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The document titled "2024 ESC Guidelines for the management of elevated blood pressure and hypertension" provides comprehensive guidelines for the management of high blood pressure and hypertension. It covers various topics such as the pathophysiology and clinical consequences of elevated blood pressure, methods for measuring blood pressure, risk assessment for cardiovascular disease, diagnosing hypertension and investigating underlying causes, prevention and treatment strategies, managing specific patient groups or circumstances, acute and short-term blood pressure management, and patient-centered care. The guidelines aim to provide evidence-based recommendations for healthcare professionals in order to improve the management and prevention of hypertension and its associated complications. [Extracted from the article]

Aims Methods and results Conclusion Real‐world data show that guidelines are insufficiently implemented, and particularly guideline‐directed medical therapies (GDMT) are underused in patients with heart failure and reduced ejection fraction (HFrEF) in clinical practice. The Council for Cardiology Practice and the Heart Failure Association of the European Society of Cardiology (ESC) developed a survey aiming to (i) evaluate the perspectives of the cardiology community on the 2021 ESC heart failure (HF) guidelines, (ii) pinpoint disparities in disease management, and (iii) propose strategies to enhance adherence to HF guidelines.A 22‐question survey regarding the diagnosis and treatment of HFrEF was delivered between March and June 2022. Of 457 physicians, 54% were general cardiologists, 19.4% were HF specialists, 18.9% other cardiac specialists, and 7.7% non‐cardiac specialists. For diagnosis, 52.1% employed echocardiography and natriuretic peptides (NPs), 33.2% primarily used echocardiography, and 14.7% predominantly relied on NPs. The first drug class initiated in HFrEF was angiotensin‐converting enzyme inhibitors/angiotensin receptor–neprilysin inhibitor (ACEi/ARNi) (91.2%), beta‐blockers (BB) (73.8%), mineralocorticoid receptor antagonists (MRAs) (53.4%), and sodium–glucose cotransporter 2 (SGLT2) inhibitors (48.1%). The combination ACEi/ARNi + MRA+ BB was preferred by 39.3% of physicians, ACEi/ARNi + SGLT2 inhibitors + BB by 33.3%, and ACEi/ARNi + BB by 22.2%. The time required to initiate and optimize GDMT was estimated to be <1 month by 8.3%, 1–3 months by 52%, 3–6 months by 31.8%, and >6 months by 7.9%. Compared to general cardiologists, HF specialists/academic cardiologists reported lower estimated time‐to‐initiation, and more commonly preferred a parallel initiation of GDMT rather than a sequential approach.Participants generally followed diagnostic and treatment guidelines, but variations in HFrEF management across care settings or HF specialties were noted. The survey may raise awareness and promote standardized HF care. [ABSTRACT FROM AUTHOR]

The document titled "2024 ESC Guidelines for the management of chronic coronary syndromes" provides comprehensive guidelines for the diagnosis and management of chronic coronary syndromes. It covers various topics such as initial management, diagnostic testing, medical therapy, revascularization options, and treatment for specific patient groups. The guidelines emphasize shared decision-making, patient education, and adherence to healthy lifestyle behaviors. It also highlights the importance of long-term follow-up and care, including strategies to improve medication adherence. These resources can be useful for library patrons conducting research on chronic coronary syndrome and seeking evidence-based guidance on its diagnosis and treatment. [Extracted from the article]

