Review: Effective Implementation of the New ESC Guidelines for the Management of Chronic Heart Failure in Routine Clinical Practice

Abstract

European guidelines for the management of chronic heart failure (CHF) have been recently updated. Key changes include emphasis on CHF with preserved ejection fraction, and recognition of the role of angiotensin receptor blockers (ARBs) in the management of CHF patients with left ventricular systolic dysfunction who remain symptomatic despite optimal therapy, or who are intolerant to angiotensin-converting enzyme (ACE) inhibitors.

Recent trials that clearly demonstrated significant mortality and morbidity benefits were integral to these new recommendations. Additionally, a high dose of an ARB, as demonstrated in the Candesartan in Heart Failure Assessment of Reduction in Mortality and morbidity (CHARM) programme, can significantly reduce hospitalisation for heart failure in these settings. The guidelines recommend that only those ARBs and doses used in clinical trials should be considered, taking into account current licensed indications. Clinicians who are directly involved in the management of CHF must play a key role in the dissemination of these guidelines to colleagues to ensure that optimal CHF management is integrated into standard practice.