex Distinguished Chair in Heart Disease, Department of Internal Medicine, Division of Cardiology Duke University Medical Center—Professor n Abbott* None None n Abbott* n Abbott* None None of Surgery, Surgery Department n Medtronic* n AbioMed† n NuPulse† n Allergan† None None n CryoLife† None None Lorraine C. American Heart Association/American None None None None n Ethicon† Nnacheta§ College of Cardiology—Guideline Advisor None None None n LivaNova† None Alexander T. Stanford University—Instructor of Medicine, None n AHA/ACC sala- Sandhu Division of Cardiology, Department of ried employee Medicine None Lynne Warner Vanderbilt University Medical Center, n Novartis None None n Abbott‡ None None Stevenson Vanderbilt Heart and Vascular Institute— n Biotronik None None Director of Cardiomyopathy and Lisa M. n Boston Jacobson Professor of Cardiovascular Scientific Medicine n Bristol-Myers Orly Vardeny Minneapolis VA Health Care System and n Amgen None None n AstraZeneca* Squibb‡ University of Minnesota—Associate n Novartis None n Bayer* n Endotronic† n Sanofi-Pasteur n Gore Medical† Professor of Medicine, Department of n Johnson & Medicine None Johnson n AstraZeneca‡ Amanda R. Vest Tufts Medical Center, Cardiovascular None None n Boehringer None None Center—Assistant Professor of Medicine Ingelheim‡* None None Clyde W. Yancy Northwestern University, Feinberg School None None None None n CareDx‡ of Medicine; Northwestern Memorial n Corvia‡ Hospital—Professor of Medicine n Transmedics‡ (Cardiology); Professor of Medical Social n Abbott† Sciences; Chief of Cardiology; Vice-Dean, n JAMA Cardiol- Diversity & Inclusion; Associate Director Cardiovascular Institute Internal Medicine/ ogy, Deputy Editor Cardiology & Medical Social Sciences This table represents the relationships of committee members with industry and other entities that were determined to be relevant to this document. These relationships were reviewed and updated in conjunction with all meetings and/or conference calls of the writing committee during the document development process. The table does not necessarily reflect relationships with industry at the time of publication. A person is deemed to have a significant interest in a business if the interest represents ownership of $5% of the voting stock or share of the business entity, or ownership of $$5000 of the fair market value of the business entity; or if funds received by the person from the business entity exceed 5% of the person’s gross income for the previous year. Relationships that exist with no financial benefit are also included for the purpose of transparency. Relationships in this table are modest unless otherwise noted. According to the ACC/AHA, a person has a relevant relationship IF: a) the relationship or interest relates to the same or similar subject matter, intellectual property or asset, topic, or issue addressed in the document; or b) the company/entity (with whom the relationship exists) makes a drug, drug class, or device addressed in the document or makes a competing drug or device addressed in the document; or c) the person or a member of the person’s household, has a reasonable potential for financial, professional or other personal gain or loss as a result of the issues/content addressed in the document. Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply. *Significant relationship. †No financial benefit. ‡This disclosure was entered under the Clinical Trial Enroller category in the ACC’s disclosure system. To appear in this category, the author acknowledges that there is no direct or institutional relationship with the trial sponsor as defined in the (ACCF or AHA/ACC) Disclosure Policy for Writing Committees. §Lorraine Nnacheta is an AHA/ACC joint staff member and acts as the guideline advisor for the “2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.” No relevant relationships to report. Non-voting author on recommendations and not included/counted in the RWI balance for this committee. ACC indicates American College of Cardiology; ACCF, American College of Cardiology Foundation; AHA, American Heart Association; HFSA, Heart Failure Society of America; RWI, relationships with industry and other entities; UCLA, University of California, Los Angeles; UT, University of Texas; and VA, Veterans Affairs.

APPENDIX 2. REVIEWER RELATIONSHIPS WITH INDUSTRY AND OTHER ENTIT THE MANAGEMENT OF HEART FAILURE (JUNE 2021) Reviewer Representation Employment Consultant Speaker None Bureau Anastasia Content Reviewer—Joint Committee University of Health Sciences Armbruster None n AstraZenec on Clinical Practice Guidelines & Pharmacy in St. Louis Pharmaceu Alison Bailey Content Reviewer—ACC Centennial Heart at Parkridge None Joshua A. Content Reviewer—Joint Committee Vanderbilt University n Amgen None Beckman on Clinical Practice Guidelines n JanOne n Janssen None Claudio Bravo Content Reviewer—AHA University of Washington None Patricia Chang Content Reviewer—AHA/ACC University of North Carolina Pharmaceuticals* None Richard Cheng Content Reviewer—AHA University of Washington None None None Lisa de las Content Reviewer—Joint Committee Washington University in St. n Acceleron n Simply Spe Fuentes on Clinical Practice Guidelines Louis n Aerovate n Altavant n Arena n Bayer n Complexa* n Express Scripts n Gossamer n Johnson&Johnson n Phase Bio n Sommetrics n V-wave n Vaderis n WebMD*

