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2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure
[Lien / /eurheartj.oxfordjournals.org/ ]
Septembre 2016

Synthèse par dragi-webdo
Globalement peu de changement (cf infra) mais bien noter que pour l'insuffisance cardiaque à FE altérée (<40%) que l'association IEC + bêtabloquant est SYSTEMATIQUE.
Si la FEVG < 35% ET patient toujours symptomatique: ajout d'un antagoniste des minéraloorticoides (spironolactone en 1ère intention). Si le patient est toujours symptomatique, remplacer l'IEC par un inhibiteur de la neprilysine (qui est forcément associé à un ARAII). Et si le patient à un QRS>130 ou un FC >70 ou est toujours symptomatique: revoir le cardio (parce que ces recos pronnent l'ivabradine, alors que le bénéfice est... bien caché).
Dragi Webdo n°106: Reco insuffisance cardiaque (ESC) [Lien / medicalement-geek.blogspot.com]

Revoir
Les recommandations 2012 [Lire]
Ivabradine - Procoralan [Lire]
Etude COPERNICUS (Jama 2003)[Lire]
Etude COMET (Lancet 2003)[Lire]


En pratique 2016 ESC Guidelines

The principal changes from the 2012 guidelines relate to:

  • A new term for patients with HF and a left ventricular ejection fraction (LVEF) that ranges from 40 to 49% "HF with mid-range EF (HFmrEF)". We believe that identifying HFmrEF as a separate group will stimulate research into the underlying characteristics, pathophysiology and treatment of this population;
  • Clear recommendations on the diagnostic criteria for HF with reduced EF (HFrEF), HFmrEF and HF with preserved EF (HFpEF);
  • A new algorithm for the diagnosis of HF in the non-acute setting based on the evaluation of HF probability; recommendations aimed at prevention or delay of the development of overt HF or the prevention of death before the onset of symptoms;
  • Indications for the use of the new compound sacubitril/valsartan, the first in the class of angiotensin receptor neprilysin inhibitors (ARNIs);
  • Modified indications for cardiac resynchronization therapy (CRT);
  • The concept of an early initiation of appropriate therapy going along with relevant investigations in acute HF that follows the ‘time to therapy’ approach already well established in acute coronary syndrome (ACS);
  • A new algorithm for a combined diagnosis and treatment approach of acute HF based on the presence/absence of congestion/hypoperfusion.
BNP = B-type natriuretic peptide;
HF = heart failure;
HFmrEF = heart failure with mid-range ejection fraction;
HFpEF = heart failure with preserved ejection fraction;
HFrEF = heart failure with reduced ejection fraction;
LAE = left atrial enlargement;
LVEF = left ventricular ejection fraction;
LVH = left ventricular hypertrophy;
NT-proBNP = N-terminal pro-B type natriuretic peptide.

NB : Signs may not be present in the early stages of HF (especially in HFpEF) and in patients treated with diuretics. NB ; BNP>35 pg/ml and/or NT-proBNP>125 pg/mL.
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