Special article
Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: Diagnosis and managementRecommandations de la Conférence consensuelle de la Société canadienne de cardiologie 2006 sur l’insuffisance cardiaque : Diagnostic et prise en charge

https://doi.org/10.1016/S0828-282X(06)70237-9Get rights and content

Heart failure remains a common diagnosis, especially in older individuals. It continues to be associated with significant morbidity and mortality, but major advances in both diagnosis and management have occurred and will continue to improve symptoms and other outcomes in patients. The Canadian Cardiovascular Society published its first consensus conference recommendations on the diagnosis and management of heart failure in 1994, followed by two brief updates, and reconvened this consensus conference to provide a comprehensive review of current knowledge and management strategies.

New clinical trial evidence and meta-analyses were critically reviewed by a multidisciplinary primary panel who developed both recommendations and practical tips, which were reviewed by a secondary panel. The resulting document is intended to provide practical advice for specialists, family physicians, nurses, pharmacists and others who are involved in the care of heart failure patients.

Management of heart failure begins with an accurate diagnosis, and requires rational combination drug therapy, individualization of care for each patient (based on their symptoms, clinical presentation and disease severity), appropriate mechanical interventions including revascularization and devices, collaborative efforts among health care professionals, and education and cooperation of the patient and their immediate caregivers. The goal is to translate best evidence-based therapies into clinical practice with a measureable impact on the health of heart failure patients in Canada.

L’insuffisance cardiaque demeure un diagnostic répandu, surtout chez les sujets âgés. Elle continue d’être associée à une morbidité et à une mortalité importantes, mais de grands progrès ont été accomplis sur les plans du diagnostic et de la prise en charge de la maladie et ils amélioreront encore les symptômes et le pronostic des patients. C’est en 1994 que la Société canadienne de cardiologie a publié son premier rapport consensuel sur le diagnostic et la prise en charge de l’insuffisance cardiaque, suivi de brèves mises à jour; et elle a choisi de répéter l’exercice afin de faire le point de manière globale sur les connaissances et les stratégies thérapeutiques actuelles.

Les conclusions et méta-analyses d’essais cliniques récents ont été analysées par un comité principal pluridisciplinaire qui a formulé ses recommandations et ses conseils pratiques avant de les soumettre à un second comité. Le document qui en résulte vise à guider de manière concrète les spécialistes, médecins de famille, infirmières, pharmaciens et autres intervenants appelés à soigner les insuffisants cardiaques.

La prise en charge de l’insuffisance cardiaque commence par un diagnostic juste et repose sur l’administration de traitements pharmacologiques associatifs, sur une individualisation de l’approche thérapeutique (selon les symptômes, le tableau clinique et la gravité de chaque cas), sur des interventions de type mécanique appropriées, telles que l’angioplastie ou d’autres dispositifs, sur une approche pluridisciplinaire concertée et sur l’enseignement au patient et à ses aidants naturels, pour une meilleure coopération. L’objectif est de transposer dans la pratique clinique les meilleurs traitements issus de la recherche, éprouvés et susceptibles d’exercer un impact véritable sur la santé des insuffisants cardiaques au Canada.

References (171)

  • J. Feenstra et al.

    Drug-induced heart failure

    J Am Coll Cardiol

    (1999)
  • K. Hogg et al.

    Heart failure with preserved left ventricular systolic function. Epidemiology, clinical characteristics, and prognosis

    J Am Coll Cardiol

    (2004)
  • T.E. Owan et al.

    Epidemiology of diastolic heart failure

    Prog Cardiovasc Dis

    (2005)
  • B.M. Massie et al.

    Clinical trials in diastolic heart failure

    Prog Cardiovasc Dis

    (2005)
  • S. Yusuf et al.

    Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: The CHARM-Preserved Trial

    Lancet

    (2003)
  • C.M. Yu et al.

    Right and left ventricular diastolic function in patients with and without heart failure: Effect of age, sex, heart rate, and respiration on Doppler-derived measurements

    Am Heart J

    (1997)
  • G.A. Haldeman et al.

    Hospitalization of patients with heart failure: National Hospital Discharge Survey, 1985 to 1995

    Am Heart J

    (1999)
  • S.A. Hunt et al.

    ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: Executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1995 Guidelines for the Evaluation and Management of Heart Failure)

    J Am Coll Cardiol

    (2001)
  • S.A. Hunt

    American College of Cardiology; American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure)

    J Am Coll Cardiol

    (2005)
  • K.F. Adams et al.

    Characteristics and outcomes of patients hospitalized for heart failure in the United States: Rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE)

    Am Heart J

    (2005)
  • J.L. Januzzi et al.

    The N-terminal Pro-BNP investigation of dyspnea in the emergency department (PRIDE) study

    Am J Cardiol

    (2005)
  • T.P. Dormans et al.

    Diuretic efficacy of high dose furosemide in severe heart failure: Bolus injection versus continuous infusion

    J Am Coll Cardiol

    (1996)
  • J. Dupuis et al.

    Sustained beneficial effect of a seventy-two hour intravenous infusion of nitroglycerin in patients with severe chronic congestive heart failure

    Am Heart J

    (1990)
  • D. Pang et al.

    The effect of positive pressure airway support on mortality and the need for intubation in cardiogenic pulmonary edema: A systematic review

    Chest

    (1998)
  • J.M. Poponick et al.

    Use of a ventilatory support system (BiPAP) for acute respiratory failure in the emergency department

    Chest

    (1999)
  • H. Johansen et al.

    On the rise: The current and projected future burden of congestive heart failure hospitalization in Canada

    Can J Cardiol

    (2003)
  • D.E. Johnstone et al.

    Report of the Canadian Cardiovascular Society's Consensus Conference on the diagnosis and management of heart failure

    Can J Cardiol

    (1994)
  • P. Liu et al.

    The 2001 Canadian Cardiovascular Society consensus guideline update for the management and prevention of heart failure

    Can J Cardiol

    (2001)
  • P. Liu et al.

    The 2002/3 Canadian Cardiovascular Society consensus guideline update for the diagnosis and management of heart failure

    Can J Cardiol

    (2003)
  • A.S. Maisel et al.

    Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure

    N Engl J Med

    (2002)
  • Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels

    (1994)
  • M.F. Piepoli et al.

    Overview of studies of exercise training in chronic heart failure: The need for a prospective randomized multicentre European trial

    Eur Heart J

    (1998)
  • M.F. Piepoli et al.

    ExTraMATCH Collaborative. Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH)

    BMJ

    (2004)
  • I.L. Pina et al.

    Exercise and heart failure: A statement from the American Heart Association Committee on exercise, rehabilitation, and prevention

    Circulation

    (2003)
  • J.A. Stone et al.

    Canadian Association of Cardiac Rehabilitation. Canadian guidelines for cardiac rehabilitation and atherosclerotic heart disease prevention: A summary

    Can J Cardiol

    (2001)
  • Recommendations for exercise testing in chronic heart failure patients

    Eur Heart J

    (2001)
  • It's About Time: Achieving Benchmarks and Best Practices in Wait Time Management

    (2005)
  • F.H. Gwadry-Sridhar et al.

    A systematic review and meta-analysis of studies comparing readmission rates and mortality rates in patients with heart failure

    Arch Intern Med

    (2004)
  • R. Holland et al.

    Systematic review of multidisciplinary interventions in heart failure

    Heart

    (2005)
  • T.D. Bradley et al.

    Continuous positive airway pressure for central sleep apnea and heart failure

    N Engl J Med

    (2005)
  • Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS)

    N Engl J Med

    (1987)
  • Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure

    N Engl J Med

    (1991)
  • Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions

    N Engl J Med

    (1992)
  • J.N. Cohn et al.

    A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure

    N Engl J Med

    (1991)
  • M.A. Pfeffer et al.

    Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators

    N Engl J Med

    (1992)
  • Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure

    Lancet

    (1993)
  • L. Kober et al.

    A clinical trial of the angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. Trandolapril Cardiac Evaluation (TRACE) Study Group

    N Engl J Med

    (1995)
  • The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): A randomised trial. Lancet...
  • MeritH.F.

    Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Interventional Trial in Congestive Heart Failure (MERIT-HF)

    Lancet

    (1999)
  • M. Packer et al.

    Effect of carvedilol on survival in severe chronic heart failure

    N Engl J Med

    (2001)
  • Cited by (341)

    • Device-based treatment of heart failure

      2020, Nanomedicine for Ischemic Cardiomyopathy: Progress, Opportunities, and Challenges
    View all citing articles on Scopus
    View full text