Canada: ESC Heart Failure Guidelines Update

The European Society of Cardiology (ESC) has taken a significant stride in the field of heart failure management with a focused update to their heart failure guidelines. This update incorporates crucial data from nearly a dozen new clinical trials that have been published since 2021. The trials include notable studies such as EMPEROR-Preserved, DELIVER, STRONG-HF, IRONMAN, and more. The updated guidelines, which were unveiled on the opening day of the ESC Congress 2023, offer novel recommendations related to the use of SGLT2 inhibitors in patients with heart failure and updates on comorbidity management.

New Recommendations

• SGLT2 Inhibitors for Heart Failure with Reduced Ejection Fraction (HFmrEF) and Preserved Ejection Fraction (HFpEF): The guidelines now recommend the use of SGLT2 inhibitors (dapagliflozin or empagliflozin) in patients with HFmrEF and HFpEF. This is to reduce the risk of heart failure hospitalization or cardiovascular death. The recommendation is classified as Class I, Level A, signifying a strong endorsement based on robust evidence.
• Acute Heart Failure Strategy: An intensive approach involving the initiation and rapid up-titration of evidence-based treatment before discharge, along with meticulous follow-up within the initial 6 weeks post-heart failure hospitalization, is recommended. This strategy aims to decrease the risk of heart failure rehospitalization or death and is classified as Class I, Level B.
• Comorbidities Management: The update addresses heart failure in the context of comorbidities, particularly type 2 diabetes and chronic kidney disease. For patients with these conditions, SGLT2 inhibitors (dapagliflozin or empagliflozin) are now recommended to mitigate the risk of heart failure, hospitalization or cardiovascular death. Additionally, the use of finerenone is recommended for heart failure hospitalization risk reduction in patients with type 2 diabetes and chronic kidney disease. Intravenous iron supplementation is endorsed for symptomatic patients with heart failure and iron deficiency, aiming to alleviate symptoms and enhance their quality of life.

Dr. Marco Metro, the chairperson of the guidelines task force and director of the Institute of Cardiology of the Civil Hospital and the University of Brescia, highlighted the dynamic nature of heart failure research, necessitating a focused update to incorporate recent advancements. He emphasized that the new recommendations cover three crucial areas: chronic heart failure, acute heart failure, and comorbidities.

Professor Theresa McDonagh, the guidelines task force chairperson and consultant cardiologist at King’s College Hospital, emphasized the swift pace of developments in heart failure research. She underscored the significance of this focused update, which merges the latest evidence-based treatments with cutting-edge management recommendations, all geared towards enhancing patient outcomes.

Reference

McDonagh TA, Metra M, Adamo M, et al. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure [published online ahead of print, 2023 Aug 25]. Eur Heart J. 2023;ehad195. doi:10.1093/eurheartj/ehad195

Focused update of ESC Heart Failure Guidelines published today. ESC Congress 2023. August 25, 2023. Accessed August 25, 2023. https://www.escardio.org/The-ESC/Press-Office/Press-releases/focused-update-of-esc-heart-failure-guidelines-published-today.