Aims: Recent guidelines recommend four core drug classes (renin–angiotensin system inhibitor/angiotensin receptor–neprilysin inhibitor [RASi/ARNi], beta‐blocker, mineralocorticoid receptor antagonist [MRA], and sodium–glucose cotransporter 2 inhibitor [SGLT2i]) for the pharmacological management of heart failure (HF) with reduced ejection fraction (HFrEF). We assessed physicians' perceived (i) comfort with implementing the recent HFrEF guideline recommendations; (ii) status of guideline‐directed medical therapy (GDMT) implementation; (iii) use of different GDMT sequencing strategies; and (iv) barriers and strategies for achieving implementation. Methods and results: A 26‐question survey was disseminated via bulletin, e‐mail and social channels directed to physicians with an interest in HF. Of 432 respondents representing 91 countries, 36% were female, 52% were aged <50 years, and 90% mainly practiced in cardiology (30% HF). Overall comfort with implementing quadruple therapy was high (87%). Only 12% estimated that >90% of patients with HFrEF without contraindications received quadruple therapy. The time required to initiate quadruple therapy was estimated at 1–2 weeks by 34% of respondents, 1 month by 36%, 3 months by 24%, and ≥6 months by 6%. The average respondent favoured traditional drug sequencing strategies (RASi/ARNi with/followed by beta‐blocker, and then MRA with/followed by SGLT2i) over simultaneous initiation or SGLT2i‐first sequences. The most frequently perceived clinical barriers to implementation were hypotension (70%), creatinine increase (47%), hyperkalaemia (45%) and patient adherence (42%). Conclusions: Although comfort with implementing all four core drug classes in patients with HFrEF was high among physicians, a majority estimated implementation of GDMT in HFrEF to be low. We identified several important perceived clinical and non‐clinical barriers that can be targeted to improve implementation. [ABSTRACT FROM AUTHOR]

For all other aspects concerning the management of patients with diabetes, we refer to the recommendations from diabetes associations, e.g. the European Association for the Study of Diabetes (EASD) or the American Diabetes Association (ADA).[1] These Guidelines offer evidence-based recommendations to manage CV risk in patients with diabetes and provide guidance for the treatment of atherosclerotic cardiovascular disease (ASCVD) in patients with diabetes. The impact of diabetes on peripheral atherosclerosis Diabetes is one of the most important risk factors for the development and progression of atherosclerosis.[[749], [751], [753]] The number of patients with atherosclerosis associated with diabetes is steadily increasing alongside the increasing number of patients with diabetes worldwide. There has not been a specific trial on revascularization strategies in patients with diabetes; however, a review of 56 studies including patients with diabetes suggested higher limb-salvage rates after revascularization (78-85% at 1 year) compared with conservative management.[770] Due to disease progression, long-term follow-up is very important in patients with diabetes and LEAD.[771] 10.1.2. [Extracted from the article]

Background: Multiple micronutrient supplementation has been suggested to have a role on health outcomes in patients with heart failure (HF), but the evidence is inconclusive.Objective: To elucidate the role of multiple micronutrient supplementation in heart failure we performed a comprehensive review of the literature.Methods and Results: The search in databases included PUBMED (until June 2018) to detect randomized controlled trials (RCTs) and meta-analyzes that investigated the impact of micronutrient supplementation in HF.Results: With more than 2357 titles and abstracts reviewed, we included only the studies suitable for the final review. Whether alone or in combination, micronutrients have been found to improve the health outcomes of patients with HF by improving symptoms, work capacity and left ventricular ejection fraction (LVEF), thus increasing the quality of life in these patients.Conclusion: Future studies are needed to document the effects of multiple micronutrient associations in order to include them in nutritional guidelines to increase survival and to improve quality of life in patients with heart failure. [ABSTRACT FROM AUTHOR]

The ESC-HF Long-Term (ESC-HF-LT) Registry is a permanent, prospective, observational study conducted in 211 Cardiology Centers of 21 European and Mediterranean countries, members of the European Society of Cardiology (ESC). The present manuscript aims to assess 1-year outcomes of patients with HF, both acute and chronic, in the subset of patients enrolled in Romania, and to compare to the rest of patients enrolled in the registry. From May 2011 to April 2013, a total of 12 440 patients were enrolled, 40.5% with acute HF and 59.5% with chronic HF. A number of 380 patients were enrolled in 10 Romanian centers, 329 with acute HF and 51 with chronic HF. In Romania, 1-year mortality was substantially higher in patients with acute HF compared to chronic HF patients (22.4% vs 6%), data similar to the rest of European countries. Notably, o proportion of 35.8% of patients with acute HF, have died or have been re-hospitalized during 1-year follow up. Although pharmacological treatments tend to increase over the time, these are underutilized when compared to other European countries. In Romania, utilization of HF device-based therapies is still very low. The ESC-HF-LT registry shows that Romanian patients have similar prognostic characteristics as patients enrolled in other countries. 1-year mortality of patients with acute HF is higher than the mortality of chronic HF patients. [ABSTRACT FROM AUTHOR]

Introduction – In heart failure (HF) anxiety and depression were relatively ignored by researchers, even if the measurement of quality of life (QoL) in these patients have become important tools to quantify disease severity. The objective of the present study was to quantify psychological stress and QoL in patients with chronic stable HF, and correlate the scores obtained with severity of heart failure and vitamin D levels. Materials and methods – The study included 45 patients with HF who performed clinical evaluation, biochemical analysis, echocardiography, determination of quality of life scores according to the Minnesota Living with Heart Failure questionnaire (MLHFQ) and the Hospital anxiety-depression scale (HAD). Results – It was found a significant correlation between the severity of HF versus vitamin D levels (p <0.001), HAD-A scores (p<0.011), HAD-D scores (p<0.033), also for the MLHFQ (p<0.001). The results of the study demonstrated a significant correlation between the MLHFQ scores and levels of vitamin D (p <0.001). Conclusions – The results obtained in this study showed that vitamin D deficiency in patients with chronic heart failure is significantly correlated with the severity of heart failure and decreased quality of life, anxiety and depression and could be used as a marker of increased risk. Keywords: vitamin D, heart failure, quality of life, anxiety, depression. [ABSTRACT FROM AUTHOR]

Biomarkers have been accepted into daily clinical practice for several decades and are now widely used in the fi eld of emergency cardiology, as a tool for quick diagnosis of some acute critical conditions requiring an early and adequate therapeutic approach. At fi rst, they were frowned upon ("guessing in the blood sample") and then they were used indiscriminately (creating a new so-called disease -"troponinitis" etc). Utilization for diagnosis, risk stratifi cation or treatment strategy purposes requires an appropriate selection of the biomarkers, assuming specific variations in different clinical conditions. The development of these biomarkers have often caused another problem concerning the need for a more cautious interpretation, adapted to the type of patient with single-organ vs multi-organ failure who will require a quantitative multimarker high sensitivity approach: in this case point-of-care assessment is not enough. Reviewing the latest European Society of Cardiology (ESC) and European Resuscitation Council (ERC) Guidelines on acute cardio-vascular conditions (ESC Guidelines for STEMI- 2012, ESC Guidelines for acute pulmonary thromboembolism and Guidelines on the diagnosis and treatment of aortic diseases date from 2014, ESC Guidelines for NSTEMI and cardiac arrest from 2015 and ESC/HFA Guidelines for acute heart failure from 2016) we noticed the considerable proportion achieved by biomarkers as components of decision making in diagnostic, prognostic and therapeutic approaches. Some biomarkers are mentioned in almost all of these Guidelines (natriuretic proteins and cardiac troponins), while copeptin, H-FABP and GFD-15 are more and more frequently referenced in different acute critical conditions and obviously, a number of particular biomarkers are specific only to certain acute situations (e.g. NSE, S100B in resuscitation, ST2, adrenomedullin and galactin-3 in heart failure). Clearly, it has lately become difficult to contest the role of biomarkers as biological signals that have to be taken into account in daily practice. [ABSTRACT FROM AUTHOR]

