European Journal of Heart FailureVolume 18, Issue 8 p. 891-975 ESC GUIDELINESFree Access 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC Piotr Ponikowski (Chairperson) (Poland), Corresponding Author Piotr Ponikowski (Chairperson) (Poland) Corresponding authors: Piotr Ponikowski, Department of Heart Diseases, Wroclaw Medical University, Centre for Heart Diseases, Military Hospital, ul. Weigla 5, 50-981 Wroclaw, Poland, Tel: +48 261 660 279, Tel/Fax: +48 261 660 237, E-mail: piotrponikowski@4wsk.pl. Adriaan Voors, Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands, Tel: +31 50 3612355, Fax: +31 50 3614391, E-mail: a.a.voors@umcg.nl.Search for more papers by this authorAdriaan A. Voors (Co-Chairperson) (The Netherlands), Corresponding Author Adriaan A. Voors (Co-Chairperson) (The Netherlands) Corresponding authors: Piotr Ponikowski, Department of Heart Diseases, Wroclaw Medical University, Centre for Heart Diseases, Military Hospital, ul. Weigla 5, 50-981 Wroclaw, Poland, Tel: +48 261 660 279, Tel/Fax: +48 261 660 237, E-mail: piotrponikowski@4wsk.pl. Adriaan Voors, Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands, Tel: +31 50 3612355, Fax: +31 50 3614391, E-mail: a.a.voors@umcg.nl.Search for more papers by this authorStefan D. Anker (Germany), Stefan D. Anker (Germany)Search for more papers by this authorHéctor Bueno (Spain), Héctor Bueno (Spain)Search for more papers by this authorJohn G. F. Cleland (UK), John G. F. Cleland (UK)Search for more papers by this authorAndrew J. S. Coats (UK), Andrew J. S. Coats (UK)Search for more papers by this authorVolkmar Falk (Germany), Volkmar Falk (Germany)Search for more papers by this authorJosé Ramón González-Juanatey (Spain), José Ramón González-Juanatey (Spain)Search for more papers by this authorVeli-Pekka Harjola (Finland), Veli-Pekka Harjola (Finland)Search for more papers by this authorEwa A. Jankowska (Poland), Ewa A. Jankowska (Poland)Search for more papers by this authorMariell Jessup (USA), Mariell Jessup (USA)Search for more papers by this authorCecilia Linde (Sweden), Cecilia Linde (Sweden)Search for more papers by this authorPetros Nihoyannopoulos (UK), Petros Nihoyannopoulos (UK)Search for more papers by this authorJohn T. Parissis (Greece), John T. Parissis (Greece)Search for more papers by this authorBurkert Pieske (Germany), Burkert Pieske (Germany)Search for more papers by this authorJillian P. Riley (UK), Jillian P. Riley (UK)Search for more papers by this authorGiuseppe M. C. Rosano (UK/Italy), Giuseppe M. C. Rosano (UK/Italy)Search for more papers by this authorLuis M. Ruilope (Spain), Luis M. Ruilope (Spain)Search for more papers by this authorFrank Ruschitzka (Switzerland), Frank Ruschitzka (Switzerland)Search for more papers by this authorFrans H. Rutten (The Netherlands), Frans H. Rutten (The Netherlands)Search for more papers by this authorPeter van der Meer (The Netherlands), Peter van der Meer (The Netherlands)Search for more papers by this authorAuthors/Task Force Members, Authors/Task Force MembersThe disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines.Search for more papers by this authorDocument Reviewers, Document ReviewersThe disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines.Search for more papers by this author Piotr Ponikowski (Chairperson) (Poland), Corresponding Author Piotr Ponikowski (Chairperson) (Poland) Corresponding authors: Piotr Ponikowski, Department of Heart Diseases, Wroclaw Medical University, Centre for Heart Diseases, Military Hospital, ul. Weigla 5, 50-981 Wroclaw, Poland, Tel: +48 261 660 279, Tel/Fax: +48 261 660 237, E-mail: piotrponikowski@4wsk.pl. Adriaan Voors, Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands, Tel: +31 50 3612355, Fax: +31 50 3614391, E-mail: a.a.voors@umcg.nl.Search for more papers by this authorAdriaan A. Voors (Co-Chairperson) (The Netherlands), Corresponding Author Adriaan A. Voors (Co-Chairperson) (The Netherlands) Corresponding authors: Piotr Ponikowski, Department of Heart Diseases, Wroclaw Medical University, Centre for Heart Diseases, Military Hospital, ul. Weigla 5, 50-981 Wroclaw, Poland, Tel: +48 261 660 279, Tel/Fax: +48 