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Changes in recommendations

2021 Class 2016 Class

Recommendations for diagnosis of HF 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 noninvasive stress tests. IIb Invasive coronary angiography should be considered in

patients with HF and intermediate to high pre-test probability of CAD and the presence of ischaemia in non-invasive stress tests (who are considered suitable for potential coronary revascularization) in order to establish the diagnosis of CAD and its severity. IIa

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. IIa Cardiac CT may be considered in patients with HF and low to intermediate pre-test probability of CAD or those

with equivocal non-invasive stress tests in order to rule out coronary artery stenosis. IIb

Recommendations for device therapy in HFrEF 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. IIa 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), and an LVEF <_35% despite >_3 months of OMT, provided they are expected to survive substantially longer than 1 year with good functional status, and they have DCM. I

CRT should be considered for symptomatic patients with HF in sinus rhythm with a QRS duration of 130149 ms and LBBB QRS morphology and with LVEF <_35% despite OMT in order to improve symptoms and reduce morbidity and mortality. IIa CRT is recommended for symptomatic patients with HF

in sinus rhythm with a QRS duration of 130149 ms and LBBB QRS morphology and with LVEF <_35% despite OMT in order to improve symptoms and reduce morbidity and mortality. I

Patients with an LVEF <_35% who have received a conventional pacemaker or an ICD and subsequently develop worsening HF despite OMT and who have a significant proportion of RV pacing should be considered for ‘upgrade’ to CRT. IIa Patients with HFrEF who have received a conventional pacemaker or an ICD and subsequently develop

worsening HF despite OMT and who have a high proportion of RV pacing may be considered for upgrade to CRT. This does not apply to patients with stable HF. IIb

Recommendations for management of patients with acute HF 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. IIa Combination of loop diuretic with either thiazide-type diuretic or spironolactone may be considered in patients with

resistant oedema or insufficient symptomatic response. IIb

In patients with AHF and SBP >110 mmHg, i.v. vasodilators may be considered as initial therapy to improve symptoms and reduce congestion. IIb In patients with hypertensive AHF, i.v. vasodilators should

be considered as initial therapy to improve symptoms and reduce congestion. IIa

Routine use of opiates is not recommended, unless in selected patients with severe/intractable pain or anxiety. III Opiates may be considered for cautious use to relieve dyspnoea and anxiety in patients with severe dyspnoea

but nausea and hypopnea may occur. IIb

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. IIa Short-term MCS may be considered in refractory cardiogenic shock depending on patient age, comorbidities, and

neurological function. IIb

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