© 2002 European Society of Cardiology
Comprehensive guidelines for the diagnosis and treatment of chronic heart failure Task force for the diagnosis and treatment of chronic heart failure of the European Society of Cardiology
a Sticares, Cardiovascular Research Foundation P.O. Box 882, 3160 AB, Rhoon, The Netherlands
b Department of Medicine, Göteborg University, Sahlgrenska University Hospital SE-416 85 Göteborg, Sweden
* Corresponding author. Tel.: +46-31-343-4078; fax: +46-31-258-933. E-mail address: w.j.remme@sticares.org, karl.swedberg@hjl.gu.se
Received October 19, 2001; Accepted October 26, 2001
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1. Diagnosis of chronic heart failure |
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1.1. Introduction and methodology
The aim of this report is to provide practical guidelines for the diagnosis, assessment and treatment of heart failure for use in clinical practice and in addition for epidemiological surveys and for clinical trials. The recommendations in these guidelines should always be considered in the light of local regulatory requirements for the administration of any chosen drug or device. This report is a comprehensive summary of the full report [1]. The full report should be used when in doubt or when further information is required.
1.1.1. Level of evidence
Recommendations regarding treatments have been based on the degree of available evidence.
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1.2. Systolic versus diastolic heart failure
Heart failure is usually associated with evidence of left ventricular (LV) systolic dysfunction, although diastolic impairment at rest is a common if not universal accompaniment. Diastolic heart failure is often presumed to be present when symptoms and signs of heart failure occur in the presence of a preserved LV systolic function.
1.3. Diagnosis of chronic heart failure
- Heart
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1.5. Symptoms and signs in the diagnosis of heart failure
1.6. Electrocardiogram
1.7. The chest X-ray
1.8. Haematology and biochemistry
1.9. Echocardiography
1.10. Additional non-invasive tests to be considered
1.11. Pulmonary function
1.12. Exercise testing
1.13. Invasive investigation
1.14. Natriuretic peptides
1.15. Other neuroendocrine evaluations
1.16. Holter electrocardiography (ambulatory ECG, long time ECG recording — LTER)
1.17. Requirements for the diagnosis of heart failure in clinical practice
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2. Treatment of heart failure |
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2.1. Management of chronic heart failure
2.2. Non-pharmacological management
2.3. Pharmacological therapy: angiotensin-converting enzyme inhibitors
2.4. Diuretics
2.4.1. Loop diuretics, thiazides and metolazone
2.5. Potassium-sparing diuretics
2.6. Beta-adrenoceptor antagonists
2.7. Aldosterone receptor antagonists — spironolactone
2.8. Angiotensin II receptor antagonists (ARBs)
2.8.1. Safety and tolerability
2.9. Cardiac glycosides
2.9.1. Digoxin
2.10. Vasodilator agents in chronic heart failure
2.11. Positive inotropic therapy
2.12. Anti-thrombotic agents
2.13. Antiarrhythmics
2.13.1. Class I anti-arrhythmics
2.13.2. Class II anti-arrhythmics
2.13.3. Class III anti-arrhythmics
2.14. Devices and surgery: revascularisation procedures, mitral valve surgery, cardiomyoplasty and partial left ventriculotomy
2.14.1. Revascularisation
2.14.2. Mitral valve surgery
2.15. Pacemakers
2.16. Arrhythmia devices and surgery
2.16.1. Implantable cardioverter defibrillators (ICD)
2.17. Heart transplantation, ventricular assist devices and artificial heart
2.17.1. Heart transplantation
2.17.2. Ventricular assist devices and artificial heart
2.18. Choice and timing of pharmacological therapy of heart failure due to systolic LV dysfunction
2.19. Asymptomatic systolic LV dysfunction
2.20. Symptomatic systolic LV dysfunction-heart failure NYHA class II
2.21. Worsening heart failure
2.22. End stage heart failure (patients who persist in NYHA IV despite optimal treatment and proper diagnosis
2.23. Management of heart failure due to diastolic dysfunction
2.24. Pharmacotherapy of diastolic heart failure
2.25. Heart failure treatment in the elderly
2.26. Arrhythmias
2.26.1. Ventricular arrhythmias
2.26.2. Atrial fibrillation
2.27. Symptomatic systolic left ventricular dysfunction and concomitant angina or hypertension
2.28. Care and follow-up
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