ABC | Volume 112, Nº5, May 2019

Updated Updated Geriatric Cardiology Guidelines of the Brazilian Society of Cardiology – 2019 Arq Bras Cardiol. 2019; 112(5):649-705 Cinecoronariography recommended in patients with CHF and angina for diagnosis of CAD I C Coronary angiotomography in patients with CHF and pre-test likelihood indicating low or intermediate risk and in patients whose non-invasive stress exams suggest CAD, with the objective of excluding invasive exams IIb C Hemogram, sodium, potassium, urea, creatinine (clearance), hepatic function, glucose, glycated hemoglobin, TSH, ferritin I C Natriuretic peptides IIa C Electrocardiogram recommended for evaluating rhythm, heart rate, morphology and QRS duration I C Chest radiography recommended to exclude pulmonary alterations. In cases of acute decompensation to detect edema/pulmonary congestion I C Endomyocardial biopsy should be considered for diagnosing specific causes in cases of rapid and progressive worsening in spite of standard therapy IIa C CAD: coronary artery disease; CHF: congestive heart failure; HF: heart failure; HFpEF: heart failure with preserved ejection fraction; HFrEF: heart failure with reduced ejection fraction; ICD: implantable cardioverter- defibrillator; MR: magnetic resonance; PET: positron emission tomography; SPECT: single photon emission computed tomography; TSH: thyroid- stimulating hormone. Grade of recommendation for pharmacological treatment of HFrEF FC II to IV Recommendation Classification of recommendation Level of evidence ACEI in conjunction with beta-blockers with the objective of reducing mortality and hospitalization I A ARB in conjunction with beta-blockers with the objective of reducing hospitalization and mortality in patients with ACEI intolerance I B Addition of aldosterone blockers in symptomatic patients, with LVEF ≤ 35%, associated with ACEI (or ARB) and beta-blockers I A Diuretics to improve symptoms in patients with congestion I B Angiotensin receptor-neprilysin inhibitor (sacubitril/valsartan), to substitute ACEI in order to reduce mortality and hospitalization in patients who continue to be symptomatic in spite of treatment with ACEI (or ARB) and beta-blockers I B Hydralazine and isosorbide dinitrate in African-American patients with EF < 35% or EF < 45% with ventricular dilatation who continue to be symptomatic, with FC III-IV, in spite of treatment with ACEI (or ARB) and beta-blockers to reduce mortality and hospitalization IIa B Hydralazine and isosorbide dinitrate in symptomatic patients with HFrEF who do not tolerate ACEI or ARB to reduce mortality IIb B Digoxin in symptomatic patients with sinus rhythm in spite of treatment with ACEI (or ARB) and beta-blockers to reduce hospitalization IIb B An If channel inhibitor (ivabradine) may be used in symptomatic patients with sinus rhythm, EF < 35%, and HR > 70 bpm, in spite of treatment with ACEI (or ARB) and beta-blockers to reduce hospitalization and mortality IIa B ACEI: angiotensin converting enzyme inhibitors;ARB: angiotensin receptor blockers; EF: ejection fraction; FC: New York Heart Association functional class; HFrEF: heart failure with reduced ejection fraction; HR: heart rate; LVEF: left ventricular ejection fraction. Treatment of comorbidities Recommendation Grade of recommendation Level of evidence Iron deficiency – IV iron replacement in patients with ferritin < 100 ng/ml or ferritin between 100 and 199 ng/ml and transferrin saturation < 20% with the objective of improving symptoms and quality of life IIa A Diabetes – metformin use IIa C IV: intravenous. 673