August 2016 at a glance: the new ESC guidelines, and pathophysiology, epidemiology and prognosis of heart failure

This issue has our new ESC guidelines for the diagnosis and treatment of heart failure (HF).1 Compared with the previous 2012 guidelines, major changes regard the introduction of the new category of patients with mid-range left ventricular ejection fraction (EF), a new algorithm for the diagnosis of HF, the inclusion of new exams for patients’ evaluation, recommendations to prevent or delay the development of overt HF, including antidiabetic treatment with empaglifozin, a new algorithm for HF treatment, with the replacement of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers with an angiotensin receptor neprilysin inhibitor in the patients still symptomatic with a low EF, updated indications to cardiac resynchronization therapy, new evidence regarding treatment of comorbidities and more detailed indications for mechanical circulatory support.1 Treatment of HF with preserved EF (HFpEF) and treatment of acute HF are updated and summarized with new algorithms but, unfortunately, no major change is present, as no new drugs have reached evidence for treatment in these conditions.2,3 A last paragraph with our gaps in evidence and a table with the messages about what to do or not to do in HF nicely summarize both future developments and current evidence.1