IES (COMPREHENSIVE)—2022 AHA/ACC/HFSA GUIDELINE FOR e414 Heidenreich et al 2022 AHA/ACC/HFSA Heart Failure Guideline s Ownership/ Personal Institutional, Expert u Partnership/ Research Organizational, or Witness ca Principal None Other Financial None uticals None Benefit None None None n EMX† n Bayer (DSMB) n American Society of Preventive None n JanaCare† n Novartis Cardiology† None n OptumRx n Vascular Interventional Advances* n NovoNordisk‡ None None None None None None None None None None None n Eidos None n Ionis None eaking* n Acceleron* n ACC† n Bayer n AHA† n Complexa* n Circulation Journals n Johnson&Johnson* n Foundation for the NIH† n Liquidia* n Pulmonary Hypertension n Medtronic* Association* n NIH* n Trio Analytics n United Therapeutics* n University of Ken- tucky (DSMB)† n University of Tor- onto (DSMB)† Continued on the next page JACC VOL. 79, NO. 17, 2022 MAY 3, 2022:e263–e421

APPENDIX 2. CONTINUED Reviewer Representation Employment Consultant Speakers Akshay Desai Content Reviewer—AHA/ACC Bureau Brigham and Women’s n Abbott None Hospital Laboratories* None Howard Eisen Official Reviewer—AHA Penn State Health n Alnylam* None Mona Fiuzat Content Reviewer—AHA/ACC Duke University n Amgen* None n AstraZeneca Bulent Gorenek Content Reviewer—Joint Committee Eskisehir Osmangazi None on Clinical Practice Guidelines University Pharmaceuticals* n Biofourmis* José A. Joglar Content Reviewer—Joint Committee UT Southwestern Medical n Boehringer on Clinical Practice Guidelines Center Ingelheim n Boston Scientific* n Corvidia Therapeutics* n Cytokinetics n Dalcor Pharma* n Lupin Pharma n Merck n Novartis* n Regeneron* n Relypsa* n Sun Pharma None n Fire1 n AstraZeneca Pharmaceuticals n Bayer n Daiichi Sankyo n Roche n Sandoz n Sanofi None

Ownership/ Personal Institutional, Expert JACC VOL. 79, NO. 17, 2022 s Partnership/ Research Organizational, or Witness MAY 3, 2022:e263–e421 Principal Other Financial Benefit None n Alnylam* n Baim Clinical Research Institute* None n AstraZeneca n TIMI Study Group* Pharmaceuticals* n Bayer† n Myokardia† n Novartis* None None None None None n Roche* None None None None None None None None None None Heidenreich et al e415 2022 AHA/ACC/HFSA Heart Failure Guideline Continued on the next page

APPENDIX 2. CONTINUED Reviewer Representation Employment Consultant Speakers Duke University Bureau W. Schuyler Content Reviewer—Joint Committee n Bayer* None Jones on Clinical Practice Guidelines n Janssen None Pharmaceuticals None Daniel Judge Content Reviewer—AHA/ACC The Medical University of n ADRx None South Carolina n Cytokinetics None Kimberly n Pfizer Ketter Lay Reviewer Morris Cardiovascular & Risk n Tenaya None Reduction Center None Dharam Content Reviewer—AHA/ACC Therapeutics Kumbhani UT Southwestern Medical None None Content Reviewer—Joint Committee Center None Daniel Mark on Clinical Practice Guidelines n ACC* Duke University n Novartis Paul Mather Content Reviewer—AHA/ACC University of Pennsylvania None Content Reviewer—AHA/ACC Harvard University Shweta n Baim Institute for Motiwala Clinical Research* Debabrata Content Reviewer—Joint Committee Texas Tech University n Eli Lilly Mukherjee on Clinical Practice Guidelines n Relay Brigham and Women’s Patrick T. Content Reviewer—Joint Committee Hospital Therapeutics* O’Gara on Clinical Practice Guidelines n ACC* None

