ESC Congress 2016 - 10

FEATuREd ARTIclE Table 9. Comorbidity Treatments Not Recommended for Patients With Heart Failure Patients with symptomatic HFrEF should be treated with life-saving pharmacotherapy containing a combination of an ACE inhibitor or ARB and a ß-blocker; if symptoms persist, a mineralocorticoid receptor antagonist should be added. Figure 5 shows the algorithm of recommended treatments for patients with symptomatic HFrEF. Patients with HFpEF or HFmrEF should be screened for comorbidities, which should be treated if safe and effective interventions exist, to improve symptoms. Diuretics are recommended for patients with congestive HFpEF or HFmrEF to alleviate symptoms and signs. Comorbidities in patients with HF can interfere with the diagnosis of HF, aggravate HF symptoms, and contribute to the burden of hospitalizations and mortality. Comorbidities may affect the use of HF treatments and drugs used to treat comorbidities may worsen HF or interact with HF drugs. Some treatments for comorbidities are not recommended in patients with HF (Table 9). Recommendations Class Level Sleep apnea: Adaptive servo-ventilation is not recommended in patients with HFrEF and a predominant central sleep apnea because of increased all-cause and cardiovascular mortality. III B Diabetes: Thiazolidinediones (glitazones) are not recommended in patients with HF, as they increase the risk of HF worsening and HF hospitalization. III A Arthritis: NSAIDs or COX-2 inhibitors are not recommended in patients with HF, as they increase the risk of HF worsening and HF hospitalization. III B COX-2, cyclooxygenase-2; HFrEF, heart failure with reduced ejection fraction; NSAIDs, nonsteroidal anti-inflammatory drugs. Reprinted from Ponikowski P et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail. 2016; 37: 2129-2200. doi:10.1093/eurheartj/ ehw128. By permission of John Wiley & Sons on behalf of the European Society of Cardiology. Figure 5. Therapeutic Algorithm for Patients With Symptomatic HFrEF Class I Patients with sympthomatica HFrEFb Class IIa if LVEF ≤ 35 % despite OMT or a history of symptomatic VT/VF, implant ICD Diuretics to relieve symptoms and signs of congestion Therapy with ACE-Ic and ß-blocker (up-titrate to maximum tolerated evidence-based doses) Still symptomatic and LVEF ≤ 35% No Yes Add MR antagonistd,e (up-titrate to maximum tolerated evidence-based doses) Yes Still symptomatic and LVEF ≤ 35% No Yes Able to tolerate ACEI (or ARB)f,g ARNI to replace ACE-I Sinus rhythm QRS duration ≤ 130 msec Evaluate need for CR Tf,g Sinus rhythm,h HR ≥ 70 bpm Ivabradine These treatments above may be combined if indicated ACE-I, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor neprilysin inhibitor; CRT, cardiac resynchronization therapy; HFrEF, heart failure with reduced ejection fraction; H-ISDN, hydralazine and isosorbide dinitrate; HR, heart rate; ICD, implantable cardioverter-defibrillator; LVAD, left ventricular assist device; LVEF, left ventricular ejection fraction; MR, mineralocorticoid receptor; OMT, optimal medical therapy; VF, ventricular fibrillation; VT, ventricular tachycardia. Reprinted from Ponikowski P et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail. 2016; 37: 2129-2200. doi:10.1093/eurheartj/ehw128. By permission of John Wiley & Sons on behalf of the European Society of Cardiology. 10 October 2016 www.escardio.org/ESCcongressinreview http://www.escardio.org/ESCcongressinreview

Table of Contents for the Digital Edition of ESC Congress 2016