Background -- The patients hospitalized for heart failure decompensation are exposed to a high risk of events during and early after hospitalization. Elevated heart rate represents an important risk factor in this category of patients. Ivabradine is a heart rate reduction agent with benefi cial effects in chronic heart failure. Objectives -- The purpose of this study was to assess the tolerability of early ivabradine administration during the vulnerable phase to unselected hospitalized heart failure patients, in conditions similar to those of current medical practice. Material and methods -- A prospective observational study that included 50 consecutive patients with hospitalized systolic heart failure, sinus rhythm and heart rate >70 b/min in whom ivabradine was administered during hospitalization or early after discharge. Clinical data, echocardiography, follow-up events were recorded at baseline and after 6 months of follow-up. Results -- Mean age was 60 ± 12 years, heart failure etiology was ischemic in 23 patients (46%) and nonischemic in 27 patients (54%). At baseline 26 patients were in NYHA class III and 24 patients in NYHA class IV, left ventricular ejection fraction was 26±7% and mean resting heart rate was 89±9 b/min. Ivabradine was initiated in the hospital in 35 patients (70%) and early after discharge in 15 P (30%). Concomitant heart failure therapy at baseline consisted of ACE inhibitors/ARBs in 41 patients (82%), betablockers in 46 patients (92%), furosemide in 50 patients (100%), spironolactone in 40 patients (80%), digoxin in 4 patients (8%). After 6 months of follow-up NYHA class improved signifi cantly (no patient in NYHA class IV, 14 patients in NYHA class III and 34 patients in NYHA class II), heart rate decreased significantly (71±11 b/min, p <0.0001) and LVEF increased by 5% (31±8%, p=0.007). At 6 months daily ivabradine dose was 5 mg in 5 patients, 7.5 mg in 1 patient, 10 mg in 26 patients and 15 mg in 15 patients. Ivabradine treatment had to be stopped due to intolerance in 3 patients (6%), bradycardia needing dose reduction was noted in 4 patients (8%) and atrial fibrillation during follow-up occurred in 2 patients (4%). There were no signifi cant differences concerning tolerability according to the moment of ivabradine initiation. Readmissions due to heart failure aggravation were noted in 10 patients (20%), 4 deaths were recorded (8%). Conclusions -- Early initiation of ivabradine therapy in patients hospitalized for decompensated heart failure, before discharge or early after discharge, is well tolerated. [ABSTRACT FROM AUTHOR]

Flow-mediated dilation (FMD) of the brachial artery and intima-media thickness (IMT) of the carotid artery are two parameters that can measure subclinical atherosclerosis. The purpose of this study was to elucidate the relationship between endothelial dysfunction in the brachial artery and intima-media thickness of the carotid artery in hypertensive patients. The study comprised 115 patients divided in three groups: 40 hypertensive patients with atherogenic dyslipidemia (HTA+DYS), 35 hypertensive patients without atherogenic dyslipidemia (HTADYS) and 40 controls subjects (CON), age and sex-matched, from IVth Medical Clinic of University of Medicine and Pharmacy “Victor Babes” Timisoara, Romania. Endothelial function was determined using ultrasonography to measure the FMD of the brachial artery that was expressed as the percentage change from the baseline diameter of the brachial artery (FMD %). The carotid intima-media thickness was assessed by high resolution B-mode ultrasound imaging according to the Mannheim Consensus. HTN+DYS group had a significantly greater carotid IMT than CON group (0.76±0.06 versus 0.64±0.05 mm, p<0.001) and HTN-DYS group than CON group (0.73±0.09 versus 0.64±0.05 mm, p<0.001). We found a significant negative correlation between the carotid intima-media thickness and brachial FMD in all patients (r=- 0.29, p<0.001).The study revealed that hypertensive patients had increased carotid IMT and decreased brachial FMD, independent of the presence of atherogenic dyslipidemia. B-mode ultrasonography of the carotid artery and flow-mediated vasodilatation of brachial artery have a potential role for evaluation of subclinical atherosclerosis in hypertensive patients. [ABSTRACT FROM AUTHOR]

The metabolic syndrome (MS) is a clinical concept that comprises a cluster of risk factors like arterial hypertension, obesity and high cholesterol in the same patient. The aim of this study was to investigate whether the metabolic syndrome is related to the extent of vascular damage evaluated by carotid intima-media thickness. Our study comprised two groups: the first group of 50 hypertensive patients (aged 56 ± 5.60 years) and the second group of 41 hypertensive patients with metabolic syndrome (aged 56 ± 3.62 years). MS was defined by the National Cholesterol Education Program Adult Treatment Panel III guidelines. In all the patients we determined intima-media thickness by B-mode ultrasound technicque and acoording to the Mannheim Consensus. We observed in patients of the second group significantly increased values for anthropometric parameters such as body mass index (p<0.001), waist circumference (p<0.001) and waist-hip ratio (p<0.001) compared to the first group. The differences between groups considering the levels of total cholesterol (p<0.001), triglycerides (p<0.001), LDL-cholesterol (p<0.001), and HDL-cholesterol (p<0.001) were also statistically significant. The patients from the second group had significantly increased carotid IMT values compared to the patients from the first group (1.27±0.03 mm vs. 1.00±0.03 mm, p<0.001). The study revealed that metabolic syndrome is associated with structurally-functional changes of arterial vessels (increased IMT). [ABSTRACT FROM AUTHOR]

