Summary
This 2024 ESC-focused update synthesises recent clinical trial evidence and guideline recommendations for heart failure management across the ejection fraction spectrum. Key advances include expanded indications for SGLT2 inhibitors in HF prevention and treatment, introduction of finerenone for diabetic CKD with HF risk, benefits of rapid quadruple therapy up-titration in acute HF, and emerging evidence for semaglutide in obese HFpEF patients. The review also discusses newer agents (vericiguat, mavacamten, tafamidis) and device-based strategies, though acknowledges gaps in evidence for some adjunctive diuretic combinations.
UK applicability
These ESC guideline updates and trial findings are directly applicable to UK clinical practice, as the National Health Service typically adopts ESC guidelines for cardiology. However, implementation may depend on NICE appraisal, drug pricing negotiations, and NHS capacity for intensive follow-up protocols such as the high-intensity care strategy outlined in STRONG-HF.
Key measures
Clinical outcomes from landmark trials (STRONG-HF, STEP-HFpEF-DM, STEP-HFpEF, PUSH-AHF); body weight change, quality of life, 6-minute walk distance, left ventricular ejection fraction classification
Outcomes reported
The paper reviews updated clinical guideline recommendations and trial evidence for heart failure management, including efficacy of SGLT2 inhibitors, finerenone, quadruple therapy, semaglutide, vericiguat, and device therapies across HF subtypes.
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