ESC Releases New Heart Failure Guidelines

The European Society of Cardiology (ESC) has released new guidelines for the diagnosis and treatment of acute and chronic heart failure.

The document features new recommendations on devices, drugs, and diagnosis in heart failure.

“These guidelines make recommendations based upon evidence for established and new diagnostic tests and therapies for heart failure,” said John McMurray, Chairperson of the ESC Clinical Practice Guidelines Task Force. “If implemented, they offer a real opportunity to improve the outcome of patients with this condition.”

The guidelines were developed by the ESC in collaboration with the Heart Failure Association of the ESC. They were launched at the Heart Failure Congress 2012 in Belgrade, Serbia and published in the European Heart Journal.

The authors say that the principal changes from the 2008 guidelines relate to an expansion of the indication for mineralocorticoid (aldosterone) receptor antagonists (MRAs), a new indication for the sinus node inhibitor ivabradine, and an expanded indication for cardiac resynchronization therapy (CRT).

New information on the role of coronary revascularization in heart failure, as well as recognition of the growing use of ventricular assist devices and the emergence of transcatheter valve interventions are also discussed.

The structure and format of the guidelines has also been changed, say the authors. For example, “therapeutic recommendations now state the treatment effect supported by the class and level of recommendation in tabular format.” In the case of chronic heart failure due to left ventricular systolic dysfunction, the recommendations focus on mortality and morbidity outcomes, they say.

Detailed summaries of the key evidence supporting generally recommended treatments are provided in the guidelines.

Practical guidance is also provided for the use of the more important disease-modifying drugs and diuretics.

The authors note, however, that the guidelines do not override the “individual responsibility of health professionals to make appropriate decision in the circumstances of the individual patients, in consultation with that patient, and where appropriate and necessary, the patient’s guardian or carer.”

They also state that it is the health professional’s responsibility to verify the rules and regulations applicable to drugs and devices at the time of prescription.

By Nikki Withers