Revision Points and Remaining Issues to be Solved in the Updated Guidelines for Treatment of Chronic Heart Failure

Abstract

Heart failure (HF) is a leading cause of morbidity and mortality in developed countries and afflicts more than 55 million people in the united states. Patients with chronic HF manifests progressive cardiac dysfunction that is characterized by either reduced systolic and diastolic left ventricular function, or both of it, with ventricular remodeling, arrhythmia, and intracardiac conduction disturbances. A growing body of evidence indicates that combination of pharmacological and non-pharmacological therapies had been significantly contributed to the improved morbidity and mortality of HF in the last decade. Reflecting those advances in HF-therapy, guidelines for treatment of chronic heart failure (JCS2010) has been updated at the end of year 2010. The new version of the guidelines includes updated information for device therapy for cardiac arrhythmia [implantable cardioverter defibllirator (ICD) and ablation therapy], respiratory support therapy for sleep disordered breathing, cardiac resynchronization therapy(CRT) for patients with wide QRS, surgical intervention for severe congestive heart failure, and newly developed left ventricular assist devices. In addition, disease management program and protocols of exercise and Waon therapy for HF patients were revised or newly added into the guideline. In this Symposium, I will review these revision points and remaining issues to be solved for treatment of chronic heart failure.