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Three Important New Sets Of Guidelines

Atrial Fibrillation, Myocardial Revascularisation and Devices For Heart Failure.

New AF Guideline From ESC

The European Society of Cardiology (ESC) has published its new Clinical Practice Guidelines covering Atrial Fibrillation (AF). These are the first guidelines to be prepared solely by the ESC. Earlier guidelines on Atrial Fibrillation had been prepared collaboratively with the American Heart Association and the American College of Cardiology, but the divergence in practice, drug treatments and the regulatory environment compared with the US have now made it vital to create a European-specific version.

Atrial Fibrillation is the most common cardiac arrhythmia, affecting over six million Europeans.

The guidelines reflect notable developments in many of the conventional treatments for the condition as well as the very latest techniques to manage it:

  • Rate control strategies for patients with permanent atrial fibrillation
  • New risk profiling to identify patients at risk of stroke
  • Availability of arrhythmic drugs with fewer side-effects
  • More specific indications for the use of ablation treatment
  • Upstream therapies that can halt the progression of the condition.

esc-2010-bProfessor John Camm (St George’s Hospital, London) Chair of the ESC Task Force that developed the highly detailed guidelines. Said that “atrial fibrillation has become an epidemic, and we estimate that around 1 to 2 percent of the total population are affected. This figure is expected to at least double in line with the demographics of an ageing population because it is particularly prevalent amongst older people. We needed to create up-to-date guidelines because of new drug therapies available, and also because accumulated evidence continuously refines the advice on treatment regimens that give the best outcomes.”

ESC Guidelines For Myocardial Revascularisation

The European Society of Cardiology (ESC) has published new Clinical Practice Guidelines covering Myocardial Revascularisation. These guidelines were developed following pioneering and extensive co-operation between the ESC and the European Association of Cardio-Thoracic Surgeons (EACTS). Myocardial Revascularisation.

These guidelines reflect the fact that there are many options available to treat the many forms of coronary artery disease (CAD), both acute and non-acute.  These include surgery, stent implantation and drug therapies, and the options cross traditional boundaries of medicine such as cardiology and surgery.   “Our intention in writing these guidelines was to give patient-centred recommendations that lead to the most appropriate treatment regime for the different types of CAD,” said Doctor William Wijns of the ESC and Co-Chair of the Task Force.  “We also wanted to provide reference materials based on best practice but not conditioned by the skill and preferences of individual physicians. The major challenge faced by physicians is not how to treat the CAD patient, but which of the many treatment options to select.”

The Task Force was made up of 24 experts, drawn equally from surgeons, interventional cardiologists and general cardiologists, and representing the ESC and the EACTS.  The new guidelines are noteworthy for three main reasons:

They are an example of strong co-operation between the ESC and the EACTS, and have proved to very successful in meeting the objectives.

The content addresses the full extent of CAD, and of associated diseases, which was previously covered in separate guidelines, or not at all.

The guidelines introduce the concept of Heart Teams, essentially a grouping from across disciplines ensuring – when practical – that the patient is fully informed and takes part in the key decisions. The heart team should include one of each of the following specialists; interventional cardiologist, clinical cardiologist, and cardiac surgeon.

The guidelines encompass the full extent of CAD treatment and expected outcomes, including managing stable and unstable angina, myocardial infarction, diabetes-related symptoms and associated renal failure.  Recommendations are made on all treatment options, from the technical aspects of stent implantation to the use of imaging technologies, and from risk management to follow-up activities.

The establishment of Heart Teams is a vital recommendation for medical teams everywhere, and formalises the make-up of the multi-discipline team responsible for patient care following CAD treatment.  Co-Chair, Professor Philippe Kolh of the EACTS explains, “It is important that physicians offer patients the opportunity to influence the response to their condition.  Clearly, for acute cases, such flexibility can be difficult to accommodate, but for the 30 percent of patients with stable conditions, it is an important factor. Immediate but less durable treatments such as a stent implantation may not be the right choice for some patients.  Depending on their lifestyle and responsibilities, some may prefer to elect for a surgical procedure that offers a longer-term result.”

Practitioners that will be using the new guidelines, as well as journalists, are offered the opportunity to have an open discussion and Q&A with Doctor Wijns and Professor Kolh and members of the Task Force.  A ‘Meet the Guidelines Task Force’ session takes place on Tuesday 31 August in lecture room Moscow, Zone A starting at 1005hrs.

ESC focused update of the guidelines for Device Therapy in Heart Failure

The European Society of Cardiology (ESC) has published a focused update of its Clinical Practice Guidelines covering Device Therapy in Heart Failure. This is the first time that current ESC guidelines have been updated, reflecting the pace of research in this field and the importance of recently published evidence.

The update is the result of collaboration between ESC Heart Failure Association (HFA) and European Heart Rhythm Association (EHRA),.The update focuses on the use of devices for the treatment of heart failure, with an emphasis on Cardiac Resynchronisation Therapy (CRT). Professor Kenneth Dickstein from Norway and Professor Panos Vardas from Greece were Co-Chairs of the Task Force responsible for developing the original guidelines, and were the natural choices to lead the new Task Force, which was formed of experts drawn equally from the HFA and the EHRA.

“This focused update to the guidelines provides recommendations for the use of devices to treat heart failure and includes the indications in conditions such as atrial fibrillation and those situations in which patients require pacemaker implantation,” says Professor Vardas. “A primary objective was to close some of the gaps in evidence that were apparent when the original guidelines were published.”

The changes made in the guidelines take account of:

Recently published evidence from clinical trials

New developments in device technology and performance

More extensive  understanding of treatment options and responses

The updated guidelines represent a fresh approach to analysing clinical trial outcomes. “In several areas we used a modified methodology to review the outcomes of clinical trials, with an emphasis on the cohort actually recruited for the trial rather than a strict interpretation of the protocol inclusion criteria,” says Professor Dickstein. “This increases the likelihood that the recommendations made are valid for the target patient population. This process impacts on the class of recommendations made and the determination of levels of evidence for therapy for specific patient populations.”

All guidelines can be downloaded from the ESC website at

Published on: September 20, 2010

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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