The 2022 American College of Cardiology (ACC)/American Heart Association (AHA)/Heart Failure Society of America (HFSA) Guidelines for the Management of Heart Failure updated classification for heart failure into 4 categories: 

Current guidelines recommend use of sodium-glucose cotransporter 2 (SGLT2) inhibitors in management across all HF categories. 

Recent studies have demonstrated a reduction in heart failure hospitalization and CV death in patients with and without type 2 diabetes (T2DM).

• DAPA-HF (dapaglifozin) and EMPEROR-reduced (empaglifozin) trials showed reduction in heart failure hospitalization and CV death for chronic HFrEF with and without T2DM

• EMPEROR-preserved (empaglifozin) trial showed reduction in heart failure hospitalization and CV death for chronic HFpEF with and without T2DM

Prescribe a SGLT-2 inhibitor (dapaglifozin, empaglifozin, or canaglifozin) for your heart failure patients with eGFR >30 regardless of whether or not they have diabetes

• In diabetic patients with A1c <8% taking insulin or sulfonylureas, medications may need to be adjusted to avoid hypoglycemia 
• For heart failure patients without diabetes, dapaglifozin and empaglifozin are currently preferred over canagliflozin
• Monitor for signs of volume depletion or symptomatic hypotension and adjust diuretic and antihypertensive medications if needed  
• Counsel patients and monitor for increased incidence of GU/mycotic infections 
• Where available, consider a referral to ambulatory pharmacy or to the Medication Access Program for patients with cost/insurance barriers to obtaining a SGLT-2 inhibitor 
• Consider referral to cardiology for new-onset of heart failure or Chronic Heart Failure with high-risk features and clinical deterioration, as indicated by worsening edema, rising biomarkers (BNP, NTproBNP, others), worsened exercise testing, decompensated hemodynamics, or evidence of progressive re-modeling on imaging

Ensure accurate clinical documentation and coding that reflects heart failure status and management  



• Active review and use of Epic “Problem List”  
• Associate orders (including medications) to Diagnosis 
• Respond to CDQI BPAs 

Ensure that your patients' true levels of complexity are accurately reflected by using accurate and specific documentation and coding. This is not only essential to performance in value-based care reimbursement but also helps ensure that future quality of care and appropriate support services are made available.

Code for chronic systolic heart failure, chronic diastolic heart failure, and chronic combined systolic and diastolic heart failure.

• Systolic heart failure is typically recognized as LVEF <50%. For patients with HFrEF, HFmrEF, and HFimpEF with recent LVEF <50%, consider documenting and coding for systolic heart failure. 

• Diastolic heart failure should be diagnosed for patients with clinical signs of heart failure with EF >50%. For patients with HFimpEF with recent LVEF >50%, consider documenting and coding for diastolic failure.  

• For patients with diastolic dysfunction on imaging without clinical heart failure, consider using codes for diastolic dysfunction. 

For any questions about coding and documentation, please email Donna Malone, Director of Clinical Documentation and Quality Improvement.

Find more on the Chronic Condition Management Hub

Mount Sinai Health System's Chronic Condition Management Hub is an online resource center for primary care physicians, specialists, and other care providers with resources and information to help them manage chronic health conditions