Mobile health (mHealth) solutions have the potential to improve self-management and clinical care. For successful integration into routine clinical practice, healthcare professionals (HCPs) need accepted criteria helping the mHealth solutions' selection, while patients require transparency to trust their use. Information about their evidence, safety and security may be hard to obtain and consensus is lacking on the level of required evidence. The new Medical Device Regulation is more stringent than its predecessor, yet its scope does not span all intended uses and several difficulties remain. The European Society of Cardiology Regulatory Affairs Committee set up a Task Force to explore existing assessment frameworks and clinical and cost-effectiveness evidence. This knowledge was used to propose criteria with which HCPs could evaluate mHealth solutions spanning diagnostic support, therapeutics, remote follow-up and education, specifically for cardiac rhythm management, heart failure and preventive cardiology. While curated national libraries of health apps may be helpful, their requirements and rigour in initial and follow-up assessments may vary significantly. The recently developed CEN-ISO/TS 82304-2 health app quality assessment framework has the potential to address this issue and to become a widely used and efficient tool to help drive decision-making internationally. The Task Force would like to stress the importance of co-development of solutions with relevant stakeholders, and maintenance of health information in apps to ensure these remain evidence-based and consistent with best practice. Several general and domain-specific criteria are advised to assist HCPs in their assessment of clinical evidence to provide informed advice to patients about mHealth utilization., Competing Interests: Conflict of interest: G.B. declares payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Bayer, Boston, Boehringer Ingelheim, Daiichi-Sankyo, Janssen, Sanofi. L.N. reports grants or contracts through her institution from Daiichi Sankyo; under 1000 USD personal honoraria from Pfizer-BMS. A.G.F. reports grant support from the European Union Horizon Europe programme for the CORE MD project (agreement 965246); being the Chairman, Regulatory Affairs Committee, Biomedical Alliance in Europe. F.D. Reports being a task force member for the European Society of Cardiology; support for attending meetings and/or travel by the BSI/TeamNB as a technical specialist; fiduciary role in Team NB as a technical specialist from BSI. A.B. reports Abiomed scientific grant (76445733); royalties or licences from Seerling Ltd; Support for attending meetings and/or travel from Pfizer for the ESC congress 2023; being a member of the Librexia ACS trial steering committee. E.G.C. reports a grant in the form of a <1K€ payment to his institution from the Advisory Board on digital Health of Medtronic USA; honoraria for presentations or educational events (total <10k€) from Servier, Summeet Srl, Dynamicom Education Srl, UVET GBT Spa, Sanofi; support for attending meetings and/or travel from the European Society of Cardiology. R.C. declares personal payments for lectures, presentations, speakers bureaus, manuscript writing or educational events from Boehringer Ingelheim, Servier, Novartis, BerlinChemie, Zentiva, Viatris, Pfizer, Astra Zeneca; support for attending meetings and/or travel from Novartis Berlin-Chemie, Astra Zeneca, Boehringer Ingelheim; participation on a Data Safety Monitoring Board or Advisory Board for Boehringer Ingelheim; receipt of drug samples from Astra Zeneca and Boehringer Ingelheim. D.A.L. declares grants or contracts to her institution from Bristol-Myers Squibb and Pfizer; consulting fees from Bristol-Myers Squibb (BMS) and Boehringer Ingelheim; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Bayer, BMS-Pfizer, Boehringer Ingelheim. G.R. declares consulting fees paid to the University no value transfer from Astra Zeneca, Bayer, Boehringer Ingelheim, Vifor, Menarini; Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events to the university no value transfer from Astra Zeneca, Bayer, Boehringer Ingelheim, Vifor, Menarini; support for attending meetings and/or travel from Fondazione Menarini, Servier, Astra Zeneca. P.H declares Horizon Europe Label2Enable project payments to the Leiden University Medical center and to be the lead expert of CEN-ISO/TS 82304-2 with no financial ties or royalties for CEN TC251; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events covered by Label2Enable project; payment for expert testimony for the Advanced and Active Living project for project reviews; support for attending meetings and/or travel from, the American Society of Clinical Oncology in 2019 as a patient advocate; being the unpaid initiator and driver of two health apps in oncology (ReMind app and Goings-On app). R.A. reports <100 € of royalties or licences from Springer-Verlag GmbH; a 750 EUR payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from the Univers Formazione SRL Roma; participation on a Data Safety Monitoring Board or Advisory Board of Resilience Trial. H.P.B.LR. declares support for the present manuscript in the form of INTERREG-NWE project NWE702; PASSION-HF grants to his institution; grants or contracts from Dutch Heart Foundation CVON 2018-28, ZONMW IMDI 104022004, Vifor Pharma, and Roche Diagnostics to his institution; consulting fees from Novartis Pharma, Boehringer-Ingelheim, AstraZeneca, Roche Diagnostics, Vifor Pharma to his institution; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events to his institution from Novartis, Roche Diagnostics; payment for expert testimony to his institution from Novartis; being on Committee on pharmacological treatment of the Dutch Society of Cardiology. K.M.R. declares payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Biosense Webster; support for attending meetings and/or travel to/from the European Heart Rhythm Association; being on the board of the European Heart Rhythm Association. E.T.L. declares a professional personal contract (2019–today) as a Senior Consultant with the IRCCS Policlinico San Donato and a professional personal contract (2003–today) as a Senior Consultant with the Italian National Health System—Lombardy Region, support for attending meetings and/or travel to/from the Japanese Heart Rhythm Society (July 2023). M.R.C. Reports having been the chair of the ESC Digital Health Committee in the period 2018–2022; being employed by AstraZeneca. G.P. declares honorariums for lectures from Omron Health Care and Somnomedics. P.S. declares payment or honorariums for educational events from Novartis and Polpharma. R.C.A. declares payment for lectures made to his institution by Abbot and Boston Scientific. CP declares honorariums for educational cardio-oncology presentations from Amgen and Beigene. P.D., S.C., A.S., C.O.M., B.B., M.S., H.K., declare no conflict of interest for this contribution., (© European Society of Cardiology 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