261 660 237, E-mail: piotrponikowski@4wsk.pl. Adriaan Voors, Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands, Tel: +31 50 3612355, Fax: +31 50 3614391, E-mail: a.a.voors@umcg.nl.Search for more papers by this authorStefan D. Anker (Germany), Stefan D. Anker (Germany)Search for more papers by this authorHéctor Bueno (Spain), Héctor Bueno (Spain)Search for more papers by this authorJohn G. F. Cleland (UK), John G. F. Cleland (UK)Search for more papers by this authorAndrew J. S. Coats (UK), Andrew J. S. Coats (UK)Search for more papers by this authorVolkmar Falk (Germany), Volkmar Falk (Germany)Search for more papers by this authorJosé Ramón González-Juanatey (Spain), José Ramón González-Juanatey (Spain)Search for more papers by this authorVeli-Pekka Harjola (Finland), Veli-Pekka Harjola (Finland)Search for more papers by this authorEwa A. Jankowska (Poland), Ewa A. Jankowska (Poland)Search for more papers by this authorMariell Jessup (USA), Mariell Jessup (USA)Search for more papers by this authorCecilia Linde (Sweden), Cecilia Linde (Sweden)Search for more papers by this authorPetros Nihoyannopoulos (UK), Petros Nihoyannopoulos (UK)Search for more papers by this authorJohn T. Parissis (Greece), John T. Parissis (Greece)Search for more papers by this authorBurkert Pieske (Germany), Burkert Pieske (Germany)Search for more papers by this authorJillian P. Riley (UK), Jillian P. Riley (UK)Search for more papers by this authorGiuseppe M. C. Rosano (UK/Italy), Giuseppe M. C. Rosano (UK/Italy)Search for more papers by this authorLuis M. Ruilope (Spain), Luis M. Ruilope (Spain)Search for more papers by this authorFrank Ruschitzka (Switzerland), Frank Ruschitzka (Switzerland)Search for more papers by this authorFrans H. Rutten (The Netherlands), Frans H. Rutten (The Netherlands)Search for more papers by this authorPeter van der Meer (The Netherlands), Peter van der Meer (The Netherlands)Search for more papers by this authorAuthors/Task Force Members, Authors/Task Force MembersThe disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines.Search for more papers by this authorDocument Reviewers, Document ReviewersThe disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines.Search for more papers by this author First published: 20 May 2016 https://doi.org/10.1002/ejhf.592Citations: 4,497 ESC Committee for Practice Guidelines (CPG) and National Cardiac Societies document reviewers: listed in the Appendix.: ESC entities having participated in the development of this document: Associations: : Acute Cardiovascular Care Association (ACCA), European Association for Cardiovascular Prevention and Rehabilitation (EACPR), European Association of Cardiovascular Imaging (EACVI), European Heart Rhythm Association (EHRA), Heart Failure Association (HFA). Councils: : Council on Cardiovascular Nursing and Allied Professions, Council for Cardiology Practice, Council on Cardiovascular Primary Care, Council on Hypertension. Working Groups: : Cardiovascular Pharmacotherapy, Cardiovascular Surgery, Myocardial and Pericardial Diseases, Myocardial Function, Pulmonary Circulation and Right Ventricular Function, Valvular Heart Disease. The content of these European Society of Cardiology (ESC) Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the ESC Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained upon submission of a written request to John Wiley & Sons, the publisher of the European Journal of Heart Failure and the party authorized to handle such permissions on behalf of the ESC (permissions@wiley.com). Disclaimer: . The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their publication. The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and in consultation with that patient and, where appropriate and/or necessary, the patient's caregiver. Nor do the ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription. AboutSectionsPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Table of contents 1. Preamble 3 2. Introduction 7 3. Definition, epidemiology and prognosis 8 3.1 Definition of heart failure 8 3.2 Terminology 9 3.2.1 Heart failure with preserved, mid-range and reduced ejection fraction 9 3.2.2 