Reference: McMurray JJV, et al. Eur Heart J. 2012.
 

LET'S CHANGE THAT TOGETHER

 
 
 

European Guidelines for Heart Failure

Current ESC standards in disease management

How is heart failure defined?

 

According to European Society of Cardiology (ESC) guidelines, “HF is a clinical syndrome characterized by typical symptoms (e.g. breathlessness, ankle swelling and fatigue) that may be accompanied by signs (e.g. elevated jugular venous pressure, pulmonary crackles and peripheral oedema) caused by a structural and/or functional cardiac abnormality, resulting in a reduced cardiac output and/or elevated intracardiac pressures at rest or during stress.” 1

 

DEFINITIONS OF HFrEF, HFmrEF AND HFpEF1
Type of HF HFrEF HFmrEF HFpEF
CRITERIA 1 Symptoms ± signsa Symptoms ± signsa Symptoms ± signsa
2 LVEF < 40% LVEF 40–49% LVEF ≥ 50%
3
  1. 1. Elevated levels of natriuretic peptidesb;
  2. 2. At least one additional criterion:
    1. a. relevant structural heat disease (LVH and/or LAE),
    2. b. diastolic dysfunction (for details see Section 4.3.2)
  1. 1. Elevated levels of natriuretic peptidesb;
  2. 2. At least one additional criterion:
    1. a. relevant structural heat disease (LVH and/or LAE),
    2. b. diastolic dysfunction (for details see Section 4.3.2)
DEFINITIONS OF HFrEF, HFmrEF AND HFpEF1
Type of HF HFrEF HFmrEF HFpEF
CRITERIA 1 Symptoms ± signsa Symptoms ± signsa Symptoms ± signsa
2 LVEF <40% LVEF 40% to 49% LVEF ≥ 50%
3 -
  1. 1. Elevated levels of natriuretic peptidesb;
  2. 2. At least one additional criterion:
    1. a. relevant structural heat disease (LVH and/or LAE),
    2. b. diastolic dysfunction
  1. 1. Elevated levels of natriuretic peptidesb;
  2. 2. At least one additional criterion:
    1. a. relevant structural heat disease (LVH and/or LAE),
    2. b. diastolic dysfunction

a. Signs may not be present in the early stages of HF (especially in HFpEF) and in patients treated with diuretics.
b. BNP >35 pg/mL and/or NT-proBNP >125 pg/mL.
Reproduced from Ponikowski P, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200 by permission of Oxford University Press on behalf of the ESC.
ESC = European Society of Cardiology; EF = ejection fraction; HFrEF = heart failure with reduced ejection fraction; HFmrEF = heart failure with mid-range ejection fraction; HFpEF = heart failure with preserved ejection fraction; LAE = left atrial enlargement; LVEF = left ventricular ejection fraction; LVH = left ventricular hypertrophy; NT-proBNP = N-terminal pro-B type natriuretic peptide.
1. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200. 2. Fauci AS, Braunwald E, Kasper DL, et al, eds. Harrison's Principles of Internal Medicine. 17th ed. New York: McGraw-Hill; 2008. 3. Ponikowski P, Anker SD, AlHabib KF, et al. Heart failure: preventing disease and death worldwide. ESC Heart Failure. 2014;1(1):4-25.

 

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NYHA classification is important for evaluating patient symptoms

 

The New York Heart Association (NYHA) functional classification is widely used and accepted based on exercise capacity and symptoms of the disease.1

NEW YORK HEART ASSOCIATION (NYHA) CLASSES1
NYHA class I No limitation of physical activity. Ordinary physical activity does not cause undue breathlessness, fatigue, or palpitations.
NYHA class II Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in undue breathlessness, fatigue, or palpitations.
NYHA class III Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity results in undue breathlessness, fatigue, or palpitations.
NYHA class IV Unable to carry on any activity without discomfort. Symptoms at rest can be present. If any physical activity is undertaken, discomfort is increased.
NEW YORK HEART ASSOCIATION (NYHA) CLASSES1
NYHA
class I
  • No limitation on physical activity.
  • No overt symptoms.
NYHA
class II
  • Slight limitation on physical activities.
  • Comfortable at rest, but ordinary physical activity causes symptoms of heart failure.
NYHA
class III
  • Marked limitation on physical activities.
  • Comfortable at rest, but less than ordinary activity causes symptoms of heart failure.
NYHA
class IV
  • Inability to carry on any activity without symptoms.
  • Presence of symptoms even at rest.

