Tag Archives: guidelines

A European benchmark: SEED exposes the variation The recently published SEED (Management of Syncope in the Emergency Department) study provides a revealing snapshot of syncope care across Europe.6 In 41 EDs across 14 countries, 952 adult patients presenting with TLoC were evaluated, amounting to 1% of all ED attendances. Findings were striking: 46% of sites had no syncope guideline; 75% lacked a dedicated outpatient clinic; and only 10% offered structured follow-up. Admission rates varied from 20% to 84%. This variation highlights a persistent gap between evidence and delivery. Despite clear European Society of Cardiology (ESC 2018)7 and Nat

Introduction Clinical guidelines recommend routine early inpatient invasive coronary angiography (ICA) in patients presenting with non-ST-elevation acute myocardial infarction acute coronary syndrome (NSTEMI-ACS) who are considered at higher risk of future recurrent myocardial infarction (MI) and death. National Institute for Health and Care Excellence (NICE) guidance recommends early ICA in high-risk patients within three days of admission,1 and the European Society of Cardiology (ESC) recommends this investigation is completed within 24 hours.2 Most UK patients presenting with NSTEMI-ACS are admitted to hospitals that do not have invasive

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