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chronic heart failure3 and the 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure,5 new guidance for interpretation of evidence has been published by the ESC.1,2 Consequently, all recommendations, new and old, have been regraded to comply with the revised ESC evidence grading system. For recommendations with more than one outcome, e.g. cardiovascular (CV) death and HF hospitalization (HFH), the wording reflects whether both outcomes were individually significant (‘AND’) or the outcome was a composite (‘OR’).
For each topic, we have considered age and sex differences and included these in the recommendations, if deemed clinically relevant. Since the publication of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure,3 several relevant guidelines on specific topics, such as cardio-oncology,6
Figure 1 Central illustration. Management of heart failure. ACE-I, angiotensin-converting enzyme inhibitor; AF, atrial fibrillation; ARB, angiotensin II receptor blocker; ARNI, angiotensin receptor–neprilysin inhibitor; AS, aortic stenosis; AV, atrioventricular; CABG, coronary artery bypass grafting; CRT, cardiac resynchronization therapy; HF, heart failure; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; HR, heart rate; ICD, implantable cardioverter-defibrillator; ISDN, isosorbide dinitrate; IV, intravenous; LVAD, left ventricular assist device; LVEF, left ventricular ejection fraction; MCS, mechanical circulatory support; MR, mitral regurgitation; MRA, mineralocorticoid receptor antagonist; TEER, transcatheter edge-to-edge repair; NYHA, New York Heart Association; SAVR, surgical aortic valve replacement; SGLT2-I, sodium–glucose co-transporter 2 inhibitor; SR, sinus rhythm; TAVI, transcatheter aortic valve implantation. Green colour refers to Class I recommendation. Yellow colour refers to Class IIa recommendation. Orange colour refers to Class IIb recommendation. aAn ARB is recommended in patients with symptomatic HFrEF if they are unable to tolerate an ACE-I or ARNI. bNo large prospective randomized controlled trial has been performed on the use of beta-blockers, ACE-I/ ARNI/ARB exclusively in patients with LVEF 41%–49%. cClass of recommendation for ICD differs according to ischaemic vs nonischaemic aetiology. dClass of recommendation for CRT differs according to QRS duration and morphology (see Figure 10 and Recommendation Table 7). eCriteria for advanced HF are listed in Table 14. fIndications and contraindications for heart transplantation are listed in Table 17. gIndications and contraindications for LVAD implantation are listed in Table 16. hPredominantly obstructive sleep apnoea. Downloaded from academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehag100/8766302 by guest on 31 August 2026
