„The aim of all the ESC Guidelines is to help health professionals to make decisions in their everyday life based on the best available evidence. We will soon be celebrating the 30th anniversary of clinical trials that for the first time incontrovertibly demonstrated that the miserable outcome of patients with heart failure (HF) can be markedly improved. Since then, in the area of HF management we have witnessed and celebrated numerous highs, which have definitely outnumbered several lows, all of which have allowed us to unravel the pathophysiology of this clinical syndrome, but more importantly has led to better care of our patients. In the year 2016, no one would any longer dispute that, by applying all evidence-based discoveries, HF is now becoming a preventable and treatable disease.“
Skaityti daugiau
„The aim of this document is to provide practical, evidence-based guidelines for the diagnosis and treatment of HF. The principal changes from the 2012 guidelines relate to: e followed the format of the previous ESC 2012 HF Guidelines. Therapeutic recommendations state the treatment effect supported by the class and level of recommendation in tabular format; in the case of chronic HF due to left ventricular systolic dysfunction (LVSD) the recommendations focus on mortality and morbidity outcomes. Detailed summaries of the key evidence supporting generally recommended treatments have been provided. For diagnostic recommendations a level of evidence C has been typically decided upon, because for the majority of diagnostic tests there are no data from randomized controlled trials (RCTs) showing that they will lead to reductions in morbidity and/or mortality. Practical guidance is provided for the use of the important disease-modifying drugs and diuretics. When possible, other relevant guidelines, consensus statements and position papers have been cited to avoid unduly lengthy text. All tables should be read in conjunction with their accompanying text and not read in isolation.
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a new term for patients with HF and a left ventricular ejection fraction (LVEF) that ranges from 40 to 49% — ‘HF with mid-range EF (HFmrEF)’; we believe that identifying HFmrEF as a separate group will stimulate research into the underlying characteristics, pathophysiology and treatment of this population;
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clear recommendations on the diagnostic criteria for HF with reduced EF (HFrEF), HFmrEF and HF with preserved EF (HFpEF);
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a new algorithm for the diagnosis of HF in the non-acute setting based on the evaluation of HF probability;
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recommendations aimed at prevention or delay of the development of overt HF or the prevention of death before the onset of symptoms;
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indications for the use of the new compound sacubitril/valsartan, the first in the class of angiotensin receptor neprilysin inhibitors (ARNIs);
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modified indications for cardiac resynchronization therapy (CRT);
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the concept of an early initiation of appropriate therapy going along with relevant investigations in acute HF that follows the ‘time to therapy’ approach already well established in acute coronary syndrome (ACS);
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a new algorithm for a combined diagnosis and treatment approach of acute HF based on the presence/absence of congestion/hypoperfusion.
This document is the result of extensive interactions between the Task Force, the review team and the ESC Committee for Practice Guidelines. It represents a consensus of opinion of all of the experts involved in its development. Concurrently to the development of the 2016 ESC Guidelines on HF, the group writing the “2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure” independently developed its recommendations on new pharmacotherapy for Heart Failure. Both working groups/Task Force independently surveyed the evidence, arrived at similar conclusions, and constructed similar, but not identical, recommendations. Given the concordance, the respective organizations simultaneously issued aligned recommendations on the use of these new treatments to minimize confusion and improve the care of patients with HF.“