In the last few days, the European Society of Cardiology has released its latest guidelines on the management of acute and chronic heart failure. An update of the ESC's last guidelines (which were published in 2012), the new 2016 document contains several changes which will be covered in forthcoming blogs.
One of the most fundamental changes is in the terminology of heart failure. The ESC now recognises three categories of heart failure based upon left ventricular ejection fraction:
|New ESC categories in heart failure|
The categories of HFpEF and HFrEF have been recognised for several years, but the category of HFmrEF is new. Why has this group of patients been highlighted as a separate group?
Well, the ESC argues that those with a mid-range LVEF (40-49%) are a 'grey area', where the benefits of heart failure therapies on morbidity and mortality have not been so conclusively proven as in the HFrEF (LVEF <40%) group.
The ESC argues that identifying patients with HFmrEF as a new group will help to stimulate research into the characteristics and management of this 'intermediate' category of left ventricular systolic dysfunction.
In its discussion on terminology, the ESC also advises against using the terms 'preserved systolic function' or 'reduced systolic function' This is because patients with HFpEF often have subtle abnormalities of systolic function, and most of those with HFrEF have evidence of diastolic dysfunction. Thus the terms HFpEF, HFrEF (and, of course, the new term HFmrEF) are now preferred by the ESC.
To obtain a copy of the full ESC 2016 guidelines, click the following link:
2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure.