Head‐to‐head comparison between recommendations by the ESC and ACC/AHA/HFSA heart failure guidelines. (29th May 2022)

• Record Type: Journal Article
• Authors: Bayés‐Genís, Antoni; Aimo, Alberto; Metra, Marco; Anker, Stefan; Seferovic, Petar; Rapezzi, Claudio; Castiglione, Vincenzo; Núñez, Julio; Emdin, Michele; Rosano, Giuseppe; Coats, Andrew J.S.
• Is Part Of: European journal of heart failure. Volume 24:Number 6(2022)
• Page Start: 916
• Page End: 926
• Publication Date: 2022-05-29
• Subjects: Clinical practice -- Comparison -- Guidelines -- Heart failure -- Recommendations; Heart failure -- Periodicals; Heart Failure -- Periodicals; Insuffisance cardiaque -- Périodiques; Heart failure; Periodicals; 616.129005
• DOI: 10.1002/ejhf.2542
• Languages: English
• ISSNs: 1388-9842

Abstract

Abstract: Recommendations represent the core messages of guidelines, and are particularly important when the body of scientific evidence is rapidly growing, as in the case of heart failure (HF). The main messages from two latest major HF guidelines, endorsed by the European Society of Cardiology (ESC) and the American College of Cardiology/American Heart Association/Heart Failure Society of America (ACC/AHA/HFSA), are partially overlapping, starting from the four pillars of treatment for HF with reduced ejection fraction. Some notable differences exist, in part related to the timing of recent publications (most notably, the Universal Definition of HF paper and the EMPEROR‐Preserved trial), and in part reflecting differing views of the natural history of HF (with a clear differentiation between stages A and B HF in the ACC/AHA/HFSA guidelines). Different approaches are proposed to specific issues such as risk stratification and implantable cardioverter defibrillator use for primary prevention in HFrEF patients with non‐ischaemic aetiology. The ACC/AHA/HFSA guidelines put a greater emphasis on some issues that are particularly relevant to the US setting, such as the cost‐effectiveness of therapies and the impact of health disparities on HF care. A comparison between guideline recommendations may give readers a deeper understanding of the ESC and ACC/AHA/HFSA guidelines, and help them apply sensible approaches to their own practice, wherever that may be in the world. A comparison may possibly also help further harmonization of recommendations between future guidelines, by identifying why some areas have led to conflicting recommendation, even when ostensibly reviewing the same published evidence. Abstract : Main similarities and differences between the European Society of Cardiology (ESC) and American College of Cardiology/American Heart Association/Heart Failure Society of America (ACC/AHA/HFSA) heart failure (HF) guidelines. See text for details. ARNI, angiotensin receptor–neprilysin inhibitor; BNP, B‐type natriuretic peptide; CRT, cardiac resynchronization therapy; GL, guidelines; HFmrEF, heart failure with mildly reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; ICD, implantable cardioverter defibrillator; LOE, level of evidence; MCS, mechanical circulatory support; MRA, mineralocorticoid receptor antagonist; NT‐proBNP, N‐terminal pro‐B‐type natriuretic peptide; RAASi, renin–angiotensin–aldosterone system inhibitor; SGLT2i, sodium – glucose co‐transporter 2 inhibitor.