Overcoming the ethnic differences in patients hospitalized for heart failure: is there a need for international harmonization of clinical practice guidelines?

2015 ◽  
Vol 17 (8) ◽  
pp. 755-757 ◽  
Author(s):  
John Parissis ◽  
Dimitrios Farmakis ◽  
John Lekakis ◽  
Gerasimos Filippatos
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Ethnic Differences ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
International Harmonization

scholarly journals The Evolving Role of Catheter Ablation in Patients With Heart Failure and AF

2019 ◽  
Vol 8 (1) ◽  
pp. 47-53
Author(s):  
Sandeep Prabhu ◽  
Wei H Lim ◽  
Richard J Schilling
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Catheter Ablation ◽  
Patient Group ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Evidence Base ◽  
Patients With Heart Failure ◽  
Recent Developments

AF and heart failure are emerging epidemics worldwide. Several recent trials have provided a growing evidence base for the benefits of catheter ablation in this patient group, which are yet to be universally adopted in clinical practice guidelines. This paper provides a summary of recent developments in this field and provides pragmatic advice to the treating physician regarding the appropriate role of catheter ablation in the overall management of patients with comorbid AF and heart failure.

scholarly journals Updated Clinical Practice Guidelines on Heart Failure: An International Alignment

Circulation ◽  
2016 ◽  
Vol 134 (13) ◽  
Author(s):  
Elliott M. Antman ◽  
Jeroen Bax ◽  
Richard A. Chazal ◽  
Mark A. Creager ◽  
Gerasimos Filippatos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines

P1659Evolution of level of evidence c recommendations in European Society of Cardiology clinical practice guidelines on heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Trindade ◽  
D Faria ◽  
J Serodio ◽  
F Batista ◽  
M Beringuilho ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
European Society ◽  
Quality Data ◽  
Level Of Evidence ◽  
Group 2 ◽  
European Society Of Cardiology ◽  
Group 1

Abstract Background Over the past two decades, the European Society of Cardiology (ESC) Clinical Practice Guidelines (CPG) on Heart Failure has increasingly become a familiar part of Cardiology practice and are used worldwide. By creating objective standards, CPG provides a mechanism to assess decision-making and straightforward references for clinicians. Level of Evidence C recommendations are based on expert consensus and/or small retrospective studies and registries with limited and non-representative populations evaluated. The resulting directives need to be proven with better quality data to assess its true benefits. Purpose The purpose of our study was to describe and evaluate the evolution of Level of Evidence C recommendations of ESC CPG on Heart Failure and to provide a quality assessment of its benefits in the following years. Methods In this retrospective observational Case-Control study, we identified and collected all Level of Evidence C recommendations in five consecutive published documents of ESC CPG in the years 2001, 2005, 2008, 2012 and 2016. Each identified recommendation was classified between two major groups: Diagnostic and Complementary Exams (group 1) and Therapeutics and Interventions (group 2) and was followed up in the following documents. Primary outcomes were classified as: (1) Upgrade to Level of Evidence A or B [Upgrade], (2) Elimination or disproven benefit/harm [Downgrade] and (3) Maintenance or minor reformulation with unchanged benefit/harm [Maintenance]. We applied a Kaplan-Meyer survival analysis to estimate the probability of Upgrade or Downgrade in each group. Results A total of 239 different Level of Evidence C recommendations were submitted to the final analysis, 22.6% (n=54) in group 1 and 77.4% (n=185) in group 2. On follow-up, 35.2% (n=76) of recommendations were upgraded, 29.6% (n=64) were downgraded and 35.2% (n=76) were maintained. Regarding outcomes, the downgrade of recommendations occurred predominantly in group 2 (94.4%). Considering all the eliminated recommendations, 60.9% took place on the next following published ESC CPG document. Likewise, 60.5% of upgraded recommendations also occurred on the next following published ESC CPG document. The probability of upgrade or downgrade in the next following document was 52.8%, predominantly in the Therapeutics and Interventions group (37.5% vs 57.9%, p=0.012). Figure 1 Conclusions Level of Evidence C recommendations constitutes an important asset of ESC CPG on Heart Failure as they are usually updated on new treatment options and are developed by experts in the specific topic. However, the probability of elimination due to disproven benefit or potential harm was high (29.6%), particularly regarding therapeutics and interventions (94%). Since a significant fraction of Level of Evidence C recommendations remains unchanged on the following document (35%), the need for high-quality data, specifically regarding therapeutic interventions, is warranted.

scholarly journals Equipoise in Appropriate Initial Volume Resuscitation for Patients in Septic Shock With Heart Failure: Results of a Multicenter Clinician Survey

2019 ◽  
Vol 35 (11) ◽  
pp. 1338-1345
Author(s):  
Gabriel Wardi ◽  
Ian Joel ◽  
Julian Villar ◽  
Michael Lava ◽  
Eric Gross ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Medicine ◽  
Septic Shock ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Volume Resuscitation ◽  
Induced Hypotension ◽  
Initial Volume ◽  
Multicenter Survey

Purpose: International clinical practice guidelines call for initial volume resuscitation of at least 30 mL/kg body weight for patients with sepsis-induced hypotension or shock. Although not considered in the guidelines, preexisting cardiac dysfunction may be an important factor clinicians weigh in deciding the quantity of volume resuscitation for patients with septic shock. Methods: We conducted a multicenter survey of clinicians who routinely treat patients with sepsis to evaluate their beliefs, behaviors, knowledge, and perceived structural barriers regarding initial volume resuscitation for patients with sepsis and concomitant heart failure with reduced ejection fraction (HFrEF) <40%. Initial volume resuscitation preferences were captured as ordinal values, and additional testing for volume resuscitation preferences was performed using McNemar and Wilcoxon signed rank tests as indicated. Univariable logistic regression models were used to identify significant predictors of ≥30 mL/kg fluid administration. Results: A total of 317 clinicians at 9 US hospitals completed the survey (response rate 47.3%). Most respondents were specialists in either internal medicine or emergency medicine. Substantial heterogeneity was found regarding sepsis resuscitation preferences for patients with concomitant HFrEF. The belief that patients with septic shock and HFrEF should be exempt from current sepsis bundle initiatives was shared by 39.4% of respondents. A minimum fluid challenge of ∼30 mL/kg or more was deemed appropriate in septic shock by only 56.4% of respondents for patients with concomitant HFrEF, compared to 89.1% of respondents for patients without HFrEF ( P < .01). Emergency medicine physicians were most likely to feel that <30 mL/kg was most appropriate in patients with septic shock and HFrEF. Conclusions: Clinical equipoise exists regarding initial volume resuscitation for patients with sepsis-induced hypotension or shock and concomitant HFrEF. Future studies and clinical practice guidelines should explicitly address resuscitation in this subpopulation.

scholarly journals 2020 Clinical practice guidelines for Chronic heart failure

2020 ◽  
Vol 25 (11) ◽  
pp. 4083 ◽  
Author(s):  
(RSC) Russian Society of Cardiology (RSC)
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Chronic Heart Failure ◽  
Russian Federation ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Ministry Of Health ◽  
The Russian Federation

Endorsed by the Research and Practical Council of the Ministry of Health of the Russian Federation.

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