European Heart Journal Advance Access originally published online on May 18, 2005
European Heart Journal 2005 26(11):1115-1140; doi:10.1093/eurheartj/ehi204
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org
Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005)
The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology
Authors/Task Force Members,* Corresponding author. Chairperson: Karl Swedberg, Sahlgrenska Academy at the Göteborg University, Department of Medicine, Sahlgrenska University Hospital Östra, SE-416 85 Göteborg, Sweden. Tel.: +46 31 3434078; fax: +46 31 258933. E-mail address: karl.swedberg@hjl.gu.se
ESC Committee for Practice Guidelines (CPG), Silvia G. Priori (Chairperson) (Italy), Jean-Jacques Blanc (France), Andrzej Budaj (Poland), John Camm (UK), Veronica Dean (France), Jaap Deckers (The Netherlands), Kenneth Dickstein (Norway), John Lekakis (Greece), Keith McGregor (France), Marco Metra (Italy), João Morais (Portugal), Ady Osterspey (Germany), Juan Tamargo (Spain), José Luis Zamorano (Spain)
Document Reviewers, Marco Metra (CPG Review Coordinator) (Italy), Michael Böhm (Germany), Alain Cohen-Solal (France), Martin Cowie (UK), Ulf Dahlström (Sweden), Kenneth Dickstein (Norway), Gerasimos S. Filippatos (Greece), Edoardo Gronda (Italy), Richard Hobbs (UK), John K. Kjekshus (Norway), John McMurray (UK), Lars Rydén (Sweden), Gianfranco Sinagra (Italy), Juan Tamargo (Spain), Michal Tendera (Poland), Dirk van Veldhuisen (The Netherlands), Faiez Zannad (France)
| The first 150 words of the full text of this article appear below. |
Preamble
Guidelines and Expert Consensus Documents aim to present all the relevant evidence on a particular issue in order to help physicians to weigh the benefits and risks of a particular diagnostic or therapeutic procedure. They should be helpful in everyday clinical decision-making.
A great number of Guidelines and Expert Consensus Documents have been issued in recent years by the European Society of Cardiology (ESC) and by different organizations and other related societies. This profusion can put at stake the authority and validity of guidelines, which can only be guaranteed if they have been developed by an unquestionable decision-making process. This is one of the reasons why the ESC and others have issued recommendations for formulating and issuing Guidelines and Expert Consensus Documents.
In spite of the fact that standards for issuing good quality Guidelines and Expert Consensus Documents are well defined, recent surveys of Guidelines and Expert Consensus Documents published
Diagnosis of chronic heart failure
Introduction
Methodology
Epidemiology
Descriptive terms in heart failure
Acute vs. chronic heart failure
Systolic vs. diastolic heart failure
Other descriptive terms in heart failure
Definition of chronic heart failure
Aspects of the pathophysiology of the symptoms of heart failure relevant to diagnosis
Possible methods for the diagnosis of heart failure in clinical practice
Symptoms and signs in the diagnosis of heart failure
Symptoms and the severity of heart failure
Electrocardiogram
The chest X-ray
Haematology and biochemistry
Natriuretic peptides
Echocardiography
Assessment of LV diastolic function
Diagnostic criteria of diastolic dysfunction
Additional non-invasive tests to be considered
Cardiac magnetic resonance imaging (CMR)
Pulmonary function
Exercise testing
Invasive investigation
Cardiac catheterization
Tests of neuroendocrine evaluations other than natriuretic peptides
Holter electrocardiography: ambulatory ECG and long-time ECG recording (LTER)
Requirements for the diagnosis of heart failure in clinical practice
Prognostication
Treatment of heart failure
Aims of treatment in heart failure
Prevention of heart failure
Management of chronic heart failure
Non-pharmacological management
General advice and measures
Educating patients and family
Weight monitoring
Dietary measures
Sodium
Fluids
Alcohol
Obesity
Abnormal weight loss
Smoking
Travelling
Sexual activity
Advice on immunizations
Drug counselling
Drugs to avoid or beware
Rest, exercise, and exercise training
Rest
Exercise
Pharmacological therapy
Angiotensin-converting enzyme inhibitors
ACE-inhibitors in asymptomatic left ventricular dysfunction
ACE-inhibitors in symptomatic heart failure
Diuretics
Loop diuretics, thiazides, and metolazone
Potassium-sparing diuretics
Beta-adrenoceptor antagonists
Initiation of therapy
Aldosterone receptor antagonists
Angiotensin II receptor blockers
Dosing
