The Year in Cardiology 2012: heart failure

In 2012 there were a number of important advances within the clinical arena of heart failure. Recent new evidence was dissected, analysed, synthesized, and incorporated into the new European Society of Cardiology Heart Failure Guideline 20121 which will facilitate the translation of clinical research in heart failure into improved patient care. In addition there were new therapeutic treatment trials presented at two of the major scientific meetings, the European Society of Cardiology (ESC) Congress in Munich and most recently, the American Heart Association (AHA) Scientific Sessions in Los Angeles. Interestingly, these focused on two areas of great unmet need in heart failure therapy, acute heart failure (AHF) and heart failure with preserved left ventricular function (HFPEF). This article summarizes the main heart failure highlights of the new guideline and those two meetings. John McMurray and his Task Force produced the new Guideline in time for presentation and publication at the ‘Heart Failure 2012’ meeting in Belgrade, Serbia. This version incorporated the results of 19 new large randomized controlled trials since the previous guideline that was published in 2008 (Figure 1). Regarding the style of the guideline one important change that improves its comprehension for general clinicians is the linking of the class and level of evidence given for treatments to the clinical indication for that therapy, e.g. angiotensin-converting enzyme inhibitors (ACE-I) are given to patients with systolic heart failure to reduce the risk of hospitalization and premature death. This allows comparison with other indications, e.g. reduction in pulmonary capillary wedge pressure for some other therapy recommendations and will be very useful for clinicians assessing the importance of implementing the treatments recommended. The main changes in the new guideline include: 1. An increased role for mineralocorticoid ( aldosterone ) receptor antagonists ( MRA ) . Spironolactone or eplerenone is now recommended for all …