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2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Paul A Heidenreich, Biykem Bozkurt, David Aguilar, Larry A Allen, Joni J Byun, Monica M Colvin, Anita Deswal, Mark H Drazner, Shannon M Dunlay, Linda R Evers, James C Fang, Savitri E Fedson, Gregg C Fonarow, Salim S Hayek, Adrian F Hernandez, Prateeti Khazanie, Michelle M Kittleson, Christopher S Lee, Mark S Link, Carmelo A Milano, Lorraine C Nnacheta, Alexander T Sandhu, Lynne Warner Stevenson, Orly Vardeny, Amanda R Vest, Clyde W Yancy
Circulation 2022 145(18):e895-e1032

Bibliography

PubMed
PMID 35363499
DOI
10.1161/CIR.0000000000001063
Funding
Clinical practice guideline developed jointly by the American Heart Association, American College of Cardiology and Heart Failure Society of America under their formal evidence-review and disclosure processes.
Competing interests
The guideline includes formal writing-committee relationship-with-industry disclosures and conflict-management procedures; individual disclosures are detailed in the guideline appendices.

Study snapshot

DesignEvidence-based clinical practice guideline
ModelMultisociety guideline based on comprehensive literature review and structured evidence grading for prevention, diagnosis and management of heart failure.
SampleNot applicable; guideline synthesis rather than a single patient cohort.
InterventionGuideline-directed heart-failure management; includes evaluation of vitamins/nutritional supplements and discussion of CoQ10/Q-SYMBIO.
DurationEvidence search May-December 2020 with additional relevant studies considered through September 2021.
EndpointsGuideline-directed medical therapy; Mortality; Heart-failure hospitalization; Symptoms and functional status; Nutritional supplements; CoQ10 and Q-SYMBIO

What the study showed, in plain terms

The 2022 AHA/ACC/HFSA guideline is important because positive supplement trials do not automatically become standard heart-failure therapy.

For HFrEF, the guideline classifies vitamins, nutritional supplements and hormonal therapy as not recommended for treatment other than to correct specific deficiencies (Class 3: No Benefit, Level B-R).

The guideline specifically discusses Q-SYMBIO: no short-term NYHA improvement at 16 weeks, but fewer major adverse cardiovascular events at two years. It notes that slow recruitment and other limitations tempered enthusiasm for CoQ10 supplementation in clinical practice. CoQ10 therefore should not replace guideline-directed medical therapy.

Key findings

HFrEF recommendation: vitamins, nutritional supplements and hormonal therapy are not recommended as heart-failure treatment except to correct specific deficiencies (Class 3: No Benefit; Level B-R).

Q-SYMBIO is acknowledged as the largest CoQ10 RCT, with no NYHA change at 16 weeks but reduced 2-year MACE (HR 0.50, 95% CI 0.32 to 0.80).

The guideline states that concerns about slow recruitment in Q-SYMBIO tempered enthusiasm for CoQ10 supplementation in clinical practice.

Guideline-directed medical therapy remains the standard of care for HFrEF; supplements are not substitutes for proven disease-modifying therapies.

What this study can and cannot tell us

The guideline evidence search predates the 2024 CoQ10 heart-failure meta-analysis and the 2025 randomized trial, so it does not incorporate those newer publications.

Clinical guidelines weigh evidence, applicability, replication and treatment standards differently from a supplement-specific meta-analysis; the recommendation therefore cannot be interpreted as proof that every CoQ10 trial is negative.

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Editorial review

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Dr. Khaled Mahmoud, MBBChCritical Care Medicine, Longevity Science & Editorial Direction Dr. Amr Yasser, PhDCardiometabolic, Musculoskeletal, Gut & Bioavailability Dr. Abdulla Mostafa, PhDCellular Senescence, Neurological, Mitochondrial & Brain-Ageing Biology