ESC 2021 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure
European Society of Cardiology｜循環器 / 心不全・心筋疾患｜128 ページ｜チャンク 1273｜推奨 140 件｜superseded
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| 頁 | クラス | レベル | 推奨文 | 表 |
|---|---|---|---|---|
| p.19 | I | B | BNP/NT-proBNPc | |
| p.19 | I | C | Transthoracic echocardiography | |
| p.19 | I | C | Chest radiography (X-ray) | |
| p.19 | I | C | Routine blood tests for comorbidities, including full blood count, urea and electrolytes, thyroid function, fasting glucose and HbA1c, lipids, iron status (TSAT and ferritin) | |
| p.20 | I | C | CMR CMR is recommended for the assessment of myocardial structure and function in those with poor echocardiogram acoustic windows. | |
| p.20 | I | C | CMR is recommended for the characterization of myocardial tissue in suspected infiltrative dis- ease, Fabry disease, inflammatory disease (myocarditis), LV non-compaction, amyloid, sarcoidosis, iron overload/haemochromatosis. | |
| p.20 | IIa | C | CMR with LGE should be considered in DCM to distinguish between ischaemic and non-ischaemic myocardial damage. | |
| p.20 | I | B | eligible for potential coronary revascularization) Invasive coronary angiography is recommended in patients with angina despite pharmacological ther- apy or symptomatic ventricular arrhythmias.5 | |
| p.20 | IIb | B | Invasive coronary angiography may be considered in patients with HFrEF with an intermediate to high pre-test probability of CAD and the presence of ischaemia in non-invasive stress tests.89 ESC 2021 | |
| p.20 | IIa | C | ............................................................................................................................................................................ Non-invasive testing CTCA should be considered in patients with a low to intermediate pre-test probability of CAD or those with equivocal non-invasive stress tests in order to rule out coronary artery stenosis. | |
| p.20 | IIb | B | Non-invasive stress imaging (CMR, stress echocar- diography, SPECT, PET) may be considered for the assessment of myocardial ischaemia and viability in patients with CAD who are considered suitable for coronary revascularization.9093 | |
| p.20 | IIb | C | Exercise testing may be considered to detect reversible myocardial ischaemia and investigate the cause of dyspnoea.9496 | |
| p.20 | I | C | Cardiopulmonary exercise testing Cardiopulmonary exercise testing is recommended as a part of the evaluation for heart transplantation and/or MCS.9496 | |
| p.20 | IIa | C | Cardiopulmonary exercise testing should be considered to optimize prescription of exercise training.9496 | |
| p.20 | IIa | C | Cardiopulmonary exercise testing should be considered to identify the cause of unexplained dyspnoea and/or exercise intolerance.9496 | |
| p.20 | I | C | Right heart catheterization Right heart catheterization is recommended in patients with severe HF being evaluated for heart transplantation or MCS. | |
| p.21 | IIa | C | Right heart catheterization should be considered in patients where HF is thought to be due to constrictive pericarditis, restrictive cardiomyopathy, congenital heart disease, and high output states. | |
| p.21 | IIb | C | Right heart catheterization should be considered in patients with probable pulmonary hyperten- sion, assessed by echo in order to confirm the diagnosis and assess its reversibility before the correction of valve/structural heart disease. | |
| p.21 | IIb | C | Right heart catheterization may be considered in selected patients with HFpEF to confirm the diagnosis. EMB | |
| p.21 | IIa | C | EMB should be considered in patients with rap- idly progressive HF despite standard therapy when there is a probability of a specific diagnosis, which can be confirmed only in myocardial samples.97,98 | |
| p.22 | I | A | hospitalization and death.110113 | |
| p.22 | I | A | HF hospitalization and death.114120 | |
| p.22 | I | A | An MRA is recommended for patients with HFrEF to reduce the risk of HF hospitalization and death.121,122 | |
| p.22 | I | A | Dapagliflozin or empagliflozin are recommended for patients with HFrEF to reduce the risk of HF hospitalization and death.108,109 | |
| p.22 | I | B | hospitalization and death.105 | |
| p.24 | I | C | Loop diuretics Diuretics are recommended in patients with HFrEF with signs and/or symptoms of congestion to alleviate HF symptoms, improve exercise capacity, and reduce HF hospitalizations.137 ARB | |
| p.24 | I | B | An ARBc is recommended to reduce the risk of HF hospitalization and CV death in symptomatic patients unable to tolerate an ACE-I or ARNI (patients should also receive a beta-blocker and an MRA).138 If-channel inhibitor | |
