2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

Ponikowski, Piotr; Voors, Adriaan A.; Anker, Stefan D.; Bueno, Héctor; Cleland, John G.F.; Coats, Andrew J.S.; Falk, Volkmar; González-Juanatey, José Ramón; Harjola, Veli‐Pekka; Jankowska, Ewa A.; Jessup, Mariell; Linde, Cecilia; Nihoyannopoulos, Petros; Parissis, John; Pieske, Burkert; Riley, Jillian; Rosano, Giuseppe; Ruilope, Luís M.; Ruschitzka, Frank; Rutten, Frans H.; Meer, Peter van der

doi:10.1093/eurheartj/ehw128

Cited by 13,221 publications

(5,363 citation statements)

References 665 publications

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“…Currently, LVEF is the gold standard for risk stratification of heart failure patients, and severe LVEF reduction is an indication for prophylactic ICD implantation 3, 4. However, LVEF reflects the global systolic function of the heart, and does not necessarily correlate with pathological changes in myocardium facilitating VT.…”

Section: Discussionmentioning

confidence: 99%

“…Ambulatory ECG, Holter recordings and exercise tests were performed at baseline in all patients. New York Heart Association (NYHA) classification was documented for each patient at the baseline according to ESC and AHA Heart Failure Guidelines: NYHA Class I: no limitation of physical activity; NYHA Class II: slight limitation of physical activity in which ordinary physical activity leads to fatigue, palpitation, dyspnoea, or anginal pain; the person is comfortable at rest; Class III: marked limitation of physical activity in which less‐than‐ordinary activity results in fatigue, palpitation, dyspnoea, or anginal pain; the person is comfortable at rest; Class IV: inability to carry on any physical activity without discomfort but also symptoms of heart failure or the anginal syndrome even at rest, with increased discomfort if any physical activity is undertaken 4, 26. Patients were followed up between 2003 and 2013.…”

Section: Methodsmentioning

confidence: 99%

“…Progressive heart failure and ventricular tachyarrhythmia (VT) are the most common cause of sudden death in these patients 3. Current guidelines for primary prevention with implantable cardioverter defibrillators (ICD) are based on the degree of LV ejection fraction (LVEF ≤ 30%‐40%) reduction 3, 4. However, patients with ischaemic heart disease seem to have more benefit from prophylactic ICD implantation 5, 6, 7.…”

Section: Introductionmentioning

confidence: 99%

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GDF‐15 is a better complimentary marker for risk stratification of arrhythmic death in non‐ischaemic, dilated cardiomyopathy than soluble ST2

Stojković

Kaider

Koller

et al. 2018

J Cellular Molecular Medi

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Growth differentiation factor (GDF)‐15 and soluble ST2 (sST2) are established prognostic markers in acute and chronic heart failure. Assessment of these biomarkers might improve arrhythmic risk stratification of patients with non‐ischaemic, dilated cardiomyopathy (DCM) based on left ventricular ejection fraction (LVEF). We studied the prognostic value of GDF‐15 and sST2 for prediction of arrhythmic death (AD) and all‐cause mortality in patients with DCM. We prospectively enrolled 52 patients with DCM and LVEF ≤ 50%. Primary end‐points were time to AD or resuscitated cardiac arrest (RCA), and secondary end‐point was all‐cause mortality. The median follow‐up time was 7 years. A cardiac death was observed in 20 patients, where 10 patients had an AD and 2 patients had a RCA. One patient died a non‐cardiac death. GDF‐15, but not sST2, was associated with increased risk of the AD/RCA with a hazard ratio (HR) of 2.1 (95% CI = 1.1‐4.3; P = .031). GDF‐15 remained an independent predictor of AD/RCA after adjustment for LVEF with adjusted HR of 2.2 (95% CI = 1.1‐4.5; P = .028). Both GDF‐15 and sST2 were independent predictors of all‐cause mortality (adjusted HR = 2.4; 95% CI = 1.4‐4.2; P = .003 vs HR = 1.6; 95% CI = 1.05‐2.7; P = .030). In a model including GDF‐15, sST2, LVEF and NYHA functional class, only GDF‐15 was significantly associated with the secondary end‐point (adjusted HR = 2.2; 95% CI = 1.05‐5.2; P = .038). GDF‐15 is superior to sST2 in prediction of fatal arrhythmic events and all‐cause mortality in DCM. Assessment of GDF‐15 could provide additional information on top of LVEF and help identifying patients at risk of arrhythmic death.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

GDF‐15 is a better complimentary marker for risk stratification of arrhythmic death in non‐ischaemic, dilated cardiomyopathy than soluble ST2

Stojković

Kaider

Koller

et al. 2018

J Cellular Molecular Medi

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“…Consequently, national and international guidelines and recommendations are required to extrapolate the beneficial impact of disease‐modifying therapies and leave a degree of the decision‐making in the hands of the clinicians 11, 12, 13, 14. It has been demonstrated that adherence to recommendations regarding prescription of disease‐modifying therapies is variable and is impacted by renal function in trial settings 2, 15, 16.…”