Cardiac glycosides
Digoxin
Vasodilator agents in chronic heart failure
Hydralazine-isosorbide dinitrate
Nitrates
Alpha-adrenergic blocking drugs
Calcium antagonists
Nesiritide
Positive inotropic therapy
Anti-thrombotic agents
Anti-arrhythmics
Class I anti-arrhythmics
Class II anti-arrhythmics
Class III anti-arrhythmics
Oxygen therapy
Surgery and devices
Revascularization procedures, mitral valve surgery, and ventricular restoration
Revascularization
Mitral valve surgery
Left ventricular restoration
LV aneurysmectomy
Cardiomyoplasty
Partial left ventriculectomy (Batista operation)
External ventricular restoration
Pacemakers
Implantable cardioverter defibrillators
Heart replacement therapies: heart transplantation, ventricular assist devices, and artificial heart
Heart transplantation
Ventricular assist devices and artificial heart
Ultrafiltration
Choice and timing of pharmacological therapy
Asymptomatic left ventricular systolic dysfunction
Symptomatic left ventricular systolic dysfunction: heart failure NYHA class II (Figure 4)
Without signs of fluid retention
With signs of fluid retention
Worsening heart failure (Figure 3)
End-stage heart failure (patients who persist in NYHA IV despite optimal treatment and proper diagnosis (Figure 4)
Management of heart failure with preserved left ventricular ejection fraction
Pharmacological therapy of heart failure with PLVEF or diastolic dysfunction
Heart failure treatment in the elderly
ACE-inhibitors and ARBs
Diuretic therapy
Beta-blockers
Cardiac glycosides
Vasodilator agents
Arrhythmias
Ventricular arrhythmias
Atrial fibrillation
Symptomatic systolic left ventricular dysfunction and concomitant angina or hypertension
Care and follow-up
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J. P. Goetze, U. Dahlstrom, J. F. Rehfeld, and U. Alehagen Impact of Epitope Specificity and Precursor Maturation in Pro-B-Type Natriuretic Peptide Measurement Clin. Chem., November 1, 2008; 54(11): 1780 - 1787. [Abstract] [Full Text] [PDF]
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L. Di Biase, M. Gasparini, M. Lunati, M. Santini, M. Landolina, G. Boriani, A. Curnis, M. Bocchiardo, A. Vincenti, A. Denaro, et al. Antiarrhythmic Effect of Reverse Ventricular Remodeling Induced by Cardiac Resynchronization Therapy: The InSync ICD (Implantable Cardioverter-Defibrillator) Italian Registry J. Am. Coll. Cardiol., October 28, 2008; 52(18): 1442 - 1449. [Abstract] [Full Text] [PDF]
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B. Pitt, G. Bakris, L. M. Ruilope, L. DiCarlo, R. Mukherjee, and on Behalf of the EPHESUS Investigators Serum Potassium and Clinical Outcomes in the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) Circulation, October 14, 2008; 118(16): 1643 - 1650. [Abstract] [Full Text] [PDF]
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T. Stanton, N. M. Hawkins, K. J. Hogg, N. E.R. Goodfield, M. C. Petrie, and J. J.V. McMurray How should we optimize cardiac resynchronization therapy? Eur. Heart J., October 2, 2008; 29(20): 2458 - 2472. [Abstract] [Full Text] [PDF]
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Authors/Task Force Members, K. Dickstein, A. Cohen-Solal, G. Filippatos, J. J.V. McMurray, P. Ponikowski, P. A. Poole-Wilson, A. Stromberg, D. J. van Veldhuisen, D. Atar, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM) Eur. Heart J., October 1, 2008; 29(19): 2388 - 2442. [Full Text] [PDF]
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K. Dickstein, A. Cohen-Solal, G. Filippatos, J. J.V. McMurray, P. Ponikowski, P. A. Poole-Wilson, A. Stromberg, D. J. van Veldhuisen, D. Atar, A. W. Hoes, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM) Eur J Heart Fail, October 1, 2008; 10(10): 933 - 989. [Full Text] [PDF]
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L. Erhardt, M. Komajda, F.D. R. Hobbs, and J. Soler-Soler Cardiologists' awareness and perceptions of guidelines for chronic heart failure. The ADDress your Heart survey Eur J Heart Fail, October 1, 2008; 10(10): 1020 - 1025. [Abstract] [Full Text] [PDF]
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M. Huelsmann, S. Neuhold, G. Strunk, D. Moertl, R. Berger, R. Prager, H. Abrahamian, M. Riedl, R. Pacher, A. Luger, et al. NT-proBNP has a high negative predictive value to rule-out short-term cardiovascular events in patients with diabetes mellitus Eur. Heart J., September 2, 2008; 29(18): 2259 - 2264. [Abstract] [Full Text] [PDF]
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