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Heart Failure Congress 2012

By 25 May 2012#!31Thu, 29 Mar 2018 15:42:38 +0200+02:003831#31Thu, 29 Mar 2018 15:42:38 +0200+02:00-3+02:003131+02:00x31 29pm31pm-31Thu, 29 Mar 2018 15:42:38 +0200+02:003+02:003131+02:00x312018Thu, 29 Mar 2018 15:42:38 +0200423423pmThursday=187#!31Thu, 29 Mar 2018 15:42:38 +0200+02:00+ 02:003#March 29th, 2018#!31Thu, 29 Mar 2018 15:42:38 +0200+02:003831#/31Thu, 29 Mar 2018 15:42:38 +0200+02:00-3+02:003131+02:00x31# !31Thu, 29 Mar 2018 15:42:38 +0200+02:00+02:003#No Comments

Revised European guideline for chronic heart failure

Europese richtlijn chronisch hartfalen herzien

The European Society of Cardiology has released updated guidelines for the diagnosis and treatment of chronic heart failure. These guidelines were presented at the Heart Failure Congress 2012 in Belgrade.

The old guideline dates from 2008. The guidelines for treatment have been adjusted on several fronts. That's how . makes the guideline in the field of diagnostics, the mid-regional pro-A-type natriuretic peptide as a biomarker has been reported for the first time.

Surgery

In the treatment section, the application of left ventricular assist devices (LVAD) has been expanded. Until now, these support devices were only advised as a temporary measure while waiting for a heart transplant. However, due to the increased reliability and reduction of complications, an LVAD can now also be used for permanent treatment in a selected group of patients. Mild symptoms of heart failure are a new indication for the use of cardiac resynchronization therapy (CRT). Research is also more clear about the expected effects of CRT. Patients with left bundle branch block QRS morphology and sinus rhythm benefit most from CRT and patients with non-left bundle branch block QRS morphology or atrial fibrillation have a less clear benefit from treatment. For the treatment of severe aortic valve stenosis, the guideline makes the first mention of transcatheter aortic valve replacement.

Pharmacotherapy

In pharmacotherapeutic treatment, the guideline recommends that the dose of beta-blockers should first be maximized to lower the heart rate before other frequency-lowering agents are added. “Beta blockers are well-established drugs that are more effective and less expensive,” said John Mc Murray, chair of the ESC Clinical Practice Guidelines Task Force.

New indications

Two new indications for pharmacotherapeutic treatment have been added. The range of indications for mineralocorticoid receptor antagonists (MRA) such as eplerenone is extensive. It may be given additionally if symptoms persist with standard treatment of an ACE inhibitor or ARB and a beta-blocker. And in patients with reduced ejection fraction and sinus rhythm who maintain a high heart rate despite treatment with a maximum dose of beta-blocker, ACE-inhibitor and MRA, ivabradine can be added to the treatment.