Heart failure guideline update: a guide for general practice

摘要

Heart failure (HF) is a clinical syndrome caused by a structural or functional cardiac abnormality and results in reduced cardiac output or elevated intracardiac pressures. It affects approximately 900 000 patients in the UK.1 In recent years, both the European Society of Cardiology (ESC) and the American Heart Association (AHA) updated their HF guidelines simultaneously, with a reassuringly large overlap in most recommendations.2,3 Furthermore, updated National Institute for Health and Care Excellence (NICE) guidelines (NG106) were published in September 2018, and are largely based on the same evidence.4This article describes updates to seven principal topics, with particular emphasis on areas of most relevance to primary care, including HF definitions, a new ‘time to therapy’ approach, diagnosis, pharmacological treatment, cardiac resynchronisation therapy (CRT) indications, prevention, and multidisciplinary team working. In addition, the management of HF with preserved ejection fraction (HFpEF) is discussed.Previously, HF was divided into those patients with left ventricular (LV) systolic impairment on transthoracic echocardiography (TTE) and those with preserved ejection fraction. The updated ESC, but not AHA or NICE, guidelines, introduce a new notion of HF with mid-range ejection fraction (HF mr EF), for patients with LV ejection fraction (EF) of 40–49%, alongside modified definitions for reduced EF (HF r EF, EF 40%) and preserved EF (HF p EF, EF ≥50%). Although this differentiation may seem semantic, it is hoped …