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.

1. Ainara Lozano Bahamonde
2021 ESC Guidelines for the diagnosis
and treatment of acute and chronic heart failure
Presentación del ESC Congress 2021

2. Ainara Lozano Bahamonde
2021 ESC 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
2021 ESC 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
2021 ESC 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
2021 ESC 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
2021 ESC 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
2021 ESC 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
2021 ESC 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
2021 ESC 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
2021 ESC 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
2021 ESC 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
2021 ESC 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
2021 ESC 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
2021 ESC 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
2021 ESC 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
2021 ESC 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
2021 ESC 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
2021 ESC 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
2021 ESC 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
2021 ESC 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
2021 ESC 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
2021 ESC 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