[The new ESC Guidelines for acute and chronic heart failure 2016]

The new guidelines for the diagnosis and treatment of acute and chronic heart failure (HF) were presented in May 2016 during the congress of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) in Florence. An important amendment affects the classification of HF which now differentiates between HF with preserved ejection fraction (HFpEF) and left ventricular EF (LVEF) > 50%, HF with reduced ejection fraction (HFrEF, LVEF < 40%) and the new entity HF with mid-range ejection fraction (HFmrEF, LVEF 40-49%). Additionally, there are revised algorithms for the diagnosis and treatment for acute and chronic HF. The algorithm for the diagnosis of acute HF is based on the clinical presentation and from this prognosis and treatment options can be derived. The algorithm for the diagnosis of chronic HF is now based on the probability for HF in a 3-step model comprised of clinical presentation, patient history and electrocardiogram (ECG) abnormalities, together with increased plasma levels of N‑terminal propeptide brain natriuretic peptide (NT-proBNP, normal <125 pg/ml) and BNP (normal <35 pg/ml). Echocardiographic assessment is essential to confirm the diagnosis and obtain further differentiation. Essential updates to medicinal therapy include the introduction of a novel drug class of angiotensin receptor neprilysin inhibitors (ARNI, sacubitril/valsartan) as a class I/B indication in the HFrEF treatment recommendations according to the PARADIGM-HF trial data. Additionally, due to the EMPA-REG trial the sodium-dependent glucose transporter 2 (SGLT2) inhibitor empagliflozin has been recommended in the new guidelines for the prevention of symptomatic HF in high-risk patients (class IIa/B indication). For cardiac resynchronization therapy (CRT) a novel class I/A indication for QRS > 150 ms and left bundle branch block (LBBB), a class I/B indication for QRS > 130 ms and LBBB as well as high-grade atrioventricular block with pacemaker indications have been put forward. The Life Vest® for bridging therapy of high-risk patients received a class IIb/C indication. In this article we summarize the major novelties of the ESC guidelines 2016 and shed light on the underlying innovations and clinical trials.