We read with great interest the two articles regarding heart failure with reduced and preserved ejection fraction that highlight common and practical issues faced by patients and clinicians.1,2 However, we were surprised to see that the first of these articles1 did not mention the Canadian Cardiovascular Society Heart Failure Guidelines, available in print, online (www.ccs.ca) and in app format. These guidelines are the national source for Canadian practitioners and were designed and written for a Canadian audience.
Indeed, the authors should be aware that a recent guideline3 and a focused guideline update in 20144 covered this topic in detail. Had the authors been aware of the former and corrected their article regarding the latter, they would have been aware of the guidance regarding spironolactone:
We suggest that in individuals with HFpEF, an increased NP [natriuretic peptide] level, serum potassium < 5.0 mmol/L, and an estimated glomerular filtration rate (eGFR) ≥ 30 mL/min, a mineralocorticoid receptor antagonist like spironolactone should be considered, with close surveillance of serum potassium and creatinine (Weak Recommendation; Low-Quality Evidence).
The second of these articles2 incorporates the guidelines correctly.
Finally, it behooves all authors (and editors) to ensure appropriate and relevant local information is conveyed, while ensuring that international science and guidelines are also incorporated. It is our belief that this means inclusion of Canadian data and guidelines for a medical publication that has a principal readership that is Canadian.
Letters to the editor.
Letters have been abbreviated for print. See www.cmaj.ca for full versions and competing interests.
References
- 1.Sharma P, Nagarajan V. A 70-year-old woman with heart failure with preserved ejection fraction. CMAJ 2015;187:510–1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Moayedi Y, Kobulnik J. Chronic heart failure with reduced ejection fraction. CMAJ 2015;187:518–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.McKelvie RS, Moe GW, Ezekowitz JA, et al. The 2012 Canadian Cardiovascular Society Heart Failure Management Guidelines update: focus on acute and chronic heart failure. CJCA 2012;29:1–14. [DOI] [PubMed] [Google Scholar]
- 4.Moe GW, Ezekowitz JA, O’Meara E, et al. The 2014 Canadian Cardiovascular Society Heart Failure Management Guidelines focus update: anemia, biomarkers, and recent therapeutic trial implications. Can J Cardiol 2015;31:3–16. [DOI] [PubMed] [Google Scholar]