Review of the new ESC guidelines for the pharmacological management of chronic heart failure

Chronic heart failure (CHF) is associated with a high burden of mortality and morbidity and is the leading principal hospital diagnosis among older adults. As a result of the complexities associated with this condition and the occurrence of asymptomatic disease and comorbidities, heart failure patients are often misdiagnosed or underprescribed effective medications. The European Society of Cardiology (ESC) guidelines for the diagnosis and treatment of CHF, were developed to provide clinicians with practical, evidence-based guidance on the optimal management of patients with this condition. The guidelines have recently been updated to incorporate diagnostic, safety, and efficacy data from large-scale clinical trials that were not available for the development of earlier guidance documents. This article discusses five pharmacological strategies for the management of CHF (angiotensin-converting enzyme-inhibitors, beta-blockers, diuretics, aldosterone antagonists, and angiotensin-II type-1 receptor blockers) in the context of the 2005 ESC CHF guidelines. Data from recent large-scale, randomized, placebo-controlled trials are discussed and the updated guidelines are compared with recommendations from the earlier 2001 guidance document.