2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

Abstract

1. Preamble 3629 2. Introduction 3631 3. Chronic heart failure 3631 4. Acute heart failure 3634 4.1. Medical therapy 3634 4.1.1. Diuretics 3634 4.1.2. Sodium–glucose co-transporter 2 inhibitors 3634 4.2. Management strategies 3634 4.2.1. Admission phase 3634 4.2.2. Pre-discharge and early post-discharge phases 3634 5. Comorbidities 3635 5.1. Chronic kidney disease and type 2 diabetes mellitus 3635 5.1.1. Sodium–glucose co-transporter 2 inhibitors 3635 5.1.2. Finerenone 3636 5.2. Iron deficiency 3636 6. Data availability statement 3637 7. Author information 3637 8. Appendix 3638 9. References 3638 Recommendation Table 1 — Recommendation for the treatment of patients with symptomatic heart failure with mildly reduced ejection fraction 3633 Recommendation Table 2 — Recommendation for the treatment of patients with symptomatic heart failure with preserved ejection fraction 3633 Recommendation Table 3 — Recommendation for pre-discharge and early post-discharge follow-up of patients hospitalized for acute heart failure 3635 Recommendation Table 4 — Recommendations for the prevention of heart failure in patients with type 2 diabetes mellitus and chronic kidney disease 3636 Recommendation Table 5 — Recommendations for the management of iron deficiency in patients with heart failure 3637 Table 1 Classes of recommendations 3630 Table 2 Levels of evidence 3630 Table 3 Definition of heart failure with reduced ejection fraction, mildly reduced ejection fraction, and preserved ejection fraction 3632 Figure 1 Management of patients with heart failure with mildly reduced ejection fraction 3633 Figure 2 Management of patients with heart failure with preserved ejection fraction 3633 Angiotensin-converting enzyme inhibitor Acetazolamide in Decompensated Heart Failure with Volume Overload (trial) A Randomized Double-blind Placebo Controlled Trial Comparing the Effects of Intravenous Ferric Carboxymaltose on Hospitalizations and Mortality in Iron Deficient Subjects Admitted for Acute Heart Failure (trial) Angiotensin receptor blocker Angiotensin receptor–neprilysin inhibitor Adjusted risk ratio Confidence interval Chronic kidney disease Combination of Loop Diuretics with Hydrochlorothiazide in Acute Heart Failure (trial) Comparison of Outcomes and Access to Care for Heart Failure (trial) Class of recommendation Clinical Practice Guidelines Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation (trial) Cardiovascular Dapagliflozin And Prevention of Adverse outcomes in Chronic Kidney Disease (trial) Dapagliflozin And Prevention of Adverse outcomes in Heart Failure (trial) Dapagliflozin Evaluation to Improve the LIVEs of Patients with PReserved Ejection Fraction Heart Failure (trial) Estimated glomerular filtration rate EMPAgliflozin once daily to assess cardio-renal outcomes in patients with chronic KIDNEY disease (trial) Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Preserved Ejection (trial) Empagliflozin in Patients Hospitalized with Acute Heart Failure Who Have Been Stabilized (trial) European Society of Cardiology Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease (trial) Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease (trial) Heart failure Heart failure with mildly reduced ejection fraction Heart failure with normal ejection fraction Heart failure with preserved ejection fraction Heart failure with reduced ejection fraction Hazard ratio Effectiveness of Intravenous Iron Treatment versus Standard Care in Patients with Heart Failure and Iron Deficiency (trial) Intravenous Kidney Disease: Improving Global Outcomes Level of evidence Left ventricular ejection fraction Mineralocorticoid receptor antagonist N-terminal pro-B-type natriuretic peptide New York Heart Association Odds ratio Proactive IV Iron Therapy in Haemodialysis Patients (trial) Revascularization for Ischemic Ventricular Dysfunction (trial) Risk ratio Effect of Sotagliflozin on Cardiovascular and Renal Events in Patients with Type 2 Diabetes and Moderate Renal Impairment Who Are at Cardiovascular Risk (trial) Sodium–glucose co-transporter 2 Safety, Tolerability and Efficacy of Rapid Optimization, Helped by NT-proBNP Testing, of Heart Failure Therapies (trial) Type 2 diabetes mellitus Torsemide Comparison with Furosemide for Management of Heart Failure (trial) Clinical Trial to Evaluate Cardiovascular Outcomes in Patients Treated With the Tricuspid Valve Repair System Pivotal (trial) Guidelines evaluate and summarize available evidence with the aim of assisting health professionals in proposing the best diagnostic or therapeutic approach for an individual patient with a given condition. Guidelines are intended for use by health professionals and the European Society of Cardiology (ESC) makes its Guidelines freely available. ESC Guidelines do not override the individual responsibility of health professionals to make appropriate