[Heart failure: update of the ESC 2023 guidelines]

Related Experiment Video

Updated: Jul 11, 2025

A Surgical Model of Heart Failure with Preserved Ejection Fraction in Tibetan Minipigs
07:09

A Surgical Model of Heart Failure with Preserved Ejection Fraction in Tibetan Minipigs

Published on: February 18, 2022

1.9K

Johann Bauersachs1, Samira Soltani2

  • 1Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland. bauersachs.johann@mh-hannover.de.

Herz
|November 14, 2023
PubMed

Insights

The 2023 European Society of Cardiology guidelines now recommend sodium-glucose transporter 2 inhibitors (SGLT2i) for all heart failure patients, improving prognosis regardless of ejection fraction. Prompt medication titration post-decompensation is also advised.

Area of Science:

  • Cardiology
  • Pharmacology

Context:

  • The 2023 European Society of Cardiology (ESC) guidelines update cardiovascular treatment protocols.
  • Previous guidelines had varying recommendations for heart failure management based on ejection fraction (EF).

Purpose:

  • To summarize key updates in the 2023 ESC guidelines for heart failure management.
  • To highlight new recommendations for specific drug classes and patient subgroups.

Summary:

  • Sodium-glucose transporter 2 inhibitors (SGLT2i) now have a Class IA recommendation for heart failure with preserved ejection fraction (HFpEF) and mildly reduced EF (HFmrEF), making them universally recommended for all heart failure patients to improve prognosis.
  • The guidelines emphasize rapid administration and prompt titration of key heart failure medications (the 'fantastic four') post-decompensation (Class IB).
  • Intravenous iron therapy (ferric carboxymaltose or ferric derisomaltose) is recommended (Class IIa) for patients with reduced EF (HFrEF) or HFmrEF experiencing iron deficiency.

Impact:

  • SGLT2 inhibitors are now established as a cornerstone therapy for all heart failure phenotypes.
  • Updated guidelines facilitate more aggressive and timely treatment strategies following heart failure decompensation.
  • Improved management of iron deficiency in heart failure patients may enhance treatment efficacy and patient outcomes.

Keywords:
Combination therapyComorbiditiesEjection fractionHeart failureSodium glucose transporter 2 inhibitors

More Related Videos

Percutaneous Contrast Echocardiography-guided Intramyocardial Injection and Cell Delivery in a Large Preclinical Model14:24

Percutaneous Contrast Echocardiography-guided Intramyocardial Injection and Cell Delivery in a Large Preclinical Model

Published on: January 21, 2018

11.7K
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction09:20

Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction

Published on: February 13, 2021

6.5K

Related Concept Videos

Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
9
Heart Failure IV: Classification and Diagnostic Evaluation01:30

Heart Failure IV: Classification and Diagnostic Evaluation

Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...
17
Heart Failure VI: Adjunct Therapies01:22

Heart Failure VI: Adjunct Therapies

Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
15
Heart Failure VII: Nursing Interventions01:30

Heart Failure VII: Nursing Interventions

The first step in nursing management of a patient with heart failure involves thoroughly assessing the patient's medical history.Subjective Data: Obtain the patient's medical history of coronary artery disease, hypertension, myocardial infarction, and symptoms like dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.Objective Data: Conduct a physical examination to identify findings such as jugular vein distention, pulmonary crackles, tachycardia, murmurs, peripheral edema, and vital signs,...
85
Cardiomyopathy V: Interprofessional Care01:29

Cardiomyopathy V: Interprofessional Care

Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
14
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
438