2016 ESC Guidelines Acute heart failure Veli-Pekka Harjola FHFA, FESC Coordinator of the acute heart failure committee of the HFA Helsinki, Finland
2 www.escardio.org/guidelines
3 12. Acute heart failure 12.1. Definition and classification 12.2. Diagnosis and initial prognostic evaluation 12.3. Management 12.3.1. Identification of precipitants/causes leading to decompensation which need urgent management 12.3.2. Criteria for hospitalization in ward versus intensive/coronary care unit 12.3.3. Management of the early phase 12.3.4. Management of patients with cardiogenic shock 12.4. Management of evidence-based oral therapies 12.5. Monitoring of clinical status of patients hospitalized 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 www.escardio.org/guidelines
4 What is new in 2016 guidelines for AHF? The concept of an early initiation of appropriate therapy going along with • identification of acute etiology follows “time to therapy” approach well established in acute coronary syndrome (ACS) • A new algorithm for a combined diagnosis and treatment approach of acute HF, • based on the clinical presentation: presence/absence of congestion/hypoperfusion Structured recommendations with class of recommendation and level of evidence • given to all the main elements of management from diagnosis, monitoring and therapies to postdischarge follow-up Individual case-by-case interpretation of recommendations have to be consistent with the level of evidence www.escardio.org/guidelines
Recommendations regarding applied diagnostic measurements in suspected AHF www.escardio.org/guidelines
Causes of elevated concentrations of natriuretic peptides www.escardio.org/guidelines
Factors triggering acute heart failure www.escardio.org/guidelines
Clinical profiles of patients with acute HF based on the presence/absence of congestion and/or hypoperfusion www.escardio.org/guidelines
Initial management of a patient with acute HF www.escardio.org/guidelines
Initial management of a patient with acute HF (1) www.escardio.org/guidelines
Initial management of a patient with acute HF (2) www.escardio.org/guidelines
Management of patients with acute heart failure based on clinical profile during an early phase www.escardio.org/guidelines
Management of patients with acute heart failure based on clinical profile during an early phase www.escardio.org/guidelines
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Recommendations for the management of patients with acute heart failure: pharmacotherapy Given for each main drug category www.escardio.org/guidelines
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Recommendations regarding monitoring, oxygen therapy and ventilatory support www.escardio.org/guidelines
Recommendations regarding renal replacement therapy in patients with acute heart failure www.escardio.org/guidelines
Recommendations regarding oral evidence-based disease-modifying therapies in patients with AHF www.escardio.org/guidelines
Recommendations regarding management of patients with cardiogenic shock www.escardio.org/guidelines
Recommendations regarding monitoring of clinical status of patients hospitalized due to acute heart failure www.escardio.org/guidelines
Goals of treatment in acute heart failure www.escardio.org/guidelines
Gaps in knowledge in AHF Prospective evaluation of the ‘time-to-treatment’ concept in AHF • Evaluation whether inadequate phenotyping is responsible for the • failure of treatments to improve outcome in AHF Better definition and treatment of diuretic resistance • Role of nitrates in the management of AHF • Treatments improving mortality and morbidity • Strategies and therapies to prevent early rehospitalization after • discharge for a hospital admission for AHF. www.escardio.org/guidelines
21.5.2016 www.escardio.org/ guidelines Thank you
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