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2010 Focused Update of ESC Guidelines on device therapy in heart failure: An update of the 2008 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure and the 2007 ESC guidelines for cardiac and resynchronization therapy Developed with the special contribution of the Heart Failure Association and the European Heart Rhythm Association

2010; Oxford University Press; Volume: 31; Issue: 21 Linguagem: Inglês

10.1093/eurheartj/ehq337

1522-9645

Kenneth Dickstein, Panos Vardas, Angelo Auricchio, J.-C. Daubert, Cecilia Linde, John J.V. McMurray, Piotr Ponikowski, Silvia G. Priori, Richard Sutton, Dirk J. van Veldhuisen, Alec Vahanian, Angelo Auricchio, Jeroen J. Bax, Claudio Ceconi, V. Dean, Gerasimos Filippatos, Christian Funck‐Brentano, Richard Hobbs, Patricia M. Kearney, Theresa A. McDonagh, Bogdan A. Popescu, Željko Reiner, Udo Sechtem, Per Anton Sirnes, Michał Tendera, Panos Vardas, Petr Widimský, Michał Tendera, Stefan D. Anker, J J Blanc, Maurizio Gasparini, Arno W. Hoes, Carsten W. Israel, Zbigniew Kalarus, Béla Merkely, Karl Swedberg, A. John Camm,

Heart Failure Treatment and Management

The Committee for Practice Guidelines (CPG) of the European Society of Cardiology recognizes that new evidence from clinical research trials may impact on current recommendations. The current heart failure (HF) guidelines1 were published in 2008 and the cardiac pacing guidelines in 2007.2 In order to keep these guidelines up to date, it would be appropriate to modify the recommendations and levels of evidence according to the most recent clinical trial evidence. This Focused Update on the use of devices in heart failure 2010 is the first publication of its kind from the CPG. Practice Guideline recommendations should represent evidence-based medicine. Traditionally, these recommendations are based on the outcomes in the cohort of patients described by the inclusion criteria in the protocols of randomized clinical trials (RCTs). More recently, based on the fact that the characteristics of the patients actually included in a trial may differ substantially from the eligibility criteria, Guideline Task Force members frequently favour restricting the applicability of these recommendations to the clinical profile and outcomes of the enrolled cohort, representing a more accurate interpretation of the evidence provided by a trial's result. In contrast to previous guidelines, this focused update considers the characteristics of the patients included in the trials and contains several examples. In MADIT-CRT, although the protocol permitted inclusion of patients in both New York Heart Association (NYHA) I and II function class, only 15% of the patients included in this trial were classified as NYHA I, many of whom had been previously symptomatic. Similarly, although the inclusion criteria permitted randomization of patients with a QRS width of ≥130 m, the favourable effect on the primary endpoint was limited to patients with a QRS width of ≥150 ms, a prospective, pre-specified cut-off. The text accompanying these recommendations explains and justifies the decisions to …