Section: Introductionmentioning

confidence: 99%

Impaired renal function affects clinical outcomes and management of patients with heart failure

et al. 2017

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AimsInpatients with heart failure and renal impairment have poor outcomes and variable quality of care. We investigate treatment practice and outcomes in an unselected real‐world cohort using historical creatinine measurements.Methods and resultsAdmissions between 1/4/2013 and 30/4/2015 diagnosed at discharge with heart failure were retrospectively analysed. Stages of chronic kidney disease (CKD) and acute kidney injury (AKI) were calculated from creatinine at discharge and 3–12 months before admission. We identified 1056 admissions of 851 patients (mean age 76 years, 56% Caucasian, 36% with diabetes mellitus, 54% with ischaemic heart disease, and 57% with valvular heart disease). CKD was common; 36%—Stage 3a/b, 11%—Stage 4/5; patients were older, more often diabetic, with higher potassium, lower haemoglobin, and more oedema but similar prevalence of left ventricular systolic dysfunction (LVSD) compared patients with Stages 0–2. AKI was present in 17.0% (10.4%—Stage 1, 3.7%—Stage 2, and 2.9%—Stage 3); these had higher potassium and lower haemoglobin than patients with no AKI. Length of stay was longer in Stage 4/5 CKD [11 days; P = 0.008] and AKI [13 days; P = 0.006]. Mortality was higher with Stage 4/5 CKD (13.8% compared with 7.7% for Stages 0–2 CKD (P = 0.036)] and increased with AKI (5%—no AKI, 20.9%—Stage 1, 35.9%—Stage 2, and 48.4%—Stage 3; P < 0.001). Adjusted for age, diabetes, and LVSD, both AKI and Stage 4/5 CKD were independent predictors of in‐hospital mortality. In survivors with LVSD, the discharge prescription of angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers decreased with progressive CKD, [84%—no‐mild, 59%—moderate, and 36%—severe CKD; P < 0.001]; this was not purely explained by hyperkalaemia.ConclusionsInpatients with heart failure and renal impairment, acute and chronic, failed to receive recommended therapy and had poor outcomes.

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“…Contemporary management of heart failure (HF) includes multidisciplinary structured follow‐up programmes that provide patient education, medical treatment optimization, psychosocial support, and improved access to care 1. Such strategies are designed to improve outcomes and reportedly reduce HF‐related hospitalization and mortality following hospital discharge 2.…”

Section: Introductionmentioning

confidence: 99%

Impact of a ‘stent for life’ initiative on post‐ST elevation myocardial infarction heart failure: a 15 year heart failure clinic experience

et al. 2017

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AimsMultidisciplinary heart failure (HF) clinics are a cornerstone of contemporary HF management. The stent‐for‐life (SFL) initiative improves mortality after ST elevation myocardial infarction (STEMI), but its impact in post‐STEMI HF is not well characterized. Here we assessed the impact of SFL among patients referred to a multidisciplinary HF clinic over a 15 year time period.Methods and resultsBetween 2001 and 2015, 1921 patients were admitted to our HF clinic. In 2009, Catalonia established the Codi IAM network, a regional STEMI network that prioritizes primary percutaneous coronary intervention in STEMI. Patients admitted during the study period were divided into two groups based on admission date: pre‐SFL (2001–June 2009; n = 1031) and post‐SFL (July 2009–2015; n = 890). Compared with those in the pre‐SFL group, patients admitted in the post‐SFL period had better New York Heart Association (NYHA) functional class (22.1 vs. 38.7 NYHA classes III–IV; P < 0.001) and higher left ventricular ejection fraction (LVEF) (36.1 ± 19.6 vs. 32.6 ± 13.4; P < 0.001). Among STEMI survivors, 101 (6.7%) pre‐SFL patients and 40 (2%) post‐SFL patients (P < 0.001) fulfilled the criteria for HF clinic referral (Killip–Kimball class ≥ 2 during index admission and/or LVEF of <40%). Furthermore, among patients admitted to the HF clinic, post‐STEMI HF with reduced ejection fraction patients comprised 8.9% of the pre‐SFL group and only 4.2% of the post‐SFL group (P < 0.001).ConclusionsAmong patients treated at our multidisciplinary HF clinic, the adoption of an SFL network has decreased the prevalence of post‐STEMI HF with reduced ejection fraction.

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2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

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Cited by 13,221 publications

References 665 publications

GDF‐15 is a better complimentary marker for risk stratification of arrhythmic death in non‐ischaemic, dilated cardiomyopathy than soluble ST2

GDF‐15 is a better complimentary marker for risk stratification of arrhythmic death in non‐ischaemic, dilated cardiomyopathy than soluble ST2

Impaired renal function affects clinical outcomes and management of patients with heart failure

Impact of a ‘stent for life’ initiative on post‐ST elevation myocardial infarction heart failure: a 15 year heart failure clinic experience

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