Kommentar zu den Leitlinien der Europäischen Gesellschaft für Kardiologie (ESC) zur Diagnostik und Behandlung der akuten und chronischen Herzinsuffizienz

It is a goal of this commentary to address 1) most important aspects of the new guidelines, 2) to discuss controversial recommendations and 3) to focus on relevant aspects which are only addressed in the long version of the guidelines, but not in the pocket guidelines. Important new topics are the administration of mineralocorticoid receptor antagonists (aldosterone antagonists) and the indication for cardiac resynchronization therapy (CRT) already in patients with mild heart failure symptoms, the application of the sinus node inhibitor ivabradine, the substitution of iron to improve symptoms in heart failure and recommendation of a structured training program in patients with heart failure. In addition, revascularization strategies in heart failure will be discussed as well as interventional approaches for aortic stenosis and mitral regurgitation and finally early implantation of cardiac assist devices in patients with terminal heart failure.