Ownership/ Personal Institutional, Expert e416 Heidenreich et al s Partnership/ Research Organizational, or Witness 2022 AHA/ACC/HFSA Heart Failure Guideline Principal Other Financial None Benefit None None n Boehringer None Ingelheim n Bristol Myers Squibb n PCORI None n Capricor (DSMB) n Array Biopharma‡ n TRiNDS (DSMB) n Eidos Therapeutics‡ n Myokardia‡ None None n Verilogue None None None None None n Circulation, Associate Editor* None None n Novartis* n Elsevier* None n Heartflow* n Relay n Puma n Merck* None n NIH* None Therapeutics* Biotechnology* None n Relypsa† n American Regent‡ n Boehringer Ingelheim‡ n Edwards Lifesciences‡ n NuPulse CV‡ None None None None None None n Edwards Lifesciences† None n Medtronic† n JAMA* JACC VOL. 79, NO. 17, 2022 n NIH* MAY 3, 2022:e263–e421 Continued on the next page

APPENDIX 2. CONTINUED Reviewer Representation Employment Consultant Speakers Francis D. Official Reviewer—AHA University of Michigan None Bureau None Pagani Content Reviewer—ACC George Washington n CVRx Gurusher University n Pfizer* Content Reviewer—Joint Committee None None Panjrath on Clinical Practice Guidelines Vanderbilt University None Content Reviewer—AHA/ACC n Abbott Mariann Piano University of Chicago Laboratories None None Sean Pinney n CareDX, Inc. n Medtronic None Bunny Pozehl Content Reviewer—AHA/ACC University of Nebraska n NuPulse None Tanveer Rab Emory University n Procyrion n Medtronic Content Reviewer—Joint Committee n Transmedics on Clinical Practice Guidelines None None Nosheen Reza Content Reviewer—ACC University of Pennsylvania None Jo E. Rodgers Content Reviewer—AHA University of North Carolina None Chris Salerno Content Reviewer—ACC St. Vincent Hospital n Abbott

Ownership/ Personal Institutional, Expert JACC VOL. 79, NO. 17, 2022 s Partnership/ Research Organizational, or Witness MAY 3, 2022:e263–e421 Principal None Other Financial None None Benefit None None None None None n Abbott None None Laboratories‡ None None None None None None None None None None None n ABIM None None None n ACC† None n Novartis† n American Bifurcation Club† None None None None n Duke Clinical Research Institute‡ None n GlaxoSmithKline None n Abbott‡ n Medtronic‡ Continued on the next page Heidenreich et al e417 2022 AHA/ACC/HFSA Heart Failure Guideline

APPENDIX 2. CONTINUED Reviewer Representation Employment Consultant Speakers Sanjiv Shah Official Reviewer—HFSA Northwestern University Bureau n Abbott n ABIM n Pulmonary n Amgen pertension n Aria Association n AstraZeneca Pharmaceuticals* n Axon n Bayer n Boehringer Ingelheim n Boston Scientific n Bristol Myers Squibb n Cardiora n CVRx n Cyclerion n Cytokinetics n Eisai n Ekoi.ai n GlaxoSmithKline n Imara n Ionis n Ironwood n Janssen Pharmaceuticals n Keyto n Eli Lilly n Merck n Myokardia n Novartis* n NovoNordisk n Pfizer n Prothena n Regeneron n Sanofi n Shifamed n Tenax n United Therapeutics

s Ownership/ Personal Institutional, Expert e418 Heidenreich et al Partnership/ Research Organizational, or Witness 2022 AHA/ACC/HFSA Heart Failure Guideline Hy- n Principal n Actelion* Other Financial None n AHA* Benefit None n Covia* n NIH* None Continued on the next page JACC VOL. 79, NO. 17, 2022 MAY 3, 2022:e263–e421

APPENDIX 2. CONTINUED Reviewer Representation Employment Consultant Speakers Erica S. Spatz Yale University None Bureau Official Reviewer, Joint Committee None on Clinical Practice Guidelines University of Arizona n Medscape* n Myokardia None Nancy Sweitzer Official Reviewer—HFSA Jacqueline E. Content Reviewer—Joint Committee Mount Sinai n Gaffney Events None Tamis- on Clinical Practice Guidelines Educational Trust Holland None None Jennifer Content Reviewer—AHA UT Southwestern Medical None None Thibodeau Center Sanjeev Trehan Official Reviewer—ACC (Board of Saint Francis Health System None Governors) Ascension Medical Group None Mary Norine Walsh Content Reviewer—AHA/ACC

Ownership/ Personal Institutional, Expert JACC VOL. 79, NO. 17, 2022 s Partnership/ Research Organizational, or Witness MAY 3, 2022:e263–e421 Principal Other Financial Benefit None None n Centers for Medicare & Medicaid None Services* n U.S. Food and Drug Administration* None n NIH* n AHA* None n Merck n Amgen‡ n Novartis† n Array BioPharma‡ n Cellular Logistics† n Corvia Medical‡ n CVRx‡ n NIH*‡ n University of Arizona* None None n AHA† None n Bronx Lebanon Hospital, Cardiol- ogy Fellowship Program Director† n NYS† n The NGS Predict Study‡ None None n CareDX‡ None n Cytokinetics‡ n Eidos Therapeutics‡ n NIH‡ None None None None None None n Amgen‡ None n EBR Systems Continued on the next page n PCORI‡ Heidenreich et al e419 n Thoratec‡ 2022 AHA/ACC/HFSA Heart Failure Guideline

