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Screening for, and treatment of, aetiologies, and CV and non-CV comorbidities is recommended in patients with HFpEF (see relevant sections of this document). I C Diuretics are recommended in congested patients with HFpEF in order to alleviate symptoms and signs. I C Recommendations for the prevention of chronic HF Treatment of hypertension is recommended to prevent or delay the onset of HF, and to prevent HF hospitalizations. 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. 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. I A Counselling against sedentary habit, obesity, cigarette smoking, and alcohol abuse is recommended to prevent or delay the onset of HF. I C Other recommendations for the management of chronic HF It is recommended that HF patients are enrolled in a multidisciplinary HF management programme to reduce the risk of HF hospitalization and mortality. I A Self-management strategies are recommended to reduce the risk of HF hospitalization and mortality. I A Either home-based and/or clinic-based programmes improve outcomes and are recommended to reduce the risk of HF hospitalization and mortality. I A Exercise is recommended for all patients who are able in order to improve exercise capacity and QOL, and reduce HF hospitalization.d I A Recommendations for treatment of patients with advanced HF Patients being considered for long-term MCS must have good compliance, appropriate capacity for device handling and psychosocial support. I C Heart transplantation is recommended for patients with advanced HF, refractory to medical/device therapy and who do not have absolute contraindications. I C Recommendations for treatment of patients with acute HF Oxygen is recommended in patients with SpO2 <90% or PaO2 <60 mmHg to correct hypoxaemia. I C Intubation is recommended for progressive respiratory failure persisting in spite of oxygen administration or non-invasive ventilation. I C Intravenous loop diuretics are recommended for all patients with AHF admitted with signs/symptoms of fluid overload to improve symptoms. I C 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. I A Inotropic agents are not recommended routinely, due to safety concerns, unless the patient has symptomatic hypotension and evidence of hypoperfusion. III C Routine use of opiates is not recommended, unless in selected patients with severe/intractable pain or anxiety. III C IABP is not routinely recommended in post-MI cardiogenic shock. III B Recommendations for management of patients after HF hospitalization It is recommended that patients hospitalized for HF be carefully evaluated to exclude persistent signs of congestion before discharge and to optimize oral treatment. I C It is recommended that evidence-based oral medical treatment be administered before discharge. I C An early follow-up visit is recommended at 12 weeks after discharge to assess signs of congestion, drug tolerance, and start and/or uptitrate evidence-based therapy. I C Recommendations for treatment of patients with HF and AF 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. I A DOACs are recommended in preference to VKAs in patients with HF, except in those with moderate or severe mitral stenosis or mechanical prosthetic heart valves. I A Urgent ECV is recommended in the setting of acute worsening of HF in patients presenting with rapid ventricular rates and haemodynamic instability. I C Treatment with the anti-arrhythmic agents flecainide, encainide, disopyramide, dronedarone, and D-sotalol is not recommended due to safety concerns. III A

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