| p.24 | IIa | B | Ivabradine should be considered in symptomatic patients with LVEF <_35%, in SR and a resting heart rate >_70 b.p.m. despite treatment with an evidence-based dose of beta-blocker (or maxi- mum tolerated dose below that), ACE-I/(or ARNI), and an MRA, to reduce the risk of HF hospitalization and CV death.139 | |
| p.24 | IIa | C | Ivabradine should be considered in symptomatic patients with LVEF <_35%, in SR and a resting heart rate >_70 b.p.m. who are unable to tolerate or have contraindications for a beta-blocker to reduce the risk of HF hospitalization and CV death. Patients should also receive an ACE-I (or ARNI) and an MRA.140 | |
| p.24 | IIb | B | Soluble guanylate cyclase stimulator Vericiguat may be considered in patients in NYHA class IIIV who have had worsening HF despite treatment with an ACE-I (or ARNI), a beta-blocker and an MRA to reduce the risk of CV mortality or HF hospitalization.141 Hydralazine and isosorbide dinitrate | |
| p.24 | IIa | B | Hydralazine and isosorbide dinitrate should be considered in self-identified black patients with LVEF <_35% or with an LVEF <45% combined with a dilated left ventricle in NYHA class IIIIV despite treatment with an ACE-I (or ARNI), a beta-blocker and an MRA to reduce the risk of HF hospitalization and death.142 | |
| p.25 | IIb | B | Hydralazine and isosorbide dinitrate may be con- sidered in patients with symptomatic HFrEF who cannot tolerate any of an ACE-I, an ARB, or ARNI (or they are contraindicated) to reduce the risk of death.143 Digoxin | |
| p.25 | IIb | B | Digoxin may be considered in patients with symptomatic HFrEF in sinus rhythm despite treatment with an ACE-I (or ARNI), a beta- blocker and an MRA, to reduce the risk of hospitalization (both all-cause and HF hospitalizations).144 | |
| p.27 | I | A | Secondary prevention An ICD is recommended to reduce the risk of sudden death and all-cause mortality in patients who have recovered from a ventricular arrhyth- mia causing haemodynamic instability, and who are expected to survive for >1 year with good functional status, in the absence of reversible causes or unless the ventricular arrhythmia has occurred <48 h after a MI.162164 | |
| p.27 | I | A | Primary prevention An ICD is recommended to reduce the risk of sudden death and all-cause mortality in patients with symptomatic HF (NYHA class IIIII) of an ischaemic aetiology (unless they have had a MI in the prior 40 days—see below), and an LVEF <_35% despite >_3 months of OMT, provided they are expected to survive substantially longer than 1 year with good functional status.161,165 | |
| p.27 | IIa | A | ............................................................................................................................................................................ An ICD should be considered to reduce the risk of sudden death and all-cause mortality in patients with symptomatic HF (NYHA class IIIII) of a non-ischaemic aetiology, and an LVEF <_35% despite >_3 months of OMT, provided they are expected to survive substantially longer than 1 year with good functional status.161,166,167 | |
| p.27 | IIa | B | Patients should be carefully evaluated by an experienced cardiologist before generator replacement, because management goals, the patient’s needs and clinical status may have changed.168172 | |
| p.27 | IIb | B | A wearable ICD may be considered for patients with HF who are at risk of sudden cardiac death for a limited period or as a bridge to an implanted device.173176 | |
| p.27 | III | A | ICD implantation is not recommended within 40 days of a MI as implantation at this time does not improve prognosis.177,178 | |
| p.27 | III | C | ICD therapy is not recommended in patients in NYHA class IV with severe symptoms refractory to pharmacological therapy unless they are can- didates for CRT, a VAD, or cardiac transplantation.179183 | |
| p.29 | I | A | CRT is recommended for symptomatic patients with HF in SR with a QRS duration >_150 ms and LBBB QRS morphology and with LVEF <_35% despite OMT in order to improve symptoms and reduce morbidity and mortality.205215 | |
| p.29 | I | A | CRT rather than RV pacing is recommended for patients with HFrEF regardless of NYHA class or QRS width who have an indication for ventricu- lar pacing for high degree AV block in order to reduce morbidity. This includes patients with AF.216219 | |
| p.29 | IIa | B | CRT should be considered for symptomatic patients with HF in SR with a QRS duration >_150 ms and non-LBBB QRS morphology and with LVEF <_35% despite OMT in order to improve symptoms and reduce morbidity and mortality.205215 | |
