2017 Comprehensive Update of the Canadian Cardiovascular Society Guidelines for the Management of Heart Failure

Abstract

Since the inception of the Canadian Cardiovascular Society heart failure (HF) guidelines in 2006, much has changed in the care for patients with HF. Over the past decade, the HF Guidelines Committee has published regular updates. However, because of the major changes that have occurred, the Guidelines Committee believes that a comprehensive reassessment of the HF management recommendations is presently needed, with a view to producing a full and complete set of updated guidelines. The primary and secondary Canadian Cardiovascular Society HF panel members as well as external experts have reviewed clinically relevant literature to provide guidance for the practicing clinician. The 2017 HF guidelines provide updated guidance on the diagnosis and management (self-care, pharmacologic, nonpharmacologic, device, and referral) that should aid in day-to-day decisions for caring for patients with HF. Among specific issues covered are risk scores, the differences in management for HF with preserved vs reduced ejection fraction, exercise and rehabilitation, implantable devices, revascularization, right ventricular dysfunction, anemia, and iron deficiency, cardiorenal syndrome, sleep apnea, cardiomyopathies, HF in pregnancy, cardio-oncology, and myocarditis. We devoted attention to strategies and treatments to prevent HF, to the organization of HF care, comorbidity management, as well as practical issues around the timing of referral and follow-up care. Recognition and treatment of advanced HF is another important aspect of this update, including how to select advanced therapies as well as end of life considerations. Finally, we acknowledge the remaining gaps in evidence that need to be filled by future research.

Modern iron replacement therapy: clinical and pathophysiological insights

“…Notwithstanding skepticism in the hematological community about this "extensive" definition, IV iron supplementation with FCM in CHF patients was effective in ameliorating either iron stores or cardiac function [74]. Such results have been consistently replicated [75,124], so that most recent and authoritative guidelines suggest to systematically check for ID in CHF and IV iron treatment if ID is present [125][126][127]. Noteworthy, a sub-analysis of the seminal FAIR-HF trial [74] focusing on anemic CHF patients showed consistent Hb increase after IV iron, implicitly validating the above mentioned "extensive" criteria for ID [128].…”

İleri evre kalp yetersizliği rehberi

“…İşlem sırasında verilen sistemik antikogulanlar nedeniyle sistemik kanama riski de vardır. [265] Fayda ve yararı işlemi yapan merkezin tecrübesine göre değişkenlik gösterir.…”

“…[266,267] Bu nedenle kılavuzlarda tüm diüretik stratejileri başarısız oldu ise dirençli konjesyonu olan hastalarda kısa süreli ve tekrarlayan ultrafiltrasyon uygulaması önerilmekte-dir. [4,17,265] Kalp yetersizliğinde ultrafiltrasyon'un etkinliğini daha iyi değerlendirmek için ileriki çalışmalarda göz önüne alınması gerekenleri şu şekilde özetleyebiliriz; -Hasta seçiminde renal fonksiyonları bozulmamış olanların da alınması -Renal disfonksiyonu tedavi etmek değil korumak amaçlanmalı -Yavaş ve daha uzun süreli sıvı çekilmeli -Laboratuvar değerlerinin değil klinik sonlanımlar hedeflenmeli -Uzun dönem (>90 gün) sonuçlara bakılmalı -Yan etkileri azaltmak için basit cihazların kullanılması ve daha iyi destek sağlanması.…”

Medical therapy doses at hospital discharge in patients with existing and de novo heart failure

“…[1][2][3] Assessment of appropriate use requires patient-level knowledge of indications, contraindications, and tolerability. [1][2][3] Assessment of appropriate use requires patient-level knowledge of indications, contraindications, and tolerability.…”