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ACC/AHA Versus ESC Guidelines on Heart Failure: JACC Guideline Comparison
Peter van der Meer1, Hanna K Gaggin2, G William Dec3
1Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands.
Insights
This review compares ACC/AHA and ESC heart failure (HF) guidelines, focusing on diagnosis, treatment, and management of HF with reduced and preserved ejection fraction. It highlights differences and recent evidence for optimal patient care.
Area of Science:
- Cardiology
- Clinical Practice Guidelines
- Heart Failure Management
Background:
- Current heart failure (HF) management relies on guidelines from the American College of Cardiology/American Heart Association (ACC/AHA) and the European Society of Cardiology (ESC).
- These guidelines provide evidence-based recommendations for diagnosing and treating acute and chronic heart failure (HF).
Purpose of the Study:
- To compare specific recommendations across HF phenotypes and disease severity between ACC/AHA and ESC guidelines.
- To identify differences in recommendations and highlight key studies published since the latest guideline updates.
- To provide a comprehensive overview of current HF management strategies.
Main Methods:
- Comparative analysis of the 2013 ACC/AHA (updated 2016/2017) and 2016 ESC guidelines for heart failure.
- Review of noninvasive and invasive diagnostic testing strategies for HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF).
- Evaluation of evidence supporting guideline-directed medical therapy and device-based therapies for HFrEF and HFpEF.
Main Results:
- Both guidelines address diagnosis and treatment for HFrEF and HFpEF, with stronger evidence for HFrEF management.
- Recommendations cover medical comorbidities, acute HF, and advanced therapies for end-stage disease.
- Key differences in specific recommendations between the guidelines were identified.
Conclusions:
- The review offers a comparative analysis of major HF guidelines to aid clinicians in managing diverse HF patient populations.
- It emphasizes the importance of guideline-directed therapies and identifies areas for future research, particularly for HFpEF.
- Understanding guideline nuances is crucial for optimizing heart failure care.
Abstract:
The 2013 (with updates in 2016 and 2017) American College of Cardiology/American Heart Association and 2016 European Society of Cardiology guidelines provide practical evidence-based clinical guidelines for the diagnosis and treatment of both acute and chronic heart failure (HF). Both guidelines address noninvasive and invasive testing to establish the diagnosis of HF with reduced ejection fraction and HF with preserved ejection fraction. Extensive trial evidence supports the use of guideline-directed medical therapy and device-based therapies for the optimal management of patients with HF with reduced ejection fraction. Specific recommendations are also provided for HF with preserved ejection fraction although the evidence is substantially weaker. Management of medical comorbidities is now addressed in both guidelines. Acute HF and end-stage disease requiring advanced therapies are also discussed. This review compares specific recommendations across the spectrum of HF phenotypes and disease severity, highlights areas where differences exist, and lists consequential studies published since the latest guidelines.
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