Why the study?
The study was conducted to describe the evolution of the heart failure care pathway and identify its current key components across clinical practice guidelines.
Systematic Review
Over the past two decades, HF clinical practice guidelines have significantly expanded and improved in quality, identifying five key components of care, though the growing volume of recommendations may limit practical applicability.
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Rapid growth in Class I recommendations may limit bedside applicability; extends mapping of HF guideline evolution and core care components.
This study provides a systematic review with narrative synthesis of Heart Failure (HF) Clinical Practice Guidelines (CPGs) published by the European Society of Cardiology (ESC) and the American Heart Association (AHA) between 2000 and 2023. The objective was to describe the evolution of the HF care pathway and to identify its current key components. The review was conducted according to PRISMA 2020 standards and registered in PROSPERO (CRD42024551462). Methodological quality was assessed using the AGREE II instrument, and Class I recommendations were extracted for thematic analysis. Fourteen CPGs were included. Over the past two decades, guideline quality has progressively improved, and the total number of recommendations increased by 344.6%. Five major components of the HF care pathway were identified: initial assessment and diagnosis; pharmacological and non-pharmacological treatment; comorbidity management; multidisciplinary care; and management of acute HF hospitalization. Although CPGs have significantly expanded and refined the structure of optimal HF care, the growing volume of recommendations may limit their practical applicability, highlighting the need for strategies that facilitate implementation within complex healthcare systems.
Raul et al. (2026) conducted a systematic review in Adults (≥18 years old) with heart failure receiving care per ESC/AHA clinical practice guidelines. Clinical Practice Guidelines (CPGs) by European Society of Cardiology and American Heart Association for heart failure management vs. Previous editions of CPGs over time was evaluated on Evolution and quality of heart failure care pathway recommendations in clinical practice guidelines (344.6% increase in total number of recommendations between 2001 and 2021/23 periods). Heart failure clinical practice guidelines by ESC/AHA increased class I recommendations by 344.6%, from 65 in 2001 to 289 in 2021/23, reflecting substantial evolution in care pathways.
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