Guidelines

2020 Heart Failure Society of South Africa perspective on the 2016 European Society of Cardiology Chronic Heart Failure Guidelines

J Hitzeroth, M Mpe, E Klug, N Ranjith, K Sliwa, L Steingo, L Lachman, N Tsabedze, N A B Ntusi, Heart Failure Society of South Africa

Abstract


Heart failure with a reduced ejection fraction (HFrEF) is a condition frequently encountered by healthcare professionals and, in order to achieve the best outcomes for patients, needs to be managed optimally. This guideline document is based on the European Society of Cardiology Guidelines for the treatment of acute and chronic heart failure published in 2016, and summarises what is considered the best current management of patients with the condition. 

It provides information on the definition, diagnosis and epidemiology of HFrEF in the African context. The best evidence-based treatments for HFrEF are discussed, including established therapies (beta-blockers, ACE-i/ARBs, mineralocorticoid receptor antagonists (MRAs), diuretics) that form the cornerstone of heart failure management as well as therapies that have only recently entered clinical use (angiotensin receptor-neprilysin inhibitor (ARNI), sodium/glucose cotransporter-2 (SGLT2) inhibitors). 

Guidance is offered in terms of more invasive therapies (revascularisation, implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy (CRT) by implantation of a biventricular pacemaker with (CRT-D) or without (CRT-P) an ICD, left ventricular assist device (LVAD) use and heart transplantation) in order to ensure efficient use of these expensive treatment modalities in a resource-limited environment. 

Furthermore, additional therapies (digoxin, hydralazine and nitrates, ivabradine, iron supplementation) are discussed and advice is provided on general preventive strategies (vaccinations). 

Sections to discuss conditions that are particularly prevalent in sub-Saharan Africa (HIV-associated cardiomyopathy (CMO), peripartum CMO, rheumatic heart disease, atrial fibrillation) have been added to further improve clinical care for these commonly encountered disease processes. 

You are encouraged to read the complete 2016 ESC Heart Failure guideline: Ponikowski P, Voors AA, Anker SD, et al.; on behalf of the European Society of Cardiology. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016,37:2129-2200.


Authors' affiliations

J Hitzeroth, Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa

M Mpe, MediClinic Heart Hospital, Arcadia, Pretoria, South Africa

E Klug, Division of Cardiology, Department of Medicine, University of the Witwatersrand and Sunninghill Hospital, Johannesburg, South Africa

N Ranjith, Cardiovascular Research Centre, Durban, South Africa

K Sliwa, Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa;Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, South Africa

L Steingo, Sandton MediClinic, Johannesburg, South Africa

L Lachman, University of Cape Town Private Academic Hospital, Cape Town, South Africa

N Tsabedze, Division of Cardiology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand and Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa

N A B Ntusi, Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa;Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, South Africa;Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, South Africa

Heart Failure Society of South Africa, -

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Cite this article

South African Medical Journal 2020;110(8b):.

Article History

Date submitted: 2020-08-31
Date published: 2020-08-31

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