APPENDIX 2. CONTINUED Reviewer Representation Employment Consultant Speakers Content Reviewer—ACC Bureau Barbara Medical University of South n Lexicomp Wiggins Carolina None Y. Joseph Woo Content Reviewer—Joint Committee Stanford University School of None None on Clinical Practice Guidelines Medicine This table represents all relationships of reviewers with industry and other entities that were reported at the time of peer review, including necessarily reflect relationships with industry at the time of publication. A person is deemed to have a significant interest in a busines of $$5000 of the fair market value of the business entity; or if funds received by the person from the business entity exceed 5% of the pe purpose of transparency. Relationships in this table are modest unless otherwise noted. Names are listed in alphabetical order within ea relationships-with-industry-policy for definitions of disclosure categories or additional information about the ACC/AHA Disclosure Policy *Significant relationship. †No financial benefit. ‡This disclosure was entered under the Clinical Trial Enroller category in the ACC’s disclosure system. To appear in this category, the autho AHA/ACC) Disclosure Policy for Writing Committees. ABIM indicates American Board of Internal Medicine; ACC, American College of Cardiology; ACCF, American College of Cardiology Found Medical Association; NGS, Next-generation sequencing; NIH, National Institutes of Health; NYS, New York State; PCORI, Patient-Cente Infarction; and UT, University of Texas.

Ownership/ Personal Institutional, Expert e420 Heidenreich et al s Partnership/ Research Organizational, or Witness 2022 AHA/ACC/HFSA Heart Failure Guideline Principal None Other Financial None Benefit None None n Uppsala University‡ None n ACC† n American Journal of Cardiovascular Drugs† n PERT Consortium Clinical Protocols† n Associate Editor, Journal of None Thoracic and Cardiovascular Disease n NIH* those not deemed to be relevant to this document, at the time this document was under review. The table does not ss if the interest represents ownership of $5% of the voting stock or share of the business entity, or ownership erson’s gross income for the previous year. Relationships that exist with no financial benefit are also included for the ach category of review. Please refer to https://www.acc.org/guidelines/about-guidelines-and-clinical-documents/ y for Writing Committees. or acknowledges that there is no direct or institutional relationship with the trial sponsor as defined in the (ACCF or dation; AHA, American Heart Association; DSMB, Data and Safety Monitoring Board; JAMA, Journal of the American ered Outcomes Research Institute; PERT, Pulmonary Embolism Response Team; TIMI, Thrombolysis in Myocardial JACC VOL. 79, NO. 17, 2022 MAY 3, 2022:e263–e421

JACC VOL. 79, NO. 17, 2022 Heidenreich et al e421 MAY 3, 2022:e263–e421 2022 AHA/ACC/HFSA Heart Failure Guideline APPENDIX 3. APPENDIX FOR TABLES 3 AND 4: SUGGESTED THRESHOLDS FOR STRUCTURAL HEART DISEASE AND EVIDENCE OF INCREASED FILLING PRESSURES Morphology n LAVI $29 mL/m2 Ventricular systolic function n LVMI >116/95 g/m2 Ventricular diastolic function n RWT >0.42 n LV wall thickness $12 mm Biomarker n LVEF <50% n GLS <16% n Average E/eʹ $15 for increased filling pressures n Septal eʹ <7 cm/s n Lateral eʹ <10 cm/s n TR velocity >2.8 m/s n Estimated PA systolic pressure >35 mm Hg n BNP $35 pg/mL* n NT-proBNP $125 pg/mL* *Cutoffs provided for natriuretic peptide levels may have lower specificity, especially in older patients or in patients with AF or CKD. Usually, higher cutoff values are recommended for the diagnosis of HF in these patients. Natriuretic peptide cutoffs selected for population screening for pre-HF (stage B HF) may be <99% reference limits and need to be defined according to the population at risk. AF indicates atrial fibrillation; BNP, brain natriuretic peptide; CKD, chronic kidney disease; GLS, global longitudinal strain; HF, heart failure; LAVI, left atrial volume index; LV, left ventricular; LVEF, left ventricular ejection fraction; LVMI, left ventricular mass index; NT-proBNP, natriuretic peptide tests; PA, pulmonary artery; RWT, relative wall thickness; and TR, tricuspid regurgitation.