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Acute and Chronic Heart Failure Guidelines

ESC Clinical Practice Guidelines

This document provides practical, evidence-based guidelines for the diagnosis and treatment of heart failure.

Cardiac Resynchronization Therapy (CRT)
Chronic Heart Failure
Acute Heart Failure
Cardiovascular Pharmacotherapy
Cardiovascular Nursing
Heart Failure
Guidelines version available to download
Published in 2016
Reference EHJ (2016) 37 (27):2129-2200 -
Published in 2016
Published in 2017
Published in 2016
Reference 2016 Addenda Web Tables - EHJ doi:10.1093/eurheartj/ehw128
Published in 2016
Reference 2016 Editorial ESC Guidelines on Heart Failure
Published in 2016
Reference 2016 Pocket Guidelines HF
Published in 2017
Reference 84 Slides on HF
Table of contents: Full Text (ESC Clinical Practice Guidelines)
  1. Preamble
  2. Introduction
  3. Definition, Epidemiology and Prognosis   

       3.1. Definition of heart failure

       3.2. Terminology

       3.3. Epidemiology, aetiology and natural history of heart failure

       3.4. Prognosis

  1. Diagnosis

       4.1. Symptoms and signs

       4.2. Essential initial investigations: natriuretic peptides, electrocardiogram, echocardiography

       4.3. Algorithm for the diagnosis of heart failure

  1. Cardiac Imaging and other Diagnostic Tests

       5.1. Chest X-ray

       5.2. Transthoracic echocardiography

       5.3. Transoesophageal echocardiography

       5.4. Stress echocardiography        

       5.5. Cardiac magnetic resonance

       5.6. Single-photon emission computed tomography and radionuclide ventriculography

       5.7. Positron emission tomography

       5.8. Coronary angiography

       5.9. Cardiac computed tomography

       5.10. Other diagnostic tests

  1. Delaying or Preventing the Development of Overt Heart Failure or Preventing Death before the Onset of Symptoms
  2. Pharmacological Treatment of Heart Failure with Reduced Ejection Fraction

       7.1. Objectives in the management of heart failure       

       7.2. Treatments recommended in all symptomatic patients with heart failure with reduced ejection fraction

       7.3. Other treatments recommended in selected patients with symptomatic heart failure with reduced ejection fraction

       7.4. Other treatments with less certain benefits in patients with symptomatic heart failure with reduced ejection fraction

       7.5. Treatments not recommended (unproven benefit) in patients with symptomatic heart failure with reduced ejection fraction

       7.6. Treatments not recommended (believed to cause harm) in patients with symptomatic heart failure with reduced ejection fraction

  1. Nonsurgical Device Treatment of Heart Failure with Reduced Ejection Fraction

       8.1. Implantable cardioverter defibrillator

       8.2. Cardiac resynchronization therapy

       8.3. Other implantable electrical devices

  1. Treatment of Heart Failure with Preserved Ejection Fraction

        9.1. Effect of treatment on symptoms in heart failure with preserved ejection fraction

        9.2. Effect of treatment on hospitalisation for heart failure in heart failure with preserved ejection fraction

        9.3. Effect of treatment on mortality in heart failure with preserved ejection fraction

        9.4. Other considerations

  1. Arrhythmias and Conductance Disturbances

       10.1. Atrial fibrillation

       10.2. Ventricular arrhythmias

       10.3. Symptomatic bradycardia, pauses and atrioventricular block

  1. Comorbidities

       11.1. Heart failure and comorbidities

       11.2. Angina and coronary artery disease

       11.3. Cachexia and sarcopenia

        11.4. Cancer

        11.5. Central nervous system (including depression, stroke and autonomic dysfunction)

        11.6. Diabetes

        11.7. Erectile dysfunction

        11.8. Gout and arthritis

        11.9. Hypokalaemia and hyperkalaemia

        11.10. Hyperlipidaemia

        11.11. Hypertension

        11.12. Iron deficiency and anaemia

        11.13. Kidney dysfunction (including chronic kidney disease, acute kidney injury, cardio-renal syndrome, and prostatic obstruction)

        11.14. Lung disease (including asthma and chronic obstructive pulmonary disease)

        11.15. Obesity

        11.16. Sleep disturbance and sleep-disordered breathing

        11.17. Valvular heart disease

  1. Acute Heart Failure

       12.1. Definition and classification

       12.2. Diagnosis and initial prognostic evaluation

       12.3. Management

       12.4. Management of evidence-based oral therapies

       12.5. Monitoring of clinical status of patients hospitalised due to acute heart failure    

       12.6. Criteria for discharge from hospital and follow-up in high-risk period

       12.7. Goals of treatment during the different stages of management of acute heart failure

  1. Mechanical Circulatory Support and Heart Transplantation

       13.1. Mechanical circulatory support

       13.2. Heart transplantation

  1. Multidisciplinary Team Management

        14.1. Organisation of care

        14.2. Discharge planning

        14.3. Lifestyle advice

        14.4. Exercise training

        14.5. Follow-up and monitoring

        14.6. The older adult, frailty and cognitive impairment

        14.7. Palliative / end-of-life care

  1. Gaps in Evidence
  2. Appendix 1
  3. References
Previous version available to download
Published in 2012
Reference 2012 Full Text HF
Published in 2012
Reference Eur Heart J -2012 EHJ doi:10.1093/eurheartj/ehs104
Published in 2012
Reference 2012 Corrigendum FT