Four separate guidelines released by the European Society of Cardiology (ESC) during ESC Congress 2021 provide updated clinical guidance for addressing cardiovascular disease prevention, pacing and cardiac resynchronization therapy, valvular heart disease (VHD) and heart failure (HF). Highlights include:

The ESC guidelines on cardiovascular disease prevention in clinical practice focus specifically on atherosclerotic cardiovascular disease and offer recommendations for a stepwise approach to intensifying preventive treatments, while taking into consideration potential benefit, other conditions or risk factors, social determinants of health and patient preferences. This tiered approach starts with healthy lifestyle recommendations for anyone (i.e., not smoking, maintaining a systolic blood pressure below 160 mm Hg, adopting a healthy diet and exercise, etc.) and then further tailors recommendations based on an individual's 10-year risk of cardiovascular disease. Shared decision-making and communication of risk, as well as mental health, are also factors included in the new guidelines. "Individualized decisions using risk estimation and a stepwise approach to therapies is more complex than a one-size-fits-all approach but reflects the diversity of patients and patient characteristics in everyday clinical practice and is essential to give the right patient the right treatment," said Guidelines Task Force Chair Frank Visseren, MD. Access the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease and related resources on ACC's Prevention Guideline Hub.

The ESC guidelines on cardiac pacing and cardiac resynchronization outline changes in indications and pacing methods that have occurred since 2013 when previous ESC pacing guidelines were published. For example, the guidelines address new approaches to pacing in response to neural mediated fainting, as well as several indications for CRT in HF and pacing after TAVR. Additionally, the guidelines cover topics like differing pacing indications and complication rates between male and female patients, when to perform genetic tests, remote monitoring and more. "The guidelines emphasize the importance of patient-centered care ... and topics of education are outlined to help patients make informed choices," said Guidelines Task Force Chair Cosedis Nielsen, MD. Explore additional clinical guidance on cardiac resynchronization and related topics at ACC.org/Guidelines.

The European guidelines for the management of VHD focus on the aortic, mitral and tricuspid valves. Specific recommendations stress the importance of clinical examination as the first step in diagnosis and the use of non-invasive evaluation using echocardiography. Additionally, the guidelines underscore the role of the heart team, as well as shared decision-making in helping to inform the choice and timing of treatment. Other topics addressed by the guidelines include evaluation and timing of surgery in tricuspid regurgitation and use of percutaneous techniques in previously inoperable patients. Read the ACC.org Key Points article on the European VHD guidelines. Access the 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease and related resources on ACC's VHD Guideline Hub.

The ESC guidelines for the diagnosis and treatment of acute and chronic HF provide recommendations for clinicians and patients to help aid in diagnosis and treatment of different aspects of the disease, including HF with reduced ejection fraction and acute HF. Key recommendations focus on diagnostic testing and referral of patients, as well as lifestyle changes and management of risk factors that can improve quality of life. The guidelines also address use of devices and drugs, including the new class of SGLT2 inhibitors, to improve outcomes and reduce mortality. Additionally, patient access to a multi-professional HF care team, as well as vaccinations for influenza, pneumonia and COVID-19 are recommended. Read the ACC.org Key Points article on ESC's acute and chronic HF guidelines. Explore additional clinical guidance on HF and related topics at ACC.org/Guidelines.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, COVID-19 Hub, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Valvular Heart Disease, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Imaging, Interventions and Structural Heart Disease, Echocardiography/Ultrasound, Diet

Keywords: ESC Congress, ESC21, ACC International, Secondary Prevention, Heart Valve Diseases, Heart Failure, Arrhythmias, Cardiac, Cardiac Resynchronization Therapy, Blood Pressure, Tricuspid Valve Insufficiency, Tricuspid Valve, Diet, Influenza, Human, COVID-19, SARS-CoV-2, Decision Making, Stroke Volume, Transcatheter Aortic Valve Replacement, Primary Prevention, Echocardiography, Vaccination, Referral and Consultation, Syncope

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