Terminology related to the time-course of heart failure 9 3.2.3 Terminology related to the symptomatic severity of heart failure 10 3.3 Epidemiology, aetiology and natural history of heart failure 10 3.4 Prognosis 10 4. Diagnosis 10 4.1 Symptoms and signs 10 4.2 Essential initial investigations: natriuretic peptides, electrocardiogram, echocardiography 11 4.3 Algorithm for the diagnosis of heart failure 12 4.3.1 Algorithm for the diagnosis of heart failure in non-acute setting 12 4.3.2 Diagnosis of heart failure with preserved ejection fraction 12 5. Cardiac imaging and other diagnostic tests 14 5.1 Chest X-ray 14 5.2 Transthoracic echocardiography 14 5.2.1 Assessment of left ventricular systolic function 14 5.2.2 Assessment of left ventricular diastolic function 15 5.2.3 Assessment of right ventricular function and pulmonary arterial pressure 15 5.3 Transoesophageal echocardiography 15 5.4 Stress echocardiography 15 5.5 Cardiac magnetic resonance 15 5.6 Single-photon emission computed tomography and radionuclide ventriculography 15 5.7 Positron emission tomography 15 5.8 Coronary angiography 16 5.9 Cardiac computed tomography 16 5.10 Other diagnostic tests 17 5.10.1 Genetic testing in heart failure 17 6. Delaying or preventing the development of overt heart failure or preventing death before the onset of symptoms 18 7. Pharmacological treatment of heart failure with reduced ejection fraction 19 7.1 Objectives in the management of heart failure 19 7.2 Treatments recommended in all symptomatic patients with heart failure with reduced ejection fraction 20 7.2.1 Angiotensin-converting enzyme inhibitors 20 7.2.2 Beta-blockers 20 7.2.3 Mineralocorticoid/aldosterone receptor antagonists 20 7.3 Other treatments recommended in selected patients with symptomatic heart failure with reduced ejection fraction 20 7.3.1 Diuretics 20 7.3.2 Angiotensin receptor neprilysin inhibitor 23 7.3.3 If-channel inhibitor 24 7.3.4 Angiotensin II type I receptor blockers 24 7.3.5 Combination of hydralazine and isosorbide dinitrate 24 7.4 Other treatments with less-certain benefits in patients with symptomatic heart failure with reduced ejection fraction 24 7.4.1 Digoxin and other digitalis glycosides 24 7.4.2 n-3 polyunsaturated fatty acids 25 7.5 Treatments not recommended (unproven benefit) in patients with symptomatic heart failure with reduced ejection fraction 25 7.5.1 3-Hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (‘statins') 25 7.5.2 Oral anticoagulants and antiplatelet therapy 25 7.5.3 Renin inhibitors 25 7.6 Treatments not recommended (believed to cause harm) in patients with symptomatic heart failure with reduced ejection fraction 26 7.6.1 Calcium-channel blockers 26 8. Non-surgical device treatment of heart failure with reduced ejection fraction 26 8.1 Implantable cardioverter-defibrillator 26 8.1.1 Secondary prevention of sudden cardiac death 26 8.1.2 Primary prevention of sudden cardiac death 27 8.2 Cardiac resynchronization therapy 28 8.3 Other implantable electrical devices 29 9. Treatment of heart failure with preserved ejection fraction 29 9.1 Effect of treatment on symptoms in heart failure with preserved ejection fraction 30 9.2 Effect of treatment on hospitalization for heart failure in heart failure with preserved ejection fraction 30 9.3 Effect of treatment on mortality in heart failure with preserved ejection fraction 30 9.4 Other considerations 30 10. Arrhythmias and conductance disturbances 30 10.1 Atrial fibrillation 31 10.1.1 Prevention of atrial fibrillation in patients with heart failure 31 10.1.2 Management of new-onset, rapid atrial fibrillation in patients with heart failure 31 10.1.3 Rate control 31 10.1.4 Rhythm control 32 10.1.5 Thromboembolism prophylaxis 33 10.2 Ventricular arrhythmias 33 10.3 Symptomatic bradycardia, pauses and atrio-ventricular block 34 11. Co-morbidities 35 11.1 Heart failure and co-morbidities 35 11.2 Angina and coronary artery disease 35 11.2.1 Pharmacological management 35 11.2.2 Myocardial revascularization 35 11.3 Cachexia and sarcopenia 36 11.4 Cancer 36 11.5 Central nervous system (including depression, stroke and autonomic dysfunction) 37 11.6 Diabetes 