Reproduced from Ponikowski P, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200 by permission of Oxford University Press on behalf of the ESC.
NYHA= New York Heart Association.
1. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200. 2. Fauci AS, Braunwald E, Kasper DL, et al, eds. Harrison's Principles of Internal Medicine. 17th ed. New York: McGraw-Hill; 2008. 3. Ponikowski P, Anker SD, AlHabib KF, et al. Heart failure: preventing disease and death worldwide. ESC Heart Failure. 2014;1(1):4-25.

 

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Recommended guidelines for care1

 

The overall goals for chronic heart failure management, including patients with established HFrEF, “are to improve their clinical status, functional capacity and quality of life, prevent hospital admission and reduce mortality.”

  • Recent studies have shown that including a focus on reducing hospitalisations can be highly important to patients and health care systems

Treatment effectiveness at slowing or preventing progressive worsening of disease can be determined by reductions in the rates of both hospital admissions and mortality.

 

 

Therapeutic algorithm for a patient with symptomatic heart failure with reduced ejection fraction. Green indicates a class I recommendation; yellow indicates a class IIa recommendation. ACEI 1⁄4 angiotensin-converting enzyme inhibitor; ARB 1⁄4 angiotensin receptor blocker; ARNI 1⁄4 angiotensin receptor neprilysin inhibitor; BNP 1⁄4 B-type natriuretic peptide; CRT 1⁄4 cardiac resynchronization therapy; HF 1⁄4 heart failure; HFrEF 1⁄4 heart failure with reduced ejection fraction; H-ISDN 1⁄4 hydralazine and isosorbide dinitrate; HR 1⁄4 heart rate; ICD 1⁄4 implantable cardioverter defibrillator; LBBB 1⁄4 left bundle branch block; LVAD 1⁄4 left ventricular assist device; LVEF 1⁄4 left ventricular ejection fraction; MR 1⁄4 mineralocorticoid receptor; NT-proBNP 1⁄4 N-terminal pro-B type natriuretic peptide; NYHA 1⁄4 New York Heart Association; OMT 1⁄4 optimal medical therapy; VF 1⁄4 ventricular fibrillation; VT 1⁄4 ventricular tachycardia.
a. Symptomatic 1⁄4 NYHA Class II-IV; b. HFrEF 1⁄4 LVEF ,40%; c. If ACE inhibitor not tolerated/contra-indicated, use ARB; d. If MR antagonist not tolerated/contra-indicated, use ARB; e. With a hospital admission for HF within the last 6 months or with elevated natriuretic peptides (BNP . 250 pg/ml or NTproBNP . 500 pg/ml in men and 750 pg/ml in women); f. With an elevated plasma natriuretic peptide level (BNP ≥ 150 pg/mL or plasma NT-proBNP ≥ 600 pg/mL, or if HF hospitalization within recent 12 months plasma BNP ≥ 100 pg/mL or plasma NT-proBNP ≥ 400 pg/mL); g. In doses equivalent to enalapril 10 mg b.i.d; h. With a hospital admission for HF within the previous year; i. CRT is recommended if QRS ≥ 130 msec and LBBB (in sinus rhythm); j. CRT should/may be considered if QRS ≥ 130 msec with non-LBBB (in a sinus rhythm) or for patients in AF provided a strategy to ensure bi-ventricular capture in place (individualized decision). For further details, see Sections 7 and 8 and corresponding web pages.

Reproduced from Ponikowski P, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200 by permission of Oxford University Press on behalf of the ESC.

1. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200. 2. Fauci AS, Braunwald E, Kasper DL, et al, eds. Harrison's Principles of Internal Medicine. 17th ed. New York: McGraw-Hill; 2008. 3. Ponikowski P, Anker SD, AlHabib KF, et al. Heart failure: preventing disease and death worldwide. ESC Heart Failure. 2014;1(1):4-25.

