Updates in heart failure

Abstract

This review provides a contemporary overview of HF management and highlights the key studies which have informed recent European HF guidelines.

Keywords: device therapy; guidelines; heart failure; pharmacotherapy; revascularisation.

Fig 1.

NICE guidelines summarising the investigation of suspected chronic heart failure. This is a summary of the NICE recommendations on tests to offer to diagnose chronic heart failure from its guideline on chronic heart failure. The guideline also covers management.

Fig 2.

Summary of the management of HFrEF from the 2021 ESC HF guidelines. Dark teal indicates class of recommendation I (‘indicated or recomended’) and light teal indicates class of recommendation IIa (‘should be considered’). ACE-I = angiotensinconverting enzyme inhibitor; ARB = angiotensin receptor blocker; ARNI = angiotensin receptor-neprilysin inhibitor; BB = beta-blocker; b.p.m. = beats per minute; BTC = bridge to candidacy; BTT = bridge to transplantation; CABG = coronary artery bypass graft; CRT-D = cardiac resynchronization therapy with defibrillator; CRT-P = cardiac resynchronization therapy pacemaker; DT = destination therapy; HF = heart failure; HFrEF = heart failure with reduced ejection fraction; ICD = implantable cardioverter-defibrillator; ISDN = isosorbide dinitrate; LBBB = left bundle branch block; MCS = mechanical circulatory support; MRA = mineralocorticoid receptor antagonist; MV = mitral valve; PVI = pulmonary vein isolation; QOL = quality of life; SAVR = surgical aortic valve replacement; SGLT2i = sodium-glucose co-transporter 2 inhibitor; SR = sinus rhythm; TAVI = transcatheter aortic valve replacement; TEE = transcatheter edge to edge.

Fig 3.

Data from National Heart Failure Audit (NICOR) 2021/2022. Left panel: Kaplan Meier plot of allcause mortality following discharge from hospital according to place of care during the admission. Right panel: Mortality following discharge associated with prescribing of HFrEF pharmacotherapy.