Head‐to‐head comparison between recommendations by the <scp>ESC</scp> and <scp>ACC</scp>/<scp>AHA</scp>/<scp>HFSA</scp> heart failure guidelines

  • Antoni Bayés‐Genís
    Institut del Cor Hospital Universitari Germans Trias i Pujol Badalona Spain
  • Alberto Aimo
    Institute of Life Sciences Scuola Superiore Sant'Anna Pisa Italy
  • Marco Metra
    Cardiology Division, ASST Spedali Civili; Department of Medical and Surgical Specialties Radiological Sciences and Public Health, University of Brescia Brescia Italy
  • Stefan Anker
    Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin Charité Universitätsmedizin Berlin Berlin Germany
  • Petar Seferovic
    Faculty of Medicine University of Belgrade Belgrade Serbia
  • Claudio Rapezzi
    Cardiologic Centre University of Ferrara Ferrara Italy
  • Vincenzo Castiglione
    Institute of Life Sciences Scuola Superiore Sant'Anna Pisa Italy
  • Julio Núñez
    CIBERCV Carlos III Institute of Health Madrid Spain
  • Michele Emdin
    Institute of Life Sciences Scuola Superiore Sant'Anna Pisa Italy
  • Giuseppe Rosano
    IRCCS San Raffaele Roma Rome Italy
  • Andrew J.S. Coats
    University of Warwick Coventry UK

抄録

<jats:title>Abstract</jats:title><jats:p>Recommendations represent the core messages of guidelines, and are particularly important when the body of scientific evidence is rapidly growing, as in the case of heart failure (HF). The main messages from two latest major HF guidelines, endorsed by the European Society of Cardiology (ESC) and the American College of Cardiology/American Heart Association/Heart Failure Society of America (ACC/AHA/HFSA), are partially overlapping, starting from the four pillars of treatment for HF with reduced ejection fraction. Some notable differences exist, in part related to the timing of recent publications (most notably, the Universal Definition of HF paper and the EMPEROR‐Preserved trial), and in part reflecting differing views of the natural history of HF (with a clear differentiation between stages A and B HF in the ACC/AHA/HFSA guidelines). Different approaches are proposed to specific issues such as risk stratification and implantable cardioverter defibrillator use for primary prevention in HFrEF patients with non‐ischaemic aetiology. The ACC/AHA/HFSA guidelines put a greater emphasis on some issues that are particularly relevant to the US setting, such as the cost‐effectiveness of therapies and the impact of health disparities on HF care. A comparison between guideline recommendations may give readers a deeper understanding of the ESC and ACC/AHA/HFSA guidelines, and help them apply sensible approaches to their own practice, wherever that may be in the world. A comparison may possibly also help further harmonization of recommendations between future guidelines, by identifying why some areas have led to conflicting recommendation, even when ostensibly reviewing the same published evidence.</jats:p>

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