Updated European (2021) and American (2022) classifications of chronic heart failure: what is important for the practitioner

Abstract

Since 2017, the Recommendations of the Association of Cardiologists of Ukraine (ACU) on the diagnosis and treatment of chronic heart failure (CHF) have been in force in Ukraine since 2017, and will require another update in 2022. It seems appropriate to analyze the recently updated international recommendations for the classification of CHF, in particular the classifications of the European Society of Cardiology (ESC) updated in 2021, and in 2022 — the American College of Cardiology/American Heart Association/American Heart Failure Society (ACC/AHA/HFSA). The aim. To analyze the updated European (2021 ESC) and American (2022 ACC/AHA/HFSA) classifications of HF with the aim of their effective implementation in clinical practice. Results. In the updated Guidelines 2021 ESC and 2022 AHA/ACC/HFSA, as in previous, experts recommend using the unchanged classification of the severity of HF according to the functional classes of the New York Heart Association (NYHA), which is based on the assessment of the dynamics of HF symptoms when performing patients of physical exertion. As in the previous classification, ESC cardiologists in 2021 recommend distinguishing 3 types of HF, depending on the size of the left ventricular ejection fraction (LVEF) according to echocardiography data: 1) HF with reduced LVEF (<40%); 2) HF with moderately reduced LVEF (41-49%); 3) HF with preserved LVEF (>50%). In the 2022 AHA/ACC/HFSA guidelines, in addition to these types, it is recommended to distinguish another variant of HF — HF with improved LVEF and to refer to this variant HF patients with reduced LVEF, in whom LVEF increased from <40% to >41-49%. However, as the authors note, these changes can be temporary and do not significantly affect either the course of HF or its prognosis. The classification of heart failure by stage and variant proposed in the 2022 AHA/ACC/HFSA classification requires improvement before their implementation into general clinical practice. Conclusion. The analysis showed that, unlike the American ones, the European guideline for the diagnosis and treatment of acute and chronic HF recommend using the practice-proven classification of CHF depending on the value of LVEF, and its severity should be assessed according to NYHA functional classes, therefore, if this year in Ukraine association of cardiologists will not update the CHF classification, then Ukrainian doctors can be recommended to implement the recently updated 2021 ESC guideline in their practice.