Comparison of clinical guidelines for the diagnosis and treatment of chronic heart failure of ČKS and ESC 2012
Abstract
In 2012, the Czech and European clinical guidelines for diagnosis and treatment of heart failure have been issued. The main difference between them is that the European guidelines include both acute and chronic heart failure while our national guidelines contain only chronic heart failure.
They differ even in the definition of heart failure; the European guidelines do not include natriuretic peptides among the diagnostic criteria and response to treatment as an auxiliary criterion in cases of unclear diagnosis. Regarding signs and symptoms of heart failure, both guidelines are similar in this part, they only differ in their categorization.
In diagnosis section, the guidelines vary in certain echocardiographic parameters, particularly of diastolic dysfunction. Cut-off points for natriuretic peptides in chronic heart failure are entirely new in the European guidelines.
For patients presenting in a non-acute way, the optimum cut-off point is 125 pg/mL for NT-proBNP and 35 pg/mL for BNP. Drug groups for treatment of heart failure are similar in both documents.
The European guidelines do not contain perindopril among ACE inhibitors and recommend 5 mg twice daily as the target dose of ramipril while 10 mg once daily is recommended in the Czech guidelines. The target dose of losartan is 100 mg once daily in the Czech guidelines and 150 mg in the European guidelines.
Triamteren and amilorid are among recommended diuretics in the European guidelines, but not in the Czech ones.