| p.29 | IIa | B | Patients with an LVEF <_35% who have received a conventional pacemaker or an ICD and subse- quently develop worsening HF despite OMT and who have a significant proportion of RV pacing should be considered for ‘upgrade’ to CRT.221 | |
| p.29 | IIb | B | CRT may be considered for symptomatic patients with HF in SR with a QRS duration of 130149 ms and non-LBBB QRS morphology and with LVEF <_35% despite OMT in order to improve symptoms and reduce morbidity and mortality.208,213 | |
| p.29 | III | A | CRT is not recommended in patients with a QRS duration <130 ms who do not have an indi- cation for pacing due to high degree AV block.222224 | |
| p.31 | I | C | Diuretics are recommended in patients with congestion and HFmrEF in order to alleviate symptoms and signs.137 | |
| p.31 | IIb | C | An ACE-I may be considered for patients with HFmrEF to reduce the risk of HF hospitalization and death.11 | |
| p.31 | IIb | C | An ARB may be considered for patients with HFmrEF to reduce the risk of HF hospitalization and death.245 | |
| p.31 | IIb | C | A beta-blocker may be considered for patients with HFmrEF to reduce the risk of HF hospital- ization and death.12,119 | |
| p.31 | IIb | C | An MRA may be considered for patients with HFmrEF to reduce the risk of HF hospitalization and death.246 | |
| p.31 | IIb | C | Sacubitril/valsartan may be considered for patients with HFmrEF to reduce the risk of HF hospitalization and death.13,247 | |
| p.34 | I | C | Screening for, and treatment of, aetiologies, and cardiovascular and non-cardiovascular comor- bidities is recommended in patients with HFpEF (see relevant sections of this document). | |
| p.34 | I | C | Diuretics are recommended in congested patients with HFpEF in order to alleviate symp- toms and signs.137 HFpEF = heart failure with preserved ejection fraction. aClass of recommendation. bLevel of evidence. | |
| p.34 | I | A | Treatment of hypertension is recommended to prevent or delay the onset of HF, and to prevent HF hospitalizations.287290 | |
| p.34 | I | A | Treatment with statins is recommended in patients at high risk of CV disease or with CV disease in order to prevent or delay the onset of HF, and to prevent HF hospitalizations.291,292 | |
| p.34 | I | A | SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin, ertugliflozin, sotagliflozin) are recommended in patients with diabetes at high risk of CV disease or with CV disease in order to prevent HF hospitalizations.293297 | |
| p.34 | I | C | Counselling against sedentary habit, obesity, ciga- rette smoking, and alcohol abuse is recom- ESC 2021 mended to prevent or delay the onset of HF.298302 | |
| p.35 | I | A | It is recommended that HF patients are enrolled in a multidisciplinary HF management programme to reduce the risk of HF hospitalization and mortality.309,314,315,316 | |
| p.35 | I | A | Self-management strategies are recommended to reduce the risk of HF hospitalization and mortality.309 | |
| p.35 | I | A | Either home-based and/or clinic-based pro- grammes improve outcomes and are recommended to reduce the risk of HF hospitalization and mortality.310,317 | |
| p.35 | IIa | B | ...................................................................................................................... Influenza and pneumococcal vaccinations should be considered in order to prevent HF hospitalizations.315,316 HF = heart failure. aClass of recommendation. bLevel of evidence. | |
| p.38 | I | A | Exercise is recommended for all patients who are able in order to improve exercise capacity, QOL, and reduce HF hospitalization.c 324328,335337 | |
| p.38 | IIa | C | A supervised, exercise-based, cardiac rehabilita- tion programme should be considered in patients with more severe disease, frailty, or with comorbidities.95,324327,338 HF = heart failure; QOL = quality of life. aClass of recommendation. bLevel of evidence. cIn those who are able to adhere to the exercise programme. | |
| p.39 | IIb | B | Recommendations for telemonitoring Non-invasive HTM may be considered for patients with HF in order to reduce the risk of recurrent CV and HF hospitalizations and CV death.374 | |
| p.39 | IIb | B | Monitoring of pulmonary artery pressure using a wireless haemodynamic monitoring system may be considered in symptomatic patients with HF in order to improve clinical outcomes.372 10 Advanced heart failure | |
| p.45 | I | C | Patients being considered for long-term MCS must have good compliance, appropriate capacity for device handling and psychosocial support.414416 | |
| p.45 | I | C | Heart transplantation is recommended for patients with advanced HF, refractory to medical/device therapy and who do not have absolute contraindications. | |
