ESC Congress 2016 - 5

Your FREE access to ESC Congress content all year long www.escardio.org/365 Long-term rhythm control can be achieved with antiarrhythmic drugs (AADs) or catheter ablation. AAD recommendations are dronedarone, flecainide, propafenone, or sotalol for patients with no or minimal signs of structural heart disease; dronedarone, sotalol, or amiodarone for patients with coronary artery disease (CAD), significant valvular heart disease, or abnormal LV hypertrophy; and amiodarone for patients with HF. The recommendations for catheter ablation of AF are shown in Table 2. GUIDELInES On CVD PREVEnTIOn In CLInICAL PRACTICE The 2016 European Guidelines on CVD prevention in clinical practice [Piepoli MF et al. Eur Heart J. 2016; Eur J Prev Cardiol. 2016] were developed by the Sixth Joint Task Force of the ESC and other societies, chaired by Massimo F. Piepoli, MD, Polichirurgico Hospital G. Da Saliceto, Piacenza, Emilia Romagna, Italy, and Arno W. Hoes, MD, University Medical Center Utrecht, The Netherlands. Even though mortality and morbidity caused by CVD have decreased owing to preventive measures, many risk factors have been increasing and implementation of preventive measures has been poor. The elimination of CVD risk behaviors has the potential to prevent 80% of CVD and even 40% of cancers. In addition to prevention at the individual level, the new guidelines emphasize a population-based approach, focusing on smoking cessation, a healthy diet, physical activity, alcohol abuse prevention, and a healthy environment. Disease-specific preventive measures are also addressed. Also new in the 2016 guidelines are preventive measures targeted at specific groups - younger persons; persons aged > 60 years; women in general; women with a history of pre-eclampsia or pregnancy-induced hypertension, polycystic ovary syndrome, or gestational diabetes mellitus (DM); ethnic minorities; and patients with conditions that increase the risk of CVD (such as with inflammatory diseases or under cancer therapy). ESC CONGRESS 2016 IN REVIEW The guidelines recommend systematic assessment of total CVD risk since atherosclerosis results from several risk factors (Table 3). The CVD risk categories are defined as follows: ■ Very high risk: documented CVD, clinical or unequivocal on imaging, DM with target organ damage or with a major risk factor, severe chronic kidney disease, calculated Systematic Coronary Risk Evaluation (SCORE) ≥ 10% ■ High risk: markedly elevated single risk factors, DM (except low-risk young people with type I DM), moderate chronic kidney disease, calculated SCORE ≥ 5% and < 10% ■ Moderate risk: SCORE ≥ 1% and < 5% at 10 years ■ Low-risk: SCORE < 1% The SCORE risk assessment tool is intended to be used in patients without DM, documented CVD or markedly elevated single risk factors (eg familial hyperlipidemia or severe hypertension) and includes gender, smoking status, age, systolic blood pressure, lipids and region (http://www.escardio.org/Education/Practice-Tools/ CVD-prevention-toolbox/SCORE-Risk-Charts). The guidelines recommend lifestyle advice for lowto moderate-risk persons; intensive lifestyle advice and possible drug treatment for high-risk persons; and drug treatment for very high-risk persons. Risk-factor goals and target levels are shown in Table 4. Other major new messages in the 2016 guidelines include recommendations for cardiac rehabilitation in patients with acute coronary syndrome (ACS), postrevascularization, or HF. Home-based, nursing home, and telemonitoring settings for interventions are recommended in addition to the traditional settings. The guidelines recommend systematically monitoring delivery of CVD prevention activities and outcomes using standard performance measures. Sign up to receive My ESC Congresses and Events newsletter Don't miss important news and deadlines http://escol.escardio.org/MyESC RememberHighlights to like the ESC onCongress Facebook Official Peer-Reviewed From ESC 2016 www.facebook.com/europeansocietyofcardiology 5 http://www.escardio.org/365 http://www.escardio.org/Education/Practice-Tools/CVD-prevention-toolbox/SCORE-Risk-Charts http://www.escardio.org/Education/Practice-Tools/CVD-prevention-toolbox/SCORE-Risk-Charts http://escol.escardio.org/MyESC http://www.facebook.com/europeansocietyofcardiology

Table of Contents for the Digital Edition of ESC Congress 2016