New HF Guidelines from the ESC

The European Society of Cardiology (ESC) recently released new guidelines for the diagnosis and treatment of acute and chronic heart failure (HF).The announcement was made at the Third World Congress on HF in Florence, Italy, in May.¹ The guidelines were simulataneously publisehd in the European Heart Journal² and the European Journal of Heart Failure.³

The slides that follow offer highlights of the new recommendations inlcuding the addition of the new agents sacubitril/valsartan (Entresto, Novartis) and ivabradine (Corlanor, Amgen) and a new catetory of HF.

Sacubitirl/valsartan now recommended to replace an ACE-I in ambulatory patients with symptoms despite optimal treatment with an ACE-I, beta blocker, and mineralocorticoid receptor antagonist (MRA).

Ivabradine is a selective I_f inhibitor. Slows heart rate via inhibition of sinoatrial node; does not affect duration of action potential; should only be used in patients with sinus rhythm (SR). ESC guidelines now recommend ivabadrine in select patients.

US Guidelines (ACC/AHA/HFSA) include sacubitril/valsartan and ivabridine in recent update. 

ESC guidelines add new HF category: HF with mid-range ejection fraction, HFmrEF: LVEF 40 to 49%.

ESC adds algorithm to help diagnose HF in non-acute settings; based on the probability of HF. Potentially useful for GPs, other non-cardiologists.

Additional ESC HF Guideline revisions: Emphasis on early diagnosis; adaptive servo-ventilation now contraindicated in patients with HFrEF and central sleep apnea; cardiac resynchronization therapy now contraindicated in patients with QRS <130 msec; new recommendations to help prevent/delay onset of HF, lengthen life.