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2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

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Last updated:20th May 2016

The aim of this document is to provide practical, evidence-based guidelines for the diagnosis and treatment of HF. The principal changes from the 2012 guidelines relate to:

I. a new term for patients with HF and a left ventricular ejection fraction (LVEF) that ranges from 40 to 49% — ‘HF with mid-range EF (HFmrEF)’; we believe that identifying HFmrEF as a separate group will stimulate research into the underlying characteristics, pathophysiology and treatment of this population;
II. clear recommendations on the diagnostic criteria for HF with reduced EF (HFrEF), HFmrEF and HF with preserved EF (HFpEF);
III. a new algorithm for the diagnosis of HF in the non-acute setting based on the evaluation of HF probability;
IV. recommendations aimed at prevention or delay of the development of overt HF or the prevention of death before the onset of symptoms;
V. indications for the use of the new compound sacubitril/valsartan, the first in the class of angiotensin receptor neprilysin inhibitors (ARNIs);
VI. modified indications for cardiac resynchronization therapy (CRT);
VII. the concept of an early initiation of appropriate therapy going along with relevant investigations in acute HF that follows the ‘time to therapy’ approach already well established in acute coronary syndrome (ACS);
VIII. a new algorithm for a combined diagnosis and treatment approach of acute HF based on the presence/absence of congestion/hypoperfusion.


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