 

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Recommended treatment guidelines in patients with symptomatic (NYHA class II–IV) HFrEF

 

PHARMACOLOGICAL TREATMENTS INDICATED IN POTENTIALLY ALL PATIENTS WITH SYMPTOMATIC
(NYHA FUNCTIONAL CLASS II–IV) HFrEF*
Recommendations Classa Levelb Refc
An ACEIc is recommended, in addition to a beta-blocker, for symptomatic patients with HFrEF to reduce the risk of HF hospitalisation and death I A 2,
163–165
A beta-blocker is recommended, in addition to an ACEId for patients with stable, symptomatic HFrEF to reduce the risk of HF hospitalisation and death I A 167–173
An MRA is recommended for patients with HFrEF, who remain symptomatic despite treatment with an ACEId and a beta-blocker, to reduce the risk of HF hospitalisation and death I A 174,175

a. Class of recommendation; b. Level of evidence; c. Reference(s) supporting recommendations; d. Or ARB, if ACEI is not tolerated/contraindicated.

Reproduced from Ponikowski P, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200 by permission of Oxford University Press on behalf of the ESC.

ACEI = angiotensin-converting enzyme inhibitor; ARB = angiotensin receptor blocker; HF = heart failure; HFrEF = heart failure with reduced ejection fraction; MRA = mineralocorticoid receptor

*Level of evidence A represents data derived from multiple randomised clinical trials or meta-analyses. Level of evidence B however, includes data derived from a single randomised clinical trial or large non-randomised studies. Consensus of opinion of the experts and/or small studies, retrospective studies, and registries, are classified under level of evidence C.

1. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200. 2. Fauci AS, Braunwald E, Kasper DL, et al, eds. Harrison's Principles of Internal Medicine. 17th ed. New York: McGraw-Hill; 2008. 3. Ponikowski P, Anker SD, AlHabib KF, et al. Heart failure: preventing disease and death worldwide. ESC Heart Failure. 2014;1(1):4-25.

 

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Other recommended treatment guidelines in patients with symptomatic
(NYHA class II–IV) HFrEF

 

OTHER PHARMACOLOGICAL TREATMENTS RECOMMENDED IN SELECTED PATIENTS WITH SYMPTOMATIC (NYHA FUNCTIONAL CLASS II–IV) HFrEF*
Recommendations Classa Levelb Refc
Diuretics
Diuretics are recommended in order to improve symptoms and exercise capacity in patients with signs and/or symptoms of congestion I B 178,179
Diuretics should be considered to reduce the risk of HF hospitalisation in patients with signs and/or symptoms of congestion IIa B 178,179
Angiotensin receptor neprilysin inhibitor
Sacubitril/valsartan is recommended as a replacement for an ACEI to further reduce the risk of HF hospitalisation and death in ambulatory patients with HFrEF who remain symptomatic despite optimal treatment with an ACEI, a beta-blocker and an MRAd I B 162
If-channel inhibitor
Ivabradine should be considered to reduce the risk of HF hospitalisation and cardiovascular death in symptomatic patients with LVEF ≤35%, in sinus rhythm and a resting heart rate ≥70 bpm despite treatment with an evidence-based dose of beta-blocker (or maximum tolerated dose below that), ACEI (or ARB), and an MRA (or ARB) IIa B 180
Ivabradine should be considered to reduce the risk of HF hospitalisation and cardiovascular death in symptomatic patients with LVEF ≤35%, in sinus rhythm and a resting heart rate ≥70 bpm who are unable to tolerate or have contra-indications for a beta-blocker. Patients should also receive an ACEI (or ARB) and an MRA (or ARB) IIa C 181
ARB
An ARB is recommended to reduce the risk of HF hospitalisation and cardiovascular death in symptomatic patients unable to tolerate an ACEI (patients should also receive a beta-blocker and an MRA) I B 182
An ARB may be considered to reduce the risk of HF hospitalisation and death in patients who are symptomatic despite treatment with a beta-blocker who are unable to tolerate an MRA IIb C -
Hydralazine and isosorbide dinitrate
Hydrazine and isosorbide dinitrate should be considered in self-identified black patients with LVEF <35% or with an LVEF <45% combined with a dilated LV in NYHA Class III–IV despite treatment with an ACEI, a beta-blocker and an MRA to reduce the risk of HF hospitalisation and death IIa B 183
Hydralazine and isosorbide dinitrate may be considered in symptomatic patients with HFrEF who can tolerate neither an ACEI nor an ARB (or they are contra-indicated) to reduce the risk of death IIb B 184
Other treatments with less-certain benefits
Digoxin
Digoxin may be considered in symptomatic patients in sinus rhythm despite treatment with an ACEI (or ARB), a beta-blocker and an MRA, to reduce the risk of hospitalisation (both all-cause and HF-hospitalisations) IIb B 185
N-3 PUFA
An n-3 PUFAe preparation may be considered in symptomatic HF patients to reduce the risk of cardiovascular hospitalisation and cardiovascular death IIb B 186

