Tag Archives: guidelines

Introduction The European Society of Cardiology (ESC) heart failure guideline has undergone major updates every few years, with recent publications being in 2016 and 2021, respectively.1,2 Advances within heart failure care continue at pace, with presentation and publication of key randomised-controlled trials (RCTs) and meta-analyses being seen at the major cardiology scientific congresses. Given the likely impact of several trials on heart failure management and patient outcomes, the decision was made to publish a focused update in 2023 incorporating the most recent data.3 After robust review by the ESC guideline task force, only trials th

This supplement provides a user’s guide to what’s new in the guidelines for the diagnosis and treatment of heart failure. This primarily relates to recommendations provided in the updated (2021) European Society of Cardiology (ESC) guidelines for the diagnosis and treatment of acute and chronic heart failure. The articles summarise the contemporary guidance with respect to the diagnosis and investigation of patients presenting with heart failure; drug therapy (including the early implementation of the ‘four pillars’ of drug treatment for heart failure with reduced ejection fraction); and recommendations on lifestyle, rehabilitation,

Introduction The heart failure (HF) community has seen huge advances in the care of HF, and we see a turning point in the narrative of doom and gloom, which has traditionally been associated with HF – we see cause for optimism. We recognise the urgency of putting these advances to prompt use, as demonstrated by the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic HF.1 The 2021 updated guidelines make it clear that we have the means to diagnose HF early, to classify it more accurately, the tools to change the HF trajectory, and the duty and ability to intervene – and to do so early. Diagnosis While the ESC diagnost

The recently published ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial is likely to change this practice.5 The ISCHEMIA trial compared medical therapy with invasive management in patients with proven ischaemia, after excluding patients with left main stem (LMS) stenosis with CTCA, and found no difference in outcome. We suggest that the ISCHEMIA trial results are likely to shift clinical practice towards CTCA as the primary diagnostic test for new chest pain. Current guidelines The updated ESC guidelines1 on new stable chest pain, published in 2019, recommended investigation based o

Introduction We are in a challenging era of increasing use of coronary stenting for coronary artery disease (CAD) in the UK,1 in conjunction with a growing population of patients with atrial fibrillation (AF) predominantly driven by age, hypertension, obesity and diabetes.2 Inevitably, these two common diseases, with similar risk factors, occur simultaneously in a significant proportion (5 to 8%) of patients undergoing revascularisation.3-5 This equates to an estimated 4,500 to 7,200 patients in the UK population, based upon British Cardiovascular Intervention Society (BCIS) data in 2014.1 Atrial phase thrombus has a stasis and fibrin drive,

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Introduction Multi-detector computed tomography coronary angiography (CTCA) is becoming increasingly available in UK Hospitals. The National Institute for Health and Clinical Excellence (NICE) clinical guideline 95, released in 2010, recommended the use of calcium score ± CTCA in patients with low likelihood chest pain of recent onset.1 American College of Cardiology (ACC)/American Heart Association (AHA) appropriateness criteria for CTCA recommend its use in patients with low or intermediate likelihood chest pain.2 The rationale for the recommendations of CTCA is its excellent negative-predictive value.3 A further important point is that fu

Heart failure The recommendations on devices, drugs and diagnosis in heart failure were developed by the ESC in collaboration with a heart failure association of the ESC. There have been several major updates since the previous guidance published in 2008.  The new updates include: In devices, left ventricular assist devices (LVADs) have been hailed as a step change in the management of heart failure. LVADs are more reliable and lead to fewer complications than in 2008. Until now, LVADs have been used as a temporary measure in patients awaiting a heart transplant. Professor John McMurray (Glasgow, UK), chairperson of the ESC Clinical Practice

EVINCI study completed The prevalence of “significant” coronary artery disease in patients with chest pain symptoms is lower than expected in Europe, according to preliminary findings from the The EValuation of INtegrated Cardiac Imaging (EVINCI) study. Once the final analysis is completed, the EVINCI study is expected to demonstrate that performing adequate non-invasive imaging screening of patients with suspected coronary artery disease could safely avoid invasive procedures in 75 out of 100 patients.  The study will have sufficient power to answer the question of which is the most cost-effective non-invasive imaging strategy for the j