Special article
Canadian Cardiovascular Society Consensus Conference recommendations on heart failure update 2007: Prevention, management during intercurrent illness or acute decompensation, and use of biomarkersMise à jour des recommandations issues de la Conférence de 2007 de la Société canadienne de cardiologie pour un consensus sur l’insuffisance cardiaque : Prévention, prise en charge lors de maladie intercurrente ou de décompensation aiguë et utilisation des biomarqueurs

https://doi.org/10.1016/S0828-282X(07)70211-8Get rights and content

Heart failure is common, yet it is difficult to treat. It presents in many different guises and circumstances in which therapy needs to be individualized. The Canadian Cardiovascular Society published a comprehensive set of recommendations in January 2006 on the diagnosis and management of heart failure, and the present update builds on those core recommendations.

Based on feedback obtained through a national program of heart failure workshops during 2006, several topics were identified as priorities because of the challenges they pose to health care professionals. New evidence-based recommendations were developed using the structured approach for the review and assessment of evidence adopted and previously described by the Society. Specific recommendations and practical tips were written for the prevention of heart failure, the management of heart failure during intercurrent illness, the treatment of acute heart failure, and the current and future roles of biomarkers in heart failure care.

Specific clinical questions that are addressed include: which patients should be identified as being at high risk of developing heart failure and which interventions should be used? What complications can occur in heart failure patients during an intercurrent illness, how should these patients be monitored and which medications may require a dose adjustment or discontinuation? What are the best therapeutic, both drug and nondrug, strategies for patients with acute heart failure? How can new biomarkers help in the treatment of heart failure, and when and how should BNP be measured in heart failure patients?

The goals of the present update are to translate best evidence into practice, to apply clinical wisdom where evidence for specific strategies is weaker, and to aid physicians and other health care providers to optimally treat heart failure patients to result in a measurable impact on patient health and clinical outcomes in Canada.

L’insuffisance cardiaque est fréquente et pourtant, elle reste difficile à traiter. Elle se manifeste sous des formes et dans des circonstances diverses, ce qui requiert une individualisation du traitement. La Société canadienne de cardiologie a publié en janvier 2006 une série complète de recommandations sur le diagnostic et la prise en charge de l’insuffisance cardiaque et la présente mise à jour se veut donc une version augmentée de ces recommandations de base.

Selon les commentaires obtenus par le biais d’un programme national d’ateliers sur l’insuffisance cardiaque tenus en 2006, plusieurs priorités ont été dégagées en raison des défis qu’elles représentent pour les professionnels de la santé. De nouvelles recommandations fondées sur des preuves ont été rédigées selon une approche structurée de révision et d’évaluation des preuves retenues, préalablement décrite par la Société. Des recommandations et des conseils pratiques spécifiques ont été mis de l’avant pour la prévention de l’insuffisance cardiaque, sa prise en charge lors de maladie intercurrente, le traitement de l’insuffisance cardiaque aiguë et les rôles actuels et futurs des biomarqueurs dans le traitement de l’insuffisance cardiaque.

Les questions cliniques spécifiques abordées ont notamment été les suivantes. Comment détermine-t-on quels patients sont exposés à un risque élevé à l’égard de l’insuffisance cardiaque et quelles interventions doit-on appliquer? Quelles sont les complications susceptibles de survenir chez les insuffisants cardiaques présentant une maladie intercurrente? Comment ces patients doivent-ils être surveillés et quels médicaments devraient être ajustés ou cessés? Quelles sont les meilleures stratégies thérapeutiques pharmacologiques ou non pharmacologiques pour les patients qui souffrent d’insuffisance cardiaque aiguë? Comment les nouveaux biomarqueurs peuvent-ils aider au traitement de l’insuffisance cardiaque et à quel moment et de quelle manière doit-on mesurer le BNP chez les insuffisants cardiaques.

Les objectifs de la présente mise à jour sont d’assurer l’application pratique des preuves les plus concluantes, de promouvoir le jugement clinique lorsque certaines stratégies spécifiques sont moins fructueuses et d’aider les médecins et autres professionnels de la santé à traiter le mieux possible les patients atteints d’insuffisance cardiaque de manière à exercer un impact mesurable sur la santé des patients et sur les résultats cliniques au Canada.

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