Vnitr Lek 2014, 60(4):366-374

Comparison of American and European (Czech) guidelines for diagnosis and treatment of chronic heart failure

Jindřich Špinar¹, Lenka Špinarová², Jiří Vítovec², Ondřej Ludka^1,*

¹ Interní kardiologická klinika LF MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jindřich Špinar, CSc., FESC

² I. interní kardio-angiologická klinika LF MU a FN u sv. Anny Brno, přednostka prof. MUDr. Lenka Špinarová, CSc., FESC

The new Czech and European recommendations for diagnosis and treatment of heart failure were published in 2012. The American guidelines ACCF/AHA were published in 2013. Main difference between them is presentation of acute and chronic heart failure in the European guidelines while the American and the Czech guidelines include only chronic heart failure. The American recommendations distinguish heart failure with reduced ejection fraction and with remained ejection fraction. In the beginning, the American guidelines introduce A-D classification which doesn't figure in the European neither Czech guidelines. Class A patients are ill with risk factors, but without heart failure. In contrast, class D patients are decompensated with symptoms in the rest. Epidemiologic data shows interesting results with prevalence about 0.2% in 60-69 years old subjects and 80% in subjects older than 85 years. 5 year mortality is 50%. The American guidelines start to treat class A which is in fact prevention and treatment of risk factors. There is mentioned inevitably treatment of hypertension, both systolic and diastolic which decrease risk of heart failure up to 50%. There is almost no difference in pharmacotherapy. Noteworthy, the American guidelines introduce also ACE inhibitors - fosinopril and quinapril, on the other hand beta-blockers don't involve nebivolol. Wide range of diuretics are mentioned, some of them aren't registered in the Czech Republic. European and Czech guidelines involve ivabradin. Neither nesiritid nor levosimendan for inpatients aren't involved. There is briefly mentioned surgery and cardiac mechanical support, moreover there are references for guidelines for heart transplantation.

Keywords: diagnosis; guidelines; heart failure; treatment

Received: January 20, 2014; Published: April 1, 2014  Show citation