By Joe Cuthbert
The recommendations for clinicians from ESC HF Guidelines 2021 most likely to impact management of the heart failure patient:
- Aim to start all patients with heart failure and a reduced ejection fraction (HeFREF) on “quadruple therapy” – with one of either an angiotensin converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), or sacubitril valsartan) plus mineralocorticoid receptor antagonist (MRA) plus β-blocker plus sodium glucose co-transporter 2 inhibitors (SGLT2I).
- Treatment with ACEI, ARB, β-blocker, MRA or sacubitril valsartan now has a class IIb indication – “may be considered” – for patients with a left ventricular ejection fraction of 40-49%.
- Primary prevention implantable cardioverter defibrillator for patients with non-ischaemic cardiomyopathy, and cardiac resynchronisation therapy for patients with left bundle branch block and QRS duration 130-149ms have been downgraded from a class I indication “recommended” to a class IIa indication “should be considered”.
- Patients admitted to hospital with HeFREF should have oral treatment “optimised” pre-discharge.
- Patient education and self-management advice has been given a class I indication so as to help patients manage their condition, and stay well.