37 11.7 Erectile dysfunction 38 11.8 Gout and arthritis 38 11.9 Hypokalaemia and hyperkalaemia 38 11.10 Hyperlipidaemia 38 11.11 Hypertension 38 11.12 Iron deficiency and anaemia 39 11.13 Kidney dysfunction (including chronic kidney disease, acute kidney injury, cardio-renal syndrome, and prostatic obstruction) 40 11.14 Lung disease (including asthma and chronic obstructive pulmonary disease) 41 11.15 Obesity 41 11.16 Sleep disturbance and sleep-disordered breathing 41 11.17 Valvular heart disease 42 11.17.1 Aortic stenosis 42 11.17.2 Aortic regurgitation 42 11.17.3 Mitral regurgitation 42 11.17.4 Tricuspid regurgitation 42 12. Acute heart failure 43 12.1 Definition and classification 43 12.2 Diagnosis and initial prognostic evaluation 44 12.3 Management 48 12.3.1 Identification of precipitants/causes leading to decompensation which need urgent management 48 12.3.2 Criteria for hospitalization in ward vs. intensive/coronary care unit 49 12.3.3 Management of the early phase 49 12.3.4 Management of patients with cardiogenic shock 54 12.4 Management of evidence-based oral therapies 54 12.5 Monitoring of clinical status of patients hospitalized due to acute heart failure 55 12.6 Criteria for discharge from hospital and follow-up in high-risk period 55 12.7 Goals of treatment during the different stages of management of acute heart failure 55 13. Mechanical circulatory support and heart transplantation 56 13.1 Mechanical circulatory support 56 13.1.1 Mechanical circulatory support in acute heart failure 56 13.1.2 Mechanical circulatory support in end-stage chronic heart failure 56 13.2 Heart transplantation 58 14. Multidisciplinary team management 59 14.1 Organization of care 59 14.2 Discharge planning 61 14.3 Lifestyle advice 61 14.4 Exercise training 61 14.5 Follow-up and monitoring 61 14.6 The older adult, frailty and cognitive impairment 62 14.7 Palliative/end-of-life care 62 15. Gaps in evidence 63 16. To do and not to do messages from the Guidelines 64 17. Web Addenda 65 18. Appendix 1 66 19. References 66 Abbreviations and acronyms ACC/AHA American College of Cardiology/American Heart Association ACCF/AHA American College of Cardiology Foundation/American Heart Association ACE angiotensin-converting enzyme ACEI angiotensin-converting enzyme inhibitor ACS acute coronary syndrome AF atrial fibrillation AHF acute heart failure AHI apnoea/hypopnoea index AIDS acquired immunodeficiency syndrome AKI acute kidney injury Aldo-DHF aldosterone receptor blockade in diastolic heart failure AL amyloid light chain ALT alanine aminotransferase AMI acute myocardial infarction AMICA Atrial fibrillation Management In Congestive heart failure with Ablation ANP A-type natriuretic peptide ANS autonomic nervous system ARB angiotensin receptor blocker ARNI angiotensin receptor neprilysin inhibitor ARVC arrhythmogenic right ventricular cardiomyopathy AST aspartate aminotransferase ASV assisted servo-ventilation ATLAS Assessment of Treatment with Lisinopril And Survival ATTR transthyretin-mediated amyloidosis AV atrio-ventricular AVP arginine vasopressin b.i.d. bis in die (twice daily) BioPACE Biventricular Pacing for Atrio-ventricular Block to Prevent Cardiac Desynchronization BiPAP bilevel positive airway pressure BiVAD biventricular assist device BLOCK-HF Biventricular versus Right Ventricular Pacing in Heart Failure Patients with Atrio-ventricular Block BMI body mass index BNP B-type natriuretic peptide BP blood pressure bpm beats per minute BSA body surface area BTB bridge to bridge BTC bridge to candidacy BTD bridge to decision BTR bridge to recovery BTT bridge to transplantation BUN blood urea nitrogen CABANA Catheter ABlation versus ANtiarrhythmic drug therapy for Atrial fibrillation CABG coronary artery bypass graft/grafting CAD coronary artery disease CARE-HF CArdiac REsynchronization in Heart Failure CASTLE-AF Catheter Ablation versus Standard conventional Treatment in patients with LEft ventricular dysfunction and Atrial Fibrillation CCB calcium-channel blocker CCM cardiac contractility modulation CCS Canadian Cardiovascular Society CCU coronary care unit CHA2DS2-VASc Congestive heart failure or left