a. Class of recommendation; b. Level of evidence; c. Reference(s) supporting recommendations; d. Patient should have elevated natriuretic peptides (plasma BNP ≥ 150 pg/mL or plasma NT-proBNP ≥ 600 pg/mL, or if HF hospitalization within the last 12 months, plasma BNP ≥ 100 pg/mL or plasma NT-proBNP ≥ 400 pg/mL) and able to tolerate enalapril 10 mg b.i.d; e. Applies only to preparation studied in cited trial.

Reproduced from Ponikowski P, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200 by permission of Oxford University Press on behalf of the ESC.

ACEI = angiotensin-converting enzyme inhibitor; ARB = angiotensin receptor blocker; BNP = B-type natriuretic peptide; bpm = beats per minute; HF = heart failure; HFrEF = heart failure with reduced ejection fraction; LVEF = left ventricular ejection fraction; MRA = mineralocorticoid receptor antagonist; NT-proBNP = N-terminal pro-B type natriuretic peptide; NYHA = New York Heart Association.

*Level of evidence A represents data derived from multiple randomised clinical trials or meta-analyses. Level of evidence B however, includes data derived from a single randomised clinical trial or large non-randomised studies. Consensus of opinion of the experts and/or small studies, retrospective studies, and registries, are classified under level of evidence C.

1. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200. 2. Fauci AS, Braunwald E, Kasper DL, et al, eds. Harrison's Principles of Internal Medicine. 17th ed. New York: McGraw-Hill; 2008. 3. Ponikowski P, Anker SD, AlHabib KF, et al. Heart failure: preventing disease and death worldwide. ESC Heart Failure. 2014;1(1):4-25.

 

For more information, the ESC Guidelines can be found here

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Benefits of a multidisciplinary approach to care

 

During the management of heart failure, it is imperative to provide a system of care that ensures optimal management of every patient. Thus, a multifaceted approach to care – focused on holistic management, including exercise training and multidisciplinary management programmes, patient monitoring, and palliative care – can play an important role in the lives of heart failure patients. 1

Despite these treatment strategies, the survival rate for heart failure patients across the globe is poor. Continuing research and new pharmacological treatments are essential to addressing unmet needs in caring for patients with heart failure.2,3

For further information regarding the quality of care measures recommended by ESC, please click here.

 

1. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200. 2. Fauci AS, Braunwald E, Kasper DL, et al, eds. Harrison's Principles of Internal Medicine. 17th ed. New York: McGraw-Hill; 2008. 3. Ponikowski P, Anker SD, AlHabib KF, et al. Heart failure: preventing disease and death worldwide. ESC Heart Failure. 2014;1(1):4-25.

 

Copyright:

© 2016 European Society of Cardiology- All Rights Reserved

This webpage comprises figures from the "2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure" ("ESC Guidelines") originally published in the "European Heart Journal Jul 2016, 37 (27) 2129–2200" by Oxford University Press under licence from the European Society of Cardiology ("ESC").

This content is for personal and educational use only. No commercial use is authorized. No part of this content or the original ESC Guidelines from which it is derived may be translated or reproduced in any form without written permission from the ESC. Permission may be obtained upon submission of a written request to Oxford University Press, the publisher of the European Heart Journal and the party authorized to handle such permissions by the ESC. Novartis has obtained permission to reproduce this content to provide disease-related information to ex-US health care professionals.

 

Please visit:

www.escardio.org/

https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure#

http://eurheartj.oxfordjournals.org/content/37/27/2129

 

Disclaimer:

The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their dating.

The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of health care or therapeutic strategies. Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies. However, the ESC Guidelines do not override in any way whatsoever the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and the patient's caregiver where appropriate and/or necessary. Nor do the ESC Guidelines exempt health professionals from taking careful and full consideration of the relevant official updated recommendations or guidelines issued by the competent public health authorities in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

Novartis was not involved in the development of these figures and in no way influenced the content.

