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............................................................................................................................................................................. P-gp P-glycoprotein PH Pulmonary hypertension PIOPED Prospective Investigation On Pulmonary Embolism Diagnosis PISAPED Prospective Investigative Study of Acute Pulmonary Embolism Diagnosis PREPIC Prevention of Recurrent Pulmonary Embolism by Vena Cava Interruption PVR Pulmonary vascular resistance RA Right atrium/atrial RCT Randomized controlled trial RIETE Registro Informatizado de la Enfermedad Thromboembolica venosa RR Relative risk rtPA Recombinant tissue-type plasminogen activator RV Right ventricle/ventricular SaO2 Arterial oxygen saturation SPECT Single-photon emission computed tomography sPESI Simplified Pulmonary Embolism Severity Index SURVET Sulodexide in Secondary Prevention of Recurrent Deep Vein Thrombosis study TAPSE Tricuspid annular plane systolic excursion TOE Transoesophageal echocardiography/ echocardiogram TTE Transthoracic echocardiography/echocardiogram TV Tricuspid valve U Unit UFH Unfractionated heparin VKA(s) Vitamin K antagonist(s) V/Q Ventilation/perfusion (lung scintigraphy) VTE Venous thromboembolism VTE-BLEED ActiVe cancer, male with uncontrolled hyperTension at baseline, anaEmia, history of BLeeding, agE >_60 years, rEnal Dysfunction WARFASA Warfarin and Aspirin study

1 Preamble

Guidelines summarize and evaluate available evidence with the aim of assisting health professionals in proposing the best management strategies for an individual patient with a given condition. Guidelines and their recommendations should facilitate decision making of health professionals in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate. A great number of guidelines have been issued in recent years by the European Society of Cardiology (ESC), as well as by other societies and organisations. Because of their impact on clinical practice, quality criteria for the development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines can be found on the ESC website (http://www.escardio.org/Guidelines-&- Education/Clinical-Practice-Guidelines/Guidelines-development/Wri ting-ESC-Guidelines). The ESC Guidelines represent the official position of the ESC on a given topic and are regularly updated. The ESC carries out a number of registries which are essential to assess, diagnostic/therapeutic processes, use of resources and adherence to Guidelines. These registries aim at providing a better understanding of medical practice in Europe and around the world, based on data collected during routine clinical practice.

The guidelines are developed together with derivative educational material addressing the cultural and professional needs for cardiologists and allied professionals. Collecting high-quality observational data, at appropriate time interval following the release of ESC Guidelines, will help evaluate the level of implementation of the Guidelines, checking in priority the key end points defined with the ESC Guidelines and Education Committees and Task Force members in charge. The Members of this Task Force were selected by the ESC, including representation from its relevant ESC sub-specialty groups, in order to represent professionals involved with the medical care of patients with this pathology. Selected experts in the field undertook a comprehensive review of the published evidence for management of a given condition according to ESC Committee for Practice Guidelines (CPG) policy. A critical evaluation of diagnostic and therapeutic procedures was performed, including assessment of the riskbenefit ratio. The level of evidence and the strength of the recommendation of particular management options were weighed and graded according to predefined scales, as outlined in Tables 1 and 2. The experts of the writing and reviewing panels provided declaration of interest forms for all relationships that might be perceived as real or potential sources of conflicts of interest. These forms were compiled into one file and can be found on the ESC website (http:// www.escardio.org/guidelines). Any changes in declarations of interest that arise during the writing period were notified to the ESC and updated. The Task Force received its entire financial support from the ESC without any involvement from the healthcare industry. The ESC CPG supervises and coordinates the preparation of new Guidelines. The Committee is also responsible for the endorsement process of these Guidelines. The ESC Guidelines undergo extensive review by the CPG and external experts. After appropriate revisions the Guidelines are approved by all the experts involved in the Task Force. The finalized document is approved by the CPG for publication in the European Heart Journal. The Guidelines were developed after careful consideration of the scientific and medical knowledge and the evidence available at the time of their dating. The task of developing ESC Guidelines also includes the creation of educational tools and implementation programmes for the recommendations including condensed pocket guideline versions, summary slides, booklets with essential messages, summary cards for non-specialists and an electronic version for digital applications (smartphones, etc.). These versions are abridged and thus, for more detailed information, the user should always access to the full text version of the Guidelines, which is freely available via the ESC website and hosted on the EHJ website. The National Societies of the ESC are encouraged to endorse, translate and implement all ESC Guidelines. Implementation programmes are needed because it has been shown that the outcome of disease may be favourably influenced by the thorough application of clinical recommendations. Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the Downloaded from academic.oup.com/eurheartj/article/41/4/543/5556136 by guest on 07 October 2026