ventricular dysfunction, Hypertension, Age ≥75 (doubled), Diabetes, Stroke (doubled)-Vascular disease, Age 65–74, Sex category (female) CHARM-Alternative Candesartan in heart failure assessment of reduction in mortality and morbidity CHARM-Added Candesartan Cilexetil in Heart Failure Assessment of Reduction in Mortality and Morbidity CHARM-Preserved Candesartan Cilexetil in Heart Failure Assessment of Reduction in Mortality and Morbidity CI cardiac index CI-AKI contrast-induced acute kidney injury CIBIS II Cardiac Insufficiency Bisoprolol Study II CK creatine kinase CKD chronic kidney disease CK-MB creatine kinase MB CMP cardiomyopathy CMR cardiac magnetic resonance COMPANION Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure CONFIRM-HF Ferric CarboxymaltOse evaluatioN on perFormance in patients with IRon deficiency in coMbination with chronic Heart Failure CONSENSUS Cooperative North Scandinavian Enalapril Survival Study COPD chronic obstructive pulmonary disease COPERNICUS Carvedilol Prospective Randomized Cumulative Survival COX-2 inhibitor cyclooxygenase-2 inhibitor CPAP continuous positive airway pressure CPG Committee for Practice Guidelines CRT cardiac resynchronization therapy CRT-D defibrillator with cardiac resynchronization therapy CRT-P pacemaker with cardiac resynchronization therapy CSA central sleep apnoea CSR Cheyne-Stokes respiration CT computed tomography CYP3A4 cytochrome P450 3A4 DCM dilated cardiomyopathy DES desmin DHA docosahexaenoic acid DIG-PEF ancillary Digitalis Investigation Group trial DNA deoxyribonucleic acid DOSE Diuretic Optimization Strategies Evaluation DPD 3,3-diphosphono-1,2-propanodicarboxylic acid DPP4i dipeptidyl peptidase-4 inhibitor DT destination therapy e′ early diastolic tissue velocity ECG electrocardiogram Echo-CRT Echocardiography Guided Cardiac Resynchronization Therapy ECLS extracorporeal life support ECMO extracorporeal membrane oxygenation ED emergency department EF ejection fraction eGFR estimated glomerular filtration rate EHRA European Heart Rhythm Association EMA European Medicines Agency EMB endomyocardial biopsy EMF endomyocardial fibrosis EMPHASIS-HF Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure EPA eicosapentaenoic acid EPHESUS Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study ESC European Society of Cardiology EU European Union EULAR European League Against Rheumatism Ex-DHF Exercise training in Diastolic Heart Failure FACIT-Pal Functional Assessment of Chronic Illness Therapy - Palliative Care FAIR-HF Ferinject Assessment in Patients with Iron Deficiency and Chronic Heart Failure FCM ferric carboxymaltose FiO2 fraction of inspired oxygen GFR glomerular filtration rate GGTP gamma-glutamyl transpeptidase GH growth hormone GLS global longitudinal strain GLP-1 glucagon-like peptide 1 HAS-BLED Hypertension, Abnormal renal/liver function (1 point each), Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (>65 years), Drugs/alcohol concomitantly (1 point each) HbA1c glycated haemoglobin HCM hypertrophic cardiomyopathy HES hypereosinophilic syndrome HF heart failure HFA Heart Failure Association HFmrEF heart failure with mid-range ejection fraction HFpEF heart failure with preserved ejection fraction HFrEF heart failure with reduced ejection fraction H-ISDN hydralazine and isosorbide dinitrate HIV/AIDS human immunodeficiency virus/acquired immune deficiency syndrome HR heart rate Hs troponin high sensitivity troponin IABP intra-aortic balloon pump IABP-SHOCK IntraAortic Balloon Pump in Cardiogenic Shock IABP-SHOCK II IntraAortic Balloon Pump in Cardiogenic Shock II ICD implantable cardioverter-defibrillator ICU intensive care unit IHD ischaemic heart disease IL interleukin INH Interdisciplinary Network for Heart Failure INTERMACS Interagency Registry for Mechanically Assisted Circulatory Support IN-TIME Implant-based multiparameter telemonitoring of patients with heart failure IPD individual patient data I-PRESERVE Irbesartan in Heart Failure with Preserved Ejection Fraction Study i.v. intravenous IVC inferior vena cava IVRT isovolumetric relaxation time KCCQ Kansas City Cardiomyopathy Questionnaire LA left atrial/atrium LAE