European Heart Journal Advance Access originally published online on October 4, 2005
European Heart Journal 2005 26(22):2472; doi:10.1093/eurheartj/ehi549
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
The Task Force for the diagnosis and treatment of chronic heart failure of the European Society of Cardiology. Guidelines for the diagnosis and treatment of chronic heart failure: full text (update 2005)
Clinical Pharmacology Unit
The Alfred Hospital
Commercial Road
Prahran
VIC 3181
Australia
Tel: +61 3 9903 0042
Fax: +61 3 9903 0556
E-mail address
: henry.krum{at}med.monash.edu.au
The Task Force for the diagnosis and treatment of chronic heart failure (CHF) of the European Society of Cardiology are to be congratulated on a comprehensive, evidence-based, and practical guide to the contemporary management of this condition.1
However, some discrepancies exist between the document's text, figures, and tables that may lead to confusion. These discrepancies relate primarily to prescribing recommendations for pharmacological therapy.
Specifically, aldosterone receptor antagonists are recommended in Figure 4 of the guidelines for patients in New York Heart Association (NYHA) functional class I or II who had post-myocardial infarction (MI). No specific time period post-MI is mentioned. Table 22 of the guidelines recommend aldosterone antagonists for these patients if there is a ‘recent MI’. However, the text states that ‘whether an aldosterone antagonist is of proven benefit in patients with class II heart failure or asymptomatic left ventricular (LV) dysfunction remains to be established’.
To resolve these discrepancies, the text, figure, and table should be more definitive on what evidence actually exists for these recommendations. Specifically, the EPHESUS study2 randomized patients to eplerenone or placebo 3–14 days post-MI who had LV systolic dysfunction and either symptoms of heart failure or diabetes mellitus, finding significant clinical benefit with the aldosterone antagonist. Whether such benefit exists when treatment is initiated beyond 14 days post-MI or in patients with established CHF of any aetiology is uncertain and requires further investigation, specifically in NYHA class I and II patients (the benefits of aldosterone antagonism in class III and IV patients with established CHF having already been observed in the RALES study).3
Similarly, discrepancies exist with regard to recommendations for angiotensin receptor blockers (ARBs). Figure 4 recommends ARBs for NYHA class II patients only if they are angiotensin-converting enzyme (ACE) inhibitor-intolerant. However, the evidence-base supports the use of ARBs in addition to ACE-inhibitors in these patients to reduce hospitalizations and mortality, as explicitly stated in the text of the guidelines. In this case, appropriate summation of the evidence (from CHARM-Added4 and Val-HeFT5) is provided in the text, documented accurately and concisely in Table 22, yet not followed in the figure.
References
- The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Guidelines for the Diagnosis and Treatment of Chronic Heart Failure: full text (update 2005); doi:10.1093/eurheartj/ehi205.
- Pitt B, Remme WJ, Zannad F, Neaton J, Martinez F, Roniker B, Bittman R, Hurley S, Kleiman J, Gatlin M. Eplerenone, a selective aldosterone blocker, in patient with left ventricular dysfunction after myocardial infarction. N Engl J Med 2003;348:1309–1321.
[Abstract/Free Full Text] - Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, Palensky J, Wittes J. The effect of spironolactone on morbidity and mortality in patients with severe heart failure Randomized Aldactone Evaluation Study Investigators. N Engl J Med 1999;341:709–717.
[Abstract/Free Full Text] - McMurray JJ, Ostergren J, Swedberg K, Granger CB, Held P, Michelson EL, Olofsson B, Yusuf S, Pfeffer MA. CHARM Investigators and Committees. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial. Lancet 2003;362:767–771.[CrossRef][Web of Science][Medline]
- Cohn JN, Tognoni G; Valsartan Heart Failure Trial Investigators. A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med 2001;345:1667–1675.
[Abstract/Free Full Text]
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  S. C. Palmer, Z. H. Endre, A. M. Richards, and T. G. Yandle Characterization of NT-proBNP in Human Urine Clin. Chem., June 1, 2009; 55(6): 1126 - 1134. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. A. Schiffer, S. S. Pedersen, J. W. Widdershoven, and J. Denollet Type D personality and depressive symptoms are independent predictors of impaired health status in chronic heart failure Eur J Heart Fail, September 1, 2008; 10(9): 922 - 930. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. A. Schiffer, S. S. Pedersen, J. W. Widdershoven, and J. Denollet Type D personality and depressive symptoms are independent predictors of impaired health status in chronic heart failure Eur J Heart Fail, August 1, 2008; 10(8): 802 - 810. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. A Schiffer, J. Denollet, J. W Widdershoven, E. H Hendriks, and O. R F Smith Failure to consult for symptoms of heart failure in patients with a type-D personality Heart, July 1, 2007; 93(7): 814 - 818. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Authors/Task Force Members, A. Vahanian, H. Baumgartner, J. Bax, E. Butchart, R. Dion, G. Filippatos, F. Flachskampf, R. Hall, B. Iung, et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology Eur. Heart J., January 26, 2007; (2007) ehl428v1. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||