65 research outputs found
Corrigendum to "2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk" [Atherosclerosis 290 (2019) 140-205].
No full text2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation--developed with the special contribution of the European Heart Rhythm Association
No full text2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation--developed with the special contribution of the European Heart Rhythm Association
No full text2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes
No full textCoronary artery disease (CAD) is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial arteries, whether obstructive or non-obstructive. This process can be modified by lifestyle adjustments, pharmacological therapies, and invasive interventions designed to achieve disease stabilization or regression. The disease can have long, stable periods but can also become unstable at any time, typically due to an acute atherothrombotic event caused by plaque rupture or erosion. However, the disease is chronic, most often progressive, and hence serious, even in clinically apparently silent periods. The dynamic nature of the CAD process results in various clinical presentations, which can be conveniently categorized as either acute coronary syndromes (ACS) or chronic coronary syndromes (CCS). The Guidelines presented here refer to the management of patients with CCS. The natural history of CCS is illustrated in Figure 1
Corrigendum to “2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk” (Atherosclerosis (2019) 290 (140–205), (S0021915019314595), (10.1016/j.atherosclerosis.2019.08.014))
No full textIn row 4 of Table 3, ‘should’ should read as ‘may’; In 4.2.1, paragraph 3, ‘should’ should read ‘may’ to read ‘Overall, CAC score assessment with CT may be considered in individuals … ’ Also in the second row of ‘Recommendations for cardiovascular imaging for risk assessment of atherosclerotic cardiovascular disease,’ the Class should read ‘llb’; In the second paragraph of 7.5.2, ‘5–10 mg of monacolin K’ should read ‘2.5–10 mg’; and in the Key messages section, number 4, ‘ApoB may be a better measure of an individual's exposure to atherosclerotic lipoproteins' should read ‘ApoB may be a better measure of an individual's exposure to pro atherogenic lipoproteins'
Managing atrial fibrillation in the global community: The European perspective.
No full textAtrial fibrillation is a common, global problem, with great personal, economic and social burdens. As populations age it increases in prevalence and becomes another condition that requires careful chronic management to ensure its effects are minimised. Assessment of the risk of stroke using well established risk prediction models is being aided by modern computerised databases and the choice
of drugs to prevent strokes is ever expanding to try and improve the major cause of morbidity in AF. In addition, newer drugs for controlling rhythm are available and guidelines are constantly changing to reflect this. As well as medications, modern techniques of electrophysiology are becoming more widely embraced worldwide to provide more targeted treatment for the underlying pathophysiology. In this review we consider these factors to concisely describe how AF can be successfully managed
2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes
No full textGuidelines evaluate and summarize available evidence, with the aim of assisting health professionals in proposing the best diagnostic or therapeutic approach for an individual patient with a given condition. Guidelines are intended for use by health professionals and the European Society of Cardiology (ESC) makes its Guidelines freely available.
ESC Guidelines do not override the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient or the patient’s caregiver where appropriate and/or necessary. It is also the health professional’s responsibility to verify the rules and regulations applicable in each country to drugs and devices at the time of prescription, and, where appropriate, to respect the ethical rules of their profession.
ESC Guidelines represent the official position of the ESC on a given topic and are regularly updated. ESC Policies and Procedures for formulating and issuing ESC Guidelines can be found on the ESC website (https://www.escardio.org/Guidelines).
The Members of this Task Force were selected by the ESC to represent professionals involved with the medical care of patients with this pathology. The selection procedure aimed to include members from across the whole of the ESC region and from relevant ESC Subspecialty Communities. Consideration was given to diversity and inclusion, notably with respect to gender and country of origin. The Task Force performed a critical evaluation of diagnostic and therapeutic approaches, including assessment of the risk-benefit ratio. The strength of every recommendation and the level of evidence supporting them were weighed and scored according to pre-defined scales as outlined below. The Task Force followed ESC voting procedures, and all approved recommendations were subject to a vote and achieved at least 75% agreement among voting members.
