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ESC Guidelines for Heart Failure
This document summarizes the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. It discusses changes and recommendations for several areas: HFrEF, HFmrEF, HFpEF, advanced HF, and acute HF. For HFrEF, it emphasizes initiating the four key drug therapies as quickly as possible. For HFmrEF, it introduces a new definition and recommends treatments similar to HFrEF. For HFpEF, it stresses actively searching for underlying causes and trial results.
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ESC Guidelines for Heart Failure
- 1. Ainara Lozano Bahamonde 2021ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Presentación del ESC Congress 2021
- 2. Ainara Lozano Bahamonde 2021ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Presentación del ESC Congress 2021 ✓ Definition ✓ HFrEF ✓ HFmrEF ✓ HFpEF ✓ Advanced HF ✓ Acute HF ✓ Comorbidities
- 3. Ainara Lozano Bahamonde 2021ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Presentación del ESC Congress 2021 ✓ Heart failure is a clinical syndrome consisting of cardinal symptoms (e.g. breathlessness, ankle swelling, and fatigue) that may be accompanied by signs (e.g. elevated jugular venous pressure, pulmonary crackles, and peripheral oedema). It is due to a structural and/or functional abnormality of the heart that results in elevated intracardiac pressures and/or in adequate cardiac output at rest and/or during exercise ✓ Fenotipo según la FEVI • Change of term “mid range” to “Mildly reduced” • Elevated NPs and evidente of structural hear disease are not mandatory • Based on evidence that patients with HRmrEF may benefit from similar therapies to those with HRrEF Definition HFrEF HFmrEF HFpEF Comorbidities Advanced HF Acute HF No cambios en definición
- 4. Ainara Lozano Bahamonde 2021ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Presentación del ESC Congress 2021 Valoración probabilidad pretest Presentación del ESC Congress 2021 Definition HFrEF HFmrEF HFpEF Comorbidities Advanced HF Acute HF
- 5. Ainara Lozano Bahamonde 2021ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Presentación del ESC Congress 2021 Therapeutic algoritm The 4 key drug therapies should be initiated as quickly and safety as possible Primary prevention ICD in non-ischaemic cardiomyopathy now IIa No otros isglt-2 Definition HFrEF HFmrEF HFpEF Comorbidities Advanced HF Acute HF El clínico es quien decide
- 6. Ainara Lozano Bahamonde 2021ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Presentación del ESC Congress 2021 Aún no disponible Definition HFrEF HFmrEF HFpEF Comorbidities Advanced HF Acute HF Therapeutic algoritm
- 7. Ainara Lozano Bahamonde 2021ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Presentación del ESC Congress 2021 DANISH trial Primary prevention ICD in non-ischaemic cardiomyopathy now IIa Definition HFrEF HFmrEF HFpEF Comorbidities Advanced HF Acute HF Implantable cardioverter defibrillator
- 8. Ainara Lozano Bahamonde 2021ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Presentación del ESC Congress 2021 Empahsis on broad LBBB in selecting patients for CRT Definition HFrEF HFmrEF HFpEF Comorbidities Advanced HF Acute HF Cardiac resyncronization therapy
- 9. Ainara Lozano Bahamonde 2021ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Presentación del ESC Congress 2021 ✓ No substantial prospective RCT has been performed exclusively in patients with HFmrEF. ✓ Some data can be gleaned from subgroup analysis of trials in HFpEF, none of which have met their primary endpoint. There is insufficient evidence to advise CRT or ICD therapy in patients withHFmrEF Definition HFrEF HFmrEF HFpEF Comorbidities Advanced HF Acute HF
- 10. Ainara Lozano Bahamonde 2021ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Presentación del ESC Congress 2021 Definition HFrEF HFmrEF HFpEF Comorbidities Advanced HF Acute HF ✓ El diagnóstico de ICFEp continua siendo un reto. ✓ Los nuevos algoritmos diagnósticos requieren pruebas complementarias no ampliamente disponibles. ✓ Las guías recomiendan un algoritmo simplificado.
- 11. Ainara Lozano Bahamonde 2021ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Presentación del ESC Congress 2021 Definition HFrEF HFmrEF HFpEF Comorbidities Advanced HF Acute HF ✓ To date, no treatment has been shown to convincingly reduced mortality and morbidity in patients with HFpEF
- 12. Ainara Lozano Bahamonde 2021ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Presentación del ESC Congress 2021 Definition HFrEF HFmrEF HFpEF Comorbidities Acute HF Advanced HF Definición
- 13. Ainara Lozano Bahamonde 2021ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Presentación del ESC Congress 2021 Long term MCS: Aumenta el nivel de recomendación Definition HFrEF HFmrEF HFpEF Comorbidities Acute HF Advanced HF
- 14. Ainara Lozano Bahamonde 2021ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Presentación del ESC Congress 2021 Manejo distinto según fenotipo Definition HFrEF HFmrEF HFpEF Comorbidities Advanced HF Acute HF
- 15. Ainara Lozano Bahamonde 2021ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Presentación del ESC Congress 2021 Clinical profiles Decompensated HF Acute pulmonary Oedema Acute Right HF Cardiogenic shock Definition HFrEF HFmrEF HFpEF Comorbidities Advanced HF Acute HF
- 16. Ainara Lozano Bahamonde 2021ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Presentación del ESC Congress 2021 Definition HFrEF HFmrEF HFpEF Comorbidities Advanced HF Acute HF Tratamiento IC aguda Determinación de sodio urinario como marcador de respuesta favorable al tratamiento
- 17. Ainara Lozano Bahamonde 2021ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Presentación del ESC Congress 2021 Definition HFrEF HFmrEF HFpEF Comorbidities Advanced HF Acute HF Seguimiento al alta
- 18. Ainara Lozano Bahamonde 2021ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Presentación del ESC Congress 2021 Definition HFrEF HFmrEF HFpEF Comorbidities Advanced HF Acute HF Chronic coronary syndrom Patients with HF should be carefully evaluated to assess signs and/or symptoms of CCS.
- 19. Ainara Lozano Bahamonde 2021ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Presentación del ESC Congress 2021 All of the following criteria must be fullfiled • LVEF 20-50% • LVESD <70 mm, • systolic pulmonary pressure <70 mmHg • absence of moderate or severe right ventricular dysfunction or severe TR • absence of haemodynamic instability COAPT criteria Definition HFrEF HFmrEF HFpEF Comorbidities Advanced HF Acute HF Secondary mitral regurgitation
- 20. Ainara Lozano Bahamonde 2021ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Presentación del ESC Congress 2021 Presentación de la Dra. Adamo ESC Congress 2021 HFmrEF HFpEF Comorbidities Advanced HF Acute HF Diabetes Definition HFrEF
- 21. Ainara Lozano Bahamonde 2021ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Presentación del ESC Congress 2021 Presentación de la Dra. Adamo ESC Congress 2021 Definition HFrEF HFmrEF HFpEF Comorbidities Advanced HF Acute HF Iron deficiency
- 22. Ainara Lozano Bahamonde 2021ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Presentación del ESC Congress 2021 Conclusiones HFrEF: las 4 dianas terapéuticas iniciadas lo antes posible, de forma segura criterio clínico disminuye indicación de DAI en etiología no isquémica HFmrEF: nueva definición y tratamientos recomendados (IIb) HFpEF: búsqueda activa de etiología. EMPEROR-Preserved Advanced HF: mayor recomendación para MCS Acute HF: tratamiento según fenotipo determinación del sodio urinario recomendaciones prealta y seguimiento