In this Q&A, cardiologist and heart failure specialist Dr Alicia Chan* talks in-depth to Australian Doctor Group about the latest treatment updates surrounding global heart failure guidelines and consensus statements, specifically the placement of angiotensin receptor-neprilysin inhibitors (ARNIs)** in the treatment sequencing.

ADG: This year we’ve seen new consensus statements and guidelines from Europe, the US and Canada, among others. Are they broadly united when it comes to the definition and classification of heart failure?

AC: The 2021 consensus statements and guidelines are specifically focused on updates in the management of heart failure with reduced ejection fraction. The cut-off specified for HFrEF is consistent across the board, with a left ventricular ejection fraction <40%.

The earlier guidelines from all three countries have been consistent with the definition and classification of heart failure. The first statement is to recognise that heart failure is a complex clinical syndrome with signs and symptoms occurring because of reduced cardiac output with evidence of pulmonary and systemic congestion. Heart failure is then classified to three categories based on their measured LVEF: HFrEF <40%, HFmrEF (mid-range, recently renamed mildly reduced in ESC Guidelines) 41-49% and HFpEF (preserved EF) 50% and above.