The experts of the writing and reviewing panels provided declaration of interest forms for all relationships that might be perceived as real or potential sources of conflicts of interest. Their declarations of interest were reviewed according to the ESC declaration of interest rules and can be found on the ESC website (http://www.escardio.org/Guidelines), and have been compiled in a report published in a supplementary document with the guidelines. The Task Force received its entire financial support from the ESC without any involvement from the healthcare industry.
The ESC Clinical Practice Guidelines (CPG) Committee supervises and co-ordinates the preparation of new guidelines and is responsible for the approval process. ESC Guidelines undergo extensive review by the CPG Committee and external experts, including members from across the whole of the ESC region and from relevant ESC Subspecialty Communities and National Cardiac Societies. After appropriate revisions, the guidelines are signed off by all the experts involved in the Task Force. The finalized document is signed off by the CPG Committee for publication in the European Heart Journal. The guidelines were developed after careful consideration of the scientific and medical knowledge and the evidence available at the time of their writing. Tables of evidence summarizing the findings of studies informing development of the guidelines are included. The ESC warns readers that the technical language may be misinterpreted and declines any responsibility in this respect.
Off-label use of medication may be presented in the current Guidelines if a sufficient level of evidence shows that it can be considered medically appropriate for a given condition. However, the final decisions concerning an individual patient must be made by the responsible health professional giving special consideration to:
The specific situation of the patient. Unless otherwise provided for by national regulations, off-label use of medication should be limited to situations where it is in the patient’s interest with regard to the quality, safety, and efficacy of care, and only after the patient has been informed and has provided consent.
Country-specific health regulations, indications by governmental drug regulatory agencies, and the ethical rules to which health professionals are subject, where applicable
Persistent hypertriglyceridemia in statin-treated patients with type 2 diabetes mellitus
No full textPurpose: This paper reports the results of an audit that assessed the prevalence of residual hypertriglyceridemia and the potential need for intensified management among patients with statin-treated type 2 diabetes mellitus (T2DM) in primary care in the UK.
Patients and methods: A cross-sectional, observational, systematic audit of patients with diagnosed diabetes from 40 primary care practices was undertaken. The audit collected basic demographic information and data on prescriptions issued during the preceding 4 months. T2DM patients were stratified according to the proportion that attained European Society of Cardiology treatment targets.
Results: The audit collected data from 14,652 patients with diagnosed diabetes: 89.5% (n = 13,108) of the total cohort had T2DM. Of the people with T2DM, 22.2% (2916) were not currently receiving lipid-lowering therapy. Up to approximately 80% of these people showed evidence of dyslipidemia. Among the group that received lipid-lowering therapy, 94.7% (9647) were on statin monotherapy, which was usually simvastatin (69.5% of patients receiving statin monotherapy; 6707). The currently available statins were prescribed, with the most common dose being 40 mg simvastatin (44.2%; 4267). Irrespective of the statin used, around half of the patients receiving statin monotherapy did not attain the European Society of Cardiology treatment targets for triglycerides, low-density lipoprotein, high-density lipoprotein, and total cholesterol.
Conclusion: T2DM patients managed in UK primary care commonly show persistent lipid abnormalities. Clinicians need to optimize compliance with lipid-lowering and other medications. Clinicians also need to consider intensifying statin regimens, prescribing additional lipid-modifying therapies, and specific treatments aimed at triglyceride lowering to improve dyslipidemia control in statin-treated patients with T2DM
ESC Guidelines for the management of grown-up congenital heart disease (new version 2010)
No full textGuidelines summarize and evaluate all currently available evidence ona
particular issuewith the aimof assisting physicians in selecting the best
management strategies for an individual patient, suffering from a given
condition, taking into account the impact on outcome, as well as the
risk–benefit ratio of particular diagnostic or therapeutic means.
Guidelines are no substitutes for textbooks, and their legal implications
have been discussed previously. Guidelines and recommendations
should help physicians to make decisions in their daily practice.
However, the ultimate judgement regarding the care of an individual
patient must be made by his/her responsible physician(s).
A large number of Guidelines have been issued in recent years by
the European Society of Cardiology (ESC) as well as by other
societies and organizations. Because of the impact on clinical practice,
quality criteria for the development of guidelines have been established in order to make all decisions transparent to the user.
