Society guidelines
The 2012 Canadian Cardiovascular Society Heart Failure Management Guidelines Update: Focus on Acute and Chronic Heart Failure

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Abstract

The 2012 Canadian Cardiovascular Society Heart Failure (HF) Guidelines Update provides management recommendations for acute and chronic HF. In 2006, the Canadian Cardiovascular Society HF Guidelines committee first published an overview of HF management. Since then, significant additions to and changes in many of these recommendations have become apparent. With this in mind and in response to stakeholder feedback, the Guidelines Committee in 2012 has updated the overview of both acute and chronic heart failure diagnosis and management. The 2012 Update also includes recommendations, values and preferences, and practical tips to assist the medical practitioner manage their patients with HF.

Résumé

La mise à jour 2012 des Linges directrices sur l'insuffisance cardiaque (IC) de la Société canadienne de cardiologie fournit des recommandations sur la prise en charge de l'IC aiguë et de l'IC chronique. En 2006, le comité des lignes directrices sur l'IC de la Société canadienne de cardiologie a publié pour la première fois un aperçu de la prise en charge de l'IC. Depuis lors, des ajouts et des changements importants à plusieurs de ces recommandations sont devenus nécessaires. À cet égard et en réponse aux commentaires des parties prenantes, le comité des lignes directrices a mis à jour en 2012 l'aperçu du diagnostic et de la prise en charge de l'IC aiguë et l'IC chronique. La mise à jour 2012 inclut également des recommandations, des valeurs et des préférences, ainsi que des conseils pratiques pour aider le praticien à prendre en charge ses patients ayant une IC.

Section snippets

Diagnosis, evaluations, and investigation

The diagnosis of AHF is based on a constellation of symptoms (eg, orthopnea and shortness of breath on exertion) and signs (eg, edema and respiratory crackles).2, 3 Physical examination evaluates systemic perfusion and presence of congestion (cold or warm, wet or dry; Supplemental Figure S1).3, 4, 5, 6 Laboratory testing, electrocardiogram (ECG), chest x-ray, and echocardiogram are all important to obtain.5 A slight mild elevation of cardiac troponin is not infrequently observed in acute

Diagnosis, evaluation, and investigation

The diagnosis of HF is made when symptoms and physical signs of congestion and reduced tissue perfusion are documented in the setting of abnormal systolic and/or diastolic cardiac function.41, 42, 43 Making a diagnosis of HF can be difficult because the cardinal triad of edema, fatigue, and dyspnea are neither sensitive nor specific manifestations and atypical presentations should be recognized particularly when evaluating women, obese patients, and the elderly.41, 42, 43 A history and physical

Acknowledgements

The present consensus conference was supported by the CCS. The authors are indebted to Marie-Josée Martin and Mirela Lukac for logistic and administrative support.

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    The disclosure information of the authors and reviewers is available from the CCS on the following websites: www.ccs.ca and/or www.ccsguidelineprograms.ca.

    This statement was developed following a thorough consideration of medical literature and the best available evidence and clinical experience. It represents the consensus of a Canadian panel comprised of multidisciplinary experts on this topic with a mandate to formulate disease-specific recommendations. These recommendations are aimed to provide a reasonable and practical approach to care for specialists and allied health professionals obliged with the duty of bestowing optimal care to patients and families, and can be subject to change as scientific knowledge and technology advance and as practice patterns evolve. The statement is not intended to be a substitute for physicians using their individual judgment in managing clinical care in consultation with the patient, with appropriate regard to all the individual circumstances of the patient, diagnostic and treatment options available and available resources. Adherence to these recommendations will not necessarily produce successful outcomes in every case.

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