Atualização de Tópicos Emergentes da Diretriz Brasileira de Insuficiência Cardíaca – 2021

The latest Heart Failure Guidelines by the Department of Heart Failure of the Brazilian Society of Cardiology (DEIC/SBC) were finalized on March 2018. Since then, a significant number of therapeutic interventions and diagnostic approaches has arisen or consolidated their position in international clinical practice and in clinical research. In addition, the COVID-19 pandemic has taught us much about the pathophysiological model of myocardial damage and raised many questions about the continuity and safety of medication use in patients with chronic HF suffering from an acute manifestation of this new and complex clinical entity. In the last few months, we have been working quickly and collaboratively, and for the first time in 20 years, DEIC used digital platforms to discuss, deliberate, and draft this important document, opting for a focused update instead of a full-text guideline. We were inspired by the 2020 Canadian Heart Failure Guidelines,1 but had the benefit of observing the impact on clinical practice and the consolidation of this new knowledge, in addition to new results from clinical trials published over the last 12 months. In order to report on these developments, we hosted a pioneering scientific conference on September 19, 2020, the I Heart Failure Summit Brazil 2020 (digital), with approximately 900 participants, many of them DEIC associates. The leadership of the Science Board was key in organizing the various working groups and developing a secure and practical method for discussions and votes. With social distancing and the use of digital technology, the conference enabled