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ESC Guidelines 2015: what’s new?



The development of the new European Society of Cardiology (ESC) guidelines 2015 involved many ­people, one of them Prof. Lancellotti. He is part of the ESC Committee Practice Guidelines (CPG), where new guidelines projects are discussed and selected. The ESC guidelines 2015 include not one but several new guidelines focusing on various topics such as infective     endocarditis, pulmonary hyper-   tension, acute coronary syndrome, pericardial diseases, and ventricular arrhythmias and sudden cardiac death. As the ESC guidelines aim to present all the relevant evidence on a particular clinical issue in order to help physicians to weight the benefits and risks of a particular diagnostic or therapeutic procedure, they fulfil in practice all the following objectives: easy to use for clinicians/physicians, improve patient outcome, standardize patient treatment approach, guide the overall follow-up strategy and many more.

As ever, the latest ESC guidelines summarise all available information and will provide an invaluable resource for the practising healthcare professional. Among their derivative products are the free ESC Pocket Guidelines App, which provides more than 100 interactive tools to help apply the guidelines in daily practice, and Essential Messages and Summary Cards, which summarise the main points and make them available to students, teachers and non-cardiologists. This year’s guidelines will also enhance what to do and not do in the clinical setting of their specific pathology; this table can be found in the last section of each guidelines document.

Overview of the new ESC ­guidelines

A short summary of the five new ESC guidelines is given below - each by specific pathology - as well as its reference.

Pulmonary hypertension

This year’s ESC/ERS Guidelines on Pulmonary Hypertension chaired by Nazzareno Galié (ESC) and Marc Humbert (ERS) cover the main clinical characteristics and relevant issues in the diagnosis of Pulmonary Hypertension as well as the latest treatment strategies and advice in decision-making. The new guidelines on Pulmonary Hypertension include definitions and classifications, epidemiology and genetics of pulmonary hypertension, pulmonary hypertension diagnosis, pulmonary arterial hypertension (group 1), specific pulmonary (arterial) hypertension subsets, pulmonary hypertension due to left heart disease (group 2), pulmonary hypertension due to lung diseases and/or hypoxia (group 3), chronic thromboembolic pulmonary hypertension (group 4), pulmonary hypertension with unclear and/or multifactorial mechanisms (group 5), definition of a pulmonary hypertension expert referral centre and to do and not to do messages from the guidelines.

d2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. European Heart Journal doi:10.1093/eurheartj/ehv317.

Ventricular arrhythmias and sudden cardiac death

The Ventricular Arrhythmias and Sudden Cardiac Death Task Force led by Silvia Priori and by Carina Blomström-Lundqvist will spark considerable interest with advice on populations at risk and the use of the different devices to prevent CV events.

The new guidelines on Ventricular Arrhythmias and Sudden Cardiac Death include definitions, epidemio-logy and future perspectives for the prevention of sudden cardiac death, therapies for ventricular arrhythmias, management of ventricular arrhy-thmias and prevention of sudden cardiac death in coronary artery   disease, therapies for patients with left ventricular dysfunction with or without heart failure, cardiomyo-   pathies, inherited primary arrhythmia syndromes, paediatric arrhythmias and congenital heart disease, ventricular tachycardias and ventricular fibrillation in structurally normal hearts, inflammatory, rheumatic and valvular heart diseases, arrhythmic risk in selected populations, gaps in evidence and to do and not to do messages from the guidelines.

d 2015 ESC Guidelines for the   management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. European Heart Journal (2015) 36, 2793–2867. doi:10.1093/eurheartj/ehv316.

Acute coronary syndrome

Marco Roffi and Carlo Patrono’s team have written a 2015 version of the Acute Coronary Syndromes-NSTE Guidelines showing the new diagnostic algorithms for decision-making in this field. These Guidelines will be followed in 2017 by a new version of the STEMI Guidelines, as well as an update on the universal definition of MI. The new guidelines on acute coronary syndrome include diagnosis, risk assessment and outcomes, treatment, performance measures, summary of management strategy, gaps in evidence and to do and not to do messages from the guidelines.

d2015 ESC Guidelines for the   management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European Heart Journal doi:10.1093/eurheartj/ehv320

Pericardial diseases

The task force responsible for the 2015 Pericardial Diseases Guidelines, long due for a new version, was led by Yehuda Adler and Philippe Charron. Their team concentrated on diagnostic and treatment strategies for patients with this condition. The new guidelines on pericardial diseases include epidemiology, aetiology and classification of pericardial diseases, pericardial syndromes, multimodality cardiovascular imaging and diagnostic work-up, specific aetiologies of pericardial syndromes, age and gender issues in pericardial diseases, interventional techniques and surgery, perspective and unmet needs and to do and not to do messages from the pericardium guidelines.

d2015 ESC Guidelines for the diagnosis and management of pericardial diseases. European Heart Journal doi:10.1093/eurheartj/ehv318.

Infective endocarditis

The new Guidelines on Infective Endocarditis, chaired by Gilbert Habib and Patrizio Lancellotti, have based some of their 2015 recommendations on prophylaxis. They also review recent publications on the use of new antibiotics. The new guidelines on infective endocarditis include justification/scope of the problem, prevention, the ‘Endocarditis Team’, diagnosis, prognostic assessment at admission, antimicrobial therapy: principles and methods, main complications of left-sided valve infective endocarditis and their management, other complications of infective endocarditis, surgical therapy: principles and methods, outcome after discharge: follow-up and long-term prognosis, management of specific situations and to do and not to do messages from the guidelines.

d 2015 ESC Guidelines for the management of infective endo-carditis. European Heart Journal doi:10.1093/eurheartj/ehv319.

ESC guidelines in the future

Although guidelines slightly touched on gap in evidence and unmet need, they should be follow-up by several position papers addressing significantly various clinical scenarios. Also, how guidelines are imple- mented in real practice is still unknown and merits further investigations linked with local promotion of education. Finally, they should also take into account the disparities across European countries.