left atrial enlargement LAVI left atrial volume index LBBB left bundle branch block LGE late gadolinium enhancement LMNA lamin A/C LMWH low-molecular-weight heparin LV left ventricular/left ventricle LVAD left ventricular assist device LVEDP left ventricular end diastolic pressure LVEDV left ventricular end diastolic volume LVEF left ventricular ejection fraction LVESV left ventricular end systolic volume LVID left ventricular internal dimension LVMI left ventricular mass index LVSD left ventricular systolic dysfunction MADIT-CRT Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy MCS mechanical circulatory support MERIT-HF Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure MR mineralocorticoid receptor/magnetic resonance MRA mineralocorticoid receptor antagonist MR-proANP mid-regional pro A-type natriuretic peptide MV mitral valve MV A-Wave mitral valve late diastolic flow MV E-Wave mitral valve early diastolic flow MYBPC3 cardiac myosin binding protein C MYH7 cardiac β-myosin heavy chain n-3 PUFA n-3 polyunsaturated fatty acid NEP neprilysin NOAC non-vitamin K antagonist oral anticoagulant NP natriuretic peptide NPPV non-invasive positive pressure ventilation NSAID non-steroidal anti-inflammatory drug NSTE-ACS non-ST elevation acute coronary syndrome NT-proBNP N-terminal pro-B type natriuretic peptide NYHA New York Heart Association o.d. omne in die (once daily) OMT optimal medical therapy OSA obstructive sleep apnoea PaCO2 partial pressure of carbon dioxide in arterial blood PAH pulmonary arterial hypertension PaO2 partial pressure of oxygen in arterial blood PARADIGM-HF Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial PARAMOUNT LCZ696 Compared to Valsartan in Patients With Chronic Heart Failure and Preserved Left-ventricular Ejection Fraction PCI percutaneous coronary intervention PCWP pulmonary capillary wedge pressure PDE5I phosphodiesterase 5 inhibitor Peak VO2 peak oxygen uptake PEP-CHF Perindopril in Elderly People with Chronic Heart Failure PET positron emission tomography PLN phospholamban PPV positive pressure ventilation PRISMA 7 seven-item, self-completion questionnaire to identify older adults with moderate to severe disabilities PROTECT II Prospective, Multi-center, Randomized Controlled Trial of the IMPELLA RECOVER LP 2.5 System Versus Intra Aortic Balloon Pump (IABP) in Patients Undergoing Non Emergent High Risk PCI PS-PEEP pressure-support positive end-expiratory pressure PV pulmonary vein PVR pulmonary vascular resistance QALY quality-adjusted life year QRS Q, R, and S waves (combination of three of the graphical deflections) RA right atrium/atrial RAAS renin–angiotensin–aldosterone system RAFT Resynchronization-Defibrillation for Ambulatory Heart Failure Trial RALES Randomized Aldactone Evaluation Study RCT randomized controlled trial RELAX Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Diastolic Heart Failure REVERSE REsynchronization reVErses Remodeling in Systolic left vEntricular dysfunction RV right ventricular/ventricle RVAD right ventricular assist device SADHART Sertraline Antidepressant Heart Attack Randomized Trial SAVE Survival After Veno-arterial ECMO SBP systolic blood pressure SCD-HeFT Sudden Cardiac Death in Heart Failure Trial SDB sleep-disordered breathing SENIORS Study of the Effects of Nebivolol Intervention on Outcomes and Rehospitalisations in Seniors with Heart Failure SERVE-HF Treatment of sleep-disordered breathing with predominant central sleep apnoea with adaptive Servo-ventilation in patients with chronic heart failure SHIFT Systolic Heart failure treatment with the If inhibitor ivabradine Trial SIGNIFY Study Assessing the Morbidity–Mortality Benefits of the If Inhibitor Ivabradine in Patients with Coronary Artery Disease SOLVD Studies of Left Ventricular Dysfunction SPECT single-photon emission computed tomography SpO2 transcutaneous oxygen saturation SPPB Short Physical Performance Battery SPRINT Systolic Blood Pressure Intervention Trial STEMI ST segment elevation myocardial infarction STICH Surgical Treatment for Ischemic Heart Failure STS structured telephone support TAPSE tricuspid annular plane systolic excursion TAVI tran