Economic Burden

The economic burden of heart failure goes beyond the cost of medicine

What is the cost of heart failure on the global economy?

 

 

Economic Burden of Heart Failure

 

 

Cost of Heart Failure

 

 

Economics of Heart Failure

 
Country name Direct cost of
HF ($ million)
Indirect cost of
HF ($ million)
Overall HF costs
($ million)
United States 20.900 9.800 30.700
Japan 7.844 3.576 11.420
Germany 5.340 2.040 7.380
France 4.314 1.568 5.882
United Kingdom 3.223 1.461 4.684
Canada 2.891 1.093 3.984
Italy 2.716 1.208 3.924
Russian Federation 1.774 1.209 2.983
Australia 1.951 912 2.863
Spain 1.810 810 2.619
Korea, Rep. 1.156 678 1.834
Netherlands 1.311 463 1.775
Switzerland 975 379 1.354

 

References: 1. Neumann T, Biermann J, Neumann A, et al. Heart failure: the commonest reason for hospital admission in Germany. Dtsch Arztebl Int. 2009;106(16):269-275. 2. Cook C, Cole G, Asaria P, Jabbour R, Francis DP. The annual global economic burden of heart failure. Int J Cardiol. 2014;171(3):368-376.

Heart Failure pathophysiology

Silent underlying neurohormonal imbalance results in continued disease progression

Neurohormonal imbalance contributes to the pathophysiology of chronic heart failure

 

In patients with heart failure, left ventricular remodeling leads to changes in cardiac volume and wall thickness. The abnormality in cardiac structure or function contributes to1:

  • Inadequate cardiac output
  • Poor organ perfusion
  • Activation of the renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system (SNS)

Activation of the RAAS gives rise to1,2:

  • Vasoconstriction
  • Increased sodium and water retention
  • Fibrosis
  • Hypertrophy
  • Increased blood pressure

Activation of the SNS leads to2:

  • Vasoconstriction
  • Increased heart rate and myocardial contractility
  • Sodium retention
  • Renin release

Natriuretic peptides help counter the effects of the RAAS and SNS in chronic heart failure but this balancing effect is diminished as heart failure progresses. Sustained overactivation of the RAAS and SNS with attenuation of the effects of the natriuretic peptide system leads to neurohormonal imbalance in heart failure.2-4

Even when heart failure symptoms are stabilised by current treatments and it may seem that patients are doing well, the neurohormonal imbalance underlying heart failure is still silently occurring, resulting in sustained progression of cardiac structure and function abnormalities.1

 

Heart Failure Progression

RAAS = Renin-angiotensin-aldosterone system
SNS = Sympathetic nervous system
NPs = Natriuretic peptides

Heart failure is a complex deteriorating condition driven by neurohormonal imbalance, leading to a spiral of worsening disease and punctuated by acute episodes that result in poor outcomes for patients.1

 

Progression of Heart Failure

From Gheorghiade M, et al. Am J Cardiol. 2005.

Natriuretic peptides may potentially be an important therapeutic target due to their ability to counterregulate the RAAS and SNS.2,3

 

Physiology of Heart Failure

BNP =  B-type natriuretic peptide
ANP =  Atrial natriuretic peptide
CNP =  C-type natriuretic peptide
CNS = Central nervous system
NT-proBNP = N-terminal-proBNP
TGF = Transforming growth factor

 

*Neprilysin is the major enzyme responsible for degrading the natriuretic peptides ANP, BNP, and CNP.4

 

References: 1. Fauci AS, Braunwald E, Kasper DL, et al, eds. Harrison's Principles of Internal Medicine. 17th ed. New York: McGraw-Hill; 2008. 2. Boerrigter G, Costello-Boerrigter L, Burnett JC Jr. Alterations in renal function in heart failure. In: Mann DL, ed. Heart Failure: A Companion to Braunwald's Heart Disease. 2nd ed. St Louis: Saunders; 2011. 3. McMurray J, Komajda M, Anker S, Gardner R. Heart failure: epidemiology, pathophysiology and diagnosis. In: Camm AJ, Lüscher TF, Serruys PW, eds. ESC Textbook of Cardiovascular Medicine, 2nd ed. New York: Oxford University Press; 2009. 4. Mann DL, Zipes DP, Libby P, Bonow RO, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia: Saunders; 2015. 5. Gheorghiade M, De Luca L, Fonarow GC, et al. Pathophysiologic targets in the early phase of acute heart failure syndromes. Am J Cardiol. 2005;96(6A):11G-17G. 6. Goetze JP, Friis-Hansen L, Rehfeld JF, Nilsson B, Svendsen JH. Atrial secretion of B-type natriuretic peptide. Eur Heart J. 2006;27(14):1648-1650.