The Council for Cardiology Practice of the European Society of Cardiology (ESC), in collaboration with the Digital Health Committee (DHC), undertook an electronic survey with 15 question multiple-choice questionnaire sent to 32 461 members of the ESC with the aim to assess the knowledge and usage of digital health (DH) technologies (DHTs) by office-based cardiologists. Of 559 respondents, 57% graded their knowledge about DH as 'fair' and three quarters identified the correct definition of DH. Clinical information systems, mHealth Apps, and telemedicine were the most frequently used DHTs, but 41% of respondents had concerns about their ethical and data transparency. Lack of legal clarity, low patient motivation, limited DH literacy, and poor access to DH were perceived as the main barriers to the adoption of DH. Seventy percent of the respondents were aware of the DH pages on the ESC website and 76% of the educational sessions in the DH area during the ESC Congress 2019. Only 16% had not read articles on DH. Eight-eight percent of responders declared that they would 'probably' or definitely attend future educational initiatives on DHT., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Unlabelled: The beta blockers (BB) being less prescribed in elderly patients (P) with heart failure (HF), the aim of this study was to assess the effectiveness and tolerance of BB (meteoprolol, bisoprolol or carvedilol) given on the top of the conventional therapy in HF due to LV systolic dysfunction in P > or = 70 year (n=57, group 1) and < 70 year (n=101, group 2). Differences in baseline clinical characteristics between the 2 groups were not significant. The BB doses given in group 1 P was lower but the difference was significant for bisoprolol only. Intolerance to BB imposing withdrawal occurred in 12% of group 1 P and in 10% group 2 P (p>0.05). Symptomatic improvement expressed as a significant decreases in NYHA class was observed in both groups. Readmission for worsening HF was needed in 42% vs. 39% while 1 year mortality rate was 11.4% vs. 10.4% in group 1 and 2 P respectively (p>0.05)., Conclusion: BB are tolerated and seem to be effective in most elderly P with HF. Therefore, BB should be tried in all HF P without contraindication irrespective of age.