The recommendations for formulating and issuing ESC Guidelines
can be found on the ESC Web Site (http://www.escardio.org/
guidelines-surveys/esc-guidelines/about/Pages/rules-writing.aspx).
Members of this Task Force were selected by the ESC to represent
all physicians involved with the medical care of patients in
this pathology. In brief, experts in the field are selected and undertake
a comprehensive review of the published evidence for management
and/or prevention of a given condition. A critical evaluation of
diagnostic and therapeutic procedures is performed, including
assessment of the risk–benefit ratio. Estimates of expected health
outcomes for larger populations are included, where data exist.
The level of evidence and the strength of recommendation of particular
treatment options are weighed and graded according to predefined
scales, as outlined in Tables 1 and 2.
The experts of the writing and reviewing panels have provided
disclosure statements of all relationships they may have which
might be perceived as real or potential sources of conflicts of interest.
These disclosure forms have been compiled into one file and can
be found on the ESCWeb Site (http://www.escardio.org/guidelines).
Any changes in disclosures of interest that arise during the writing
period must be notified to the ESC. The Task Force report received
its entire financial support from the ESC without any involvement
from the pharmaceutical, device, or surgical industry.
The ESC Committee for Practice Guidelines (CPG) supervises
and coordinates the preparation of new Guidelines produced by
Task Forces, expert groups, or consensus panels. The Committee
is also responsible for the endorsement process of these Guidelines.The finalized document has been approved by all the experts
involved in the Task Force, and was submitted to outside specialists
for review. The document was revised, and finally approved by and
subsequently published in the European Heart Journal.
After publication, dissemination of the message is of paramount
importance. Pocket-sized versions and personal digital assistant
(PDA) downloadable versions are useful at the point of care.
Some surveys have shown that the intended end-users are sometimes
unaware of the existence of guidelines, or simply do not translate
them into practice, so this is why implementation programmes
for new guidelines form an important component of the dissemination
of knowledge. Meetings are organized by the ESC, and directed
towards its member National Societies and key opinion leaders in
Europe. Implementation meetings can also be undertaken at national
levels, once the guidelines have been endorsed by the ESC member
societies, and translated into the national language. Implementation
programmes are needed because it has been shown that the
outcome of disease may be favourably influenced by the thorough
application of clinical recommendations.
Thus, the task of writing guidelines covers not only the integration
of the most recent research, but also the creation of educational
tools and implementation programmes for the recommendations.
The loop between clinical research, writing of guidelines, and implementing
them in clinical practice can then only be completed if
surveys and registries are performed to verify that real-life daily practice
is in keeping with what is recommended in the guidelines. Such
surveys and registries also make it possible to evaluate the impact
of implementation of the guidelines on patient outcomes. The guidelines
do not, however, override the individual responsibility of health
professionals to make appropriate decisions in the circumstances of
the individual patients, in consultation with that patient, and where
appropriate and necessary the patient’s guardian or carer. It is also
the health professional’s responsibility to verify the rules and regulations
applicable to drugs and devices at the time of prescription
2010 Focused Update of ESC Guidelines on device therapy in heart failure: An update of the 2008 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure and the 2007 ESC Guidelines for cardiac and resynchronization therapy * Developed with the special contribution of the Heart Failure Association and the European Heart Rhythm Association
No full textThe Committee for Practice Guidelines (CPG) of the European Society of Cardiology recognizes that new evidence from clinical research trials may impact on current recommendations. The current heart failure (HF) guidelines1 were published in 2008 and the cardiac pacing guidelines in 2007.2 In order to keep these guidelines up to date, it would be appropriate to modify the recommendations and levels of evidence according to the most recent clinical trial evidence. This Focused Update on the use of devices in heart failure 2010 is the first publication of its kind from the CPG.
The text accompanying these recommendations explains and justifies the decisions to diverge from a traditional recommendation based strictly on the protocol inclusion criteria. The Task Force hopes that the users of the Guidelines will appreciate that this adjustment provides a more realistic application of the trial evidence to daily clinical practice
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