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Heart Failure videos, interviews, slides and events. Be sure to check back often to see the latest tools.

Key international cardiology events
Meeting Place Date Attendees
ACC 2016
Annual Scientific Session of the American College of Cardiology
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United States 02-04 April 2016 20,000
CCNAP 2016
EuroHeartCare (Annual Congress of the Council on Cardiovascular Nursing and Allied Professions)
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Greece 15-16 April 2016 500
ACCP 2016
World Congress of the American College of Chest Physicians
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China 15-17 April 2016 2200
HRS 2016
Annual Scientific Sessions of the Heart Rhythm Society
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United States 04-07 May 2016 12,000 - 13,000
EuroPRevent 2016
Annual Congress of the European Association for Cardiovascular Prevention and Rehabilitation
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Turkey 5-7 May 2016 1,800
ASH 2016
Annual Scientific Meeting of the American Society of Hypertension
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United States 13-17 May 2016 4,000
EuroPCR 2016
Annual EuroPCR (official congress of the European Association of Percutaneous Cardiovascular Interventions)
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France 17-20 May 2016 12,500 - 13,000
HFA 2016
Annual Heart Failure Congress
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Italy 21-24 May 2016 4,700 - 4,800
OCC 2016
Annual Oriental Congress of Cardiology
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China 26-29 May 2016 6,000
EUROCVP 2016
Annual EuroCVP (annual meeting of the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy)
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Israel 29-30 May 2016 -
WCC 2016
Biennial World Congress of Cardiology
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Mexico 04-07 June 2016 6,000 - 7,000
Cardiostim 2016
Biennial World Congress in Cardiac Electrophysiology and Cardiac Techniques
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France 8-11 June 2016 5,700 - 5,800
WCHD 2016
Annual World Congress on Heart Disease
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United States 30 July - 01 August 2016 501 - 1,000
ESH 2016
Annual Scientific Meeting of the European Society of Hypertension
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France 10-13 June 2016 8,000
ESC 2016
Annual Congress of the European Society of Cardiology
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Italy 27-31 August 2016 30,000 - 33,000
HFSA 2016
Annual Scientific Meeting of the Heart Failure Society of America
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United States 17-20 September 2016 3,400 - 3,500
ISH 2016
Biennial Scientific Meeting of the International Society of Hypertension
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South Korea 24-29 September 2016 3,000 - 4,000
EACTS 2016
Annual Meeting of the European Association for Cardio-Thoracic Surgery
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Spain 1-5 October 2016 4,600 - 5,000
ACCA 2016
Annual Congress of the Acute Cardiovascular Care Association
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Portugal 15-17 October 2016 1,000 - 1,100
ACCP 2016
Annual International Scientific Assembly of the American College of Chest Physicians
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United States 22-26 October 2016 5,000
TCT 2016
Annual Transcatheter Cardiovascular Therapeutics Scientific Symposium
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United States 29 October - 02 November 2016 11,000 - 12,000
AHA 2016
Annual Scientific Sessions of the American Heart Association
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United States 12-16 November 2016 17,000 - 18,000
EACVI 2016
Annual Meeting of the European Association of Cardiovascular Imaging
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Germany 7-10 December 2016 3,300 - 3,500

References (from Homepage and Social media post): 1. Roger VL, Weston SA, Redfield MM, et al. Trends in heart failure incidence and survival in a community-based population. JAMA. 2004;292(3):344-350. 2. Krumholz HM, Merrill AR, Schone EM, et al. Patterns of hospital performance in acute myocardial infarction and heart failure 30-day mortality and readmission. Circ Cardiovasc Qual Outcomes. 2009;2(5):407-413. 3. Moser DK, Dracup K, Evangelista LS, et al. Comparison of prevalence of symptoms of depression, anxiety and hostility in elderly heart failure, myocardial infarction and coronary artery bypass graft patients. Heart Lung. 2010;39(5):378-385.

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