| p.45 | IIa | A | ........................................................................................................................ Long-term MCS should be considered in patients with advanced HFrEF despite optimal medical and device therapy, not eligible for heart transplantation or other surgical options, and without severe right ventricular dysfunction, to reduce the risk of death and improve symptoms.378,396,397,401,402,404,417 | |
| p.45 | IIa | B | Long-term MCS should be considered in patients with advanced HFrEF refractory to optimal medical and device therapy as a bridge to cardiac transplantation in order to improve symptoms, reduce the risk of HF hospitalization and the risk of premature death.398400,402,404 | |
| p.45 | IIa | C | Renal replacement therapy should be considered in patients with refractory volume overload and end-stage kidney failure. | |
| p.45 | IIb | C | Continuous inotropes and/or vasopressors may be considered in patients with low cardiac out- put and evidence of organ hypoperfusion as bridge to MCS or heart transplantation.389,390 | |
| p.45 | IIb | C | ESC 2021 Ultrafiltration may be considered in refractory volume overload unresponsive to diuretic treatment.391,392 | |
| p.57 | I | C | Oxygen and ventilatory support Oxygen is recommended in patients with SpO2 <90% or PaO2 <60 mmHg to correct hypoxaemia. | |
| p.57 | I | C | Intubation is recommended for progressive res- piratory failure persisting in spite of oxygen administration or non-invasive ventilation.448 Non-invasive positive pressure ventilation | |
| p.57 | IIa | B | should be considered in patients with respiratory distress (respiratory rate >25 breaths/min, SpO2 <90%) and started as soon as possible in order to decrease respiratory distress and reduce the rate of mechanical endotracheal intubation.448 | |
| p.57 | I | C | Diuretics Intravenous loop diuretics are recommended for all patients with AHF admitted with signs/symptoms of fluid overload to improve symptoms.145 | |
| p.57 | IIa | B | Combination of a loop diuretic with thiazide- type diuretic should be considered in patients with resistant oedema who do not respond to an increase in loop diuretic doses.145 | |
| p.57 | IIb | B | Vasodilators In patients with AHF and SBP >110 mmHg, i.v. vasodilators may be considered as initial therapy to improve symptoms and reduce congestion.475477,479,480 | |
| p.58 | III | B | cardiogenic shock.500502 | |
| p.58 | IIb | C | Inotropic agents Inotropic agents may be considered in patients with SBP <90 mmHg and evidence of hypoperfu- sion who do not respond to standard treatment, including fluid challenge, to improve peripheral perfusion and maintain end-organ function.387 | |
| p.58 | III | C | Inotropic agents are not recommended routinely, due to safety concerns, unless the patient has symptomatic hypotension and evidence of hypoperfusion.387,467,478 | |
| p.58 | IIb | B | Vasopressors A vasopressor, preferably norepinephrine, may be considered in patients with cardiogenic shock to increase blood pressure and vital organ perfusion.485487 Other drugs | |
| p.58 | I | A | Thromboembolism prophylaxis (e.g. with LMWH) is recommended in patients not already anticoagulated and with no contraindication to anticoagulation, to reduce the risk of deep venous thrombosis and pulmonary embolism.494,495 | |
| p.58 | III | C | Routine use of opiates is not recommended, unless in selected patients with severe/intractable pain or anxiety.488,489 | |
| p.58 | IIa | C | Short-term MCS should be considered in patients with cardiogenic shock as a BTR, BTD, BTB. Further indications include treatment of the cause of cardiogenic shock or long-term MCS or transplantation. | |
| p.58 | IIb | C | ............................................................... IABP may be considered in patients with cardio- genic shock as a BTR, BTD, BTB, including treat- ment of the cause of cardiogenic shock (i.e. mechanical complication of acute MI) or long- term MCS or transplantation.450 IABP is not routinely recommended in post-MI | |
| p.59 | I | C | It is recommended that patients hospitalized for HF be carefully evaluated to exclude persistent signs of congestion before discharge and to optimize oral treatment.427,472 | |
| p.59 | I | C | It is recommended that evidence-based oral medical treatment be administered before discharge.103,513 | |
| p.59 | I | C | ............................................................................... An early follow-up visit is recommended at 12 weeks after discharge to assess signs of conges- tion, drug tolerance and start and/or uptitrate evidence-based therapy.517,518 | |
| p.59 | IIa | B | Ferric carboxymaltose should be considered for iron deficiency, defined as serum ferritin <100 ng/mL or serum ferritin 100299 ng/mL with TSAT <20%, to improve symptoms and reduce rehospitalizations.512 HR = heart failure; TSAT = transferrin saturation. aClass of recommendation. bLevel of evidence. | |
| p.62 | I | A | Anticoagulation Long-term treatment with an oral anticoagulant is recommended in all patients with AF, HF, and CHA2DS2-VASc score >_2 in men or >_3 in women.7 | |
| p.62 | I | A | DOACs are recommended in preference to VKAs in patients with HF, except in those with moderate or severe mitral stenosis or mechani- cal prosthetic heart valves.528,558 | |
| p.62 | IIa | B | Long-term treatment with an oral anticoagulant should be considered for stroke prevention in AF patients with a CHA2DS2-VASc score of 1 in men or 2 in women.7,559 | |
| p.62 | IIa | B | Rate control Beta-blockers should be considered for short- and long-term rate control in patients with HF and AF.535 | |
| p.62 | IIa | C | Digoxin should be considered when the ventric- ular rate remains high, despite beta-blockers, or when beta-blockers are contraindicated or not tolerated.536 | |
| p.62 | I | C | Cardioversion Urgent ECV is recommended in the setting of acute worsening of HF in patients presenting with rapid ventricular rates and haemodynamic instability. | |
| p.62 | IIb | B | Cardioversion may be considered in patients in whom there is an association between AF and worsening of HF symptoms despite optimal medical treatment.7,541 AF catheter ablation | |
| p.62 | IIa | B | In cases of a clear association between paroxys- mal or persistent AF and worsening of HF symp- toms, which persist despite MT, catheter ablation should be considered for the prevention or treatment of AF.552554,557 | |
| p.64 | IIa | B | CABG should be considered as the first-choice revascularization strategy, in patients suitable for surgery, especially if they have diabetes and for those with multivessel disease.581,587,588,590 | |
| p.64 | IIa | C | Coronary revascularization should be considered to relieve persistent symptoms of angina (or an angina-equivalent) in patients with HFrEF, CCS, and coronary anatomy suitable for revasculariza- | |
| p.64 | IIa | C | tion, despite OMT including anti-anginal drugs. In LVAD candidates needing coronary revascularization, CABG should be avoided, if possible. Coronary revascularization may be considered to improve outcomes in patients with HFrEF, | |
| p.64 | IIb | C | ..................................................................................................................... CCS, and coronary anatomy suitable for revascularization, after careful evaluation of the indi- vidual risk to benefit ratio, including coronary anatomy (i.e. proximal stenosis >90% of large vessels, stenosis of left main or proximal LAD), comorbidities, life expectancy, and patient’s | |
| p.64 | IIb | C | perspectives. PCI may be considered as an alternative to CABG, based on Heart Team evaluation, consid- ering coronary anatomy, comorbidities, and surgical risk. | |
| p.67 | I | B | Aortic stenosis Aortic valve intervention, TAVI or SAVR, is recommended in patients with HF and severe high- gradient aortic stenosis to reduce mortality and improve symptoms.594 | |
| p.67 | I | C | It is recommended that the choice between TAVI and SAVR be made by the Heart Team, according to individual patient preference and features including age, surgical risk, clinical, anatomical and procedural aspects, weighing the risks and benefits of each approach.592 Secondary mitral regurgitation | |
| p.67 | IIa | B | ....................................................................................................................................... Percutaneous edge-to-edge mitral valve repair should be considered in carefully selected patients with secondary mitral regurgitation, not eligible for surgery and not needing coronary revascularization, who are symptomaticc despite OMT and who fulfil criteriad for achieving a | |
| p.67 | IIa | C | reduction in HF hospitalizations.612 In patients with HF, severe secondary mitral regurgitation and CAD who need revasculariza- tion, CABG and mitral valve surgery should be considered. Percutaneous edge-to-edge mitral valve repair | |
| p.67 | IIb | C | may be considered to improve symptoms in carefully selected patients with secondary mitral regurgitation, not eligible for surgery and not needing coronary revascularization, highly symp- tomatic despite OMT and who do not fulfil criteria for reducing HF hospitalization.617 | |
| p.69 | I | A | SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin, ertugliflozin, sotagliflozin) are rec- ommended in patients with T2DM at risk of CV events to reduce hospitalizations for HF, major CV events, end-stage renal dysfunction, and CV death.293297 | |
| p.69 | I | A | ............................................................................. SGLT2 inhibitors (dapagliflozin, empagliflozin, and sotagliflozin) are recommended in patients with T2DM and HFrEF to reduce hospitalizations for HF and CV death.108,109,136 | |
| p.71 | I | C | It is recommended that all patients with HF be periodically screened for anaemia and iron defi- ciency with a full blood count, serum ferritin concentration, and TSAT. | |
| p.71 | IIa | A | Intravenous iron supplementation with ferric carboxymaltose should be considered in symp- tomatic patients with LVEF <45% and iron defi- ciency, defined as serum ferritin <100 ng/mL or serum ferritin 100299 ng/mL with TSAT <20%, to alleviate HF symptoms, improve exer- cise capacity and QOL.720,722,724 | |
| p.71 | IIa | B | Intravenous iron supplementation with ferric carboxymaltose should be considered in symp- tomatic HF patients recently hospitalized for HF and with LVEF <50% and iron deficiency, defined as serum ferritin <100 ng/mL or serum ferritin 100299 ng/mL with TSAT <20%, to reduce the risk of HF hospitalization.512 | |
| p.77 | I | C | It is recommended that cancer patients at increased risk for cardiotoxicity, defined by a history or risk factors of CV disease, previous cardiotoxicity or exposure to cardiotoxic agents, undergo CV evaluation before scheduled anticancer therapy, preferably by a cardi- ologist with experience/interest in Cardio- Oncology. | |
| p.77 | IIa | B | Treatment with an ACE-I and a beta-blocker (preferably carvedilol) should be considered in cancer patients developing LV systolic dysfunction, defined as a 10% or more decrease in LVEF and to a value lower than 50%, during anthracycline chemotherapy.861,862 | |
| p.77 | IIa | C | A baseline CV risk assessment should be considered in all cancer patients scheduled to receive a cancer treatment with the potential to cause heart failure.846,865 | |
| p.88 | I | B | Tafamidis is recommended in patients with genetic testing proven hTTR-CA and NYHA class I or II symptoms to reduce symptoms, CV hospitalization and mortality.979 | |
| p.88 | I | B | .......................................................... Tafamidis is recommended in patients with wtTTR-CA and NYHA class I or II symptoms to reduce symptoms, CV hospitalization and mortality.979 X X X X X X X X | |
| p.92 | I | B | BNP/NT-proBNP.c | |
| p.92 | I | C | 12-lead ECG. | |
| p.92 | I | C | Transthoracic echocardiography. | |
| p.92 | I | C | Chest radiography (X-ray). | |
| p.92 | I | C | Cardiopulmonary exercise testing is recommended as a part of the evaluation for heart transplantation and/or MCS. | |
| p.92 | I | C | Right heart catheterization is recommended in patients with severe HF being evaluated for heart transplantation or MCS. | |
| p.92 | I | A | ACE-I is recommended for patients with HFrEF to reduce the risk of HF hospitalization and death. | |
| p.92 | I | A | Beta-blocker is recommended for patients with stable HFrEF to reduce the risk of HF hospitalization and death. | |
| p.92 | I | A | MRA is recommended for patients with HFrEF to reduce the risk of HF hospitalization and death. | |
| p.92 | I | A | Dapagliflozin or empagliflozin are recommended for patients with HFrEF to reduce the risk of HF hospitalization and death. | |
| p.92 | III | A | ICD implantation is not recommended within 40 days of an MI as implantation at this time does not improve prognosis. | |
| p.92 | I | C | Diuretics are recommended in patients with congestion and HFmrEF in order to alleviate symptoms and signs. | |
| p.93 | I | C | Diuretics are recommended in congested patients with HFpEF in order to alleviate symptoms and signs. | |
| p.93 | I | A | Treatment of hypertension is recommended to prevent or delay the onset of HF, and to prevent HF hospitalizations. | |
| p.93 | I | A | Self-management strategies are recommended to reduce the risk of HF hospitalization and mortality. | |
| p.93 | I | A | Exercise is recommended for all patients who are able in order to improve exercise capacity and QOL, and reduce HF hospitalization.d | |
| p.93 | I | C | Oxygen is recommended in patients with SpO2 <90% or PaO2 <60 mmHg to correct hypoxaemia. | |
| p.93 | III | C | Routine use of opiates is not recommended, unless in selected patients with severe/intractable pain or anxiety. | |
| p.93 | III | B | IABP is not routinely recommended in post-MI cardiogenic shock. | |
| p.93 | I | C | It is recommended that evidence-based oral medical treatment be administered before discharge. | |
| p.94 | III | B | The DPP-4 inhibitor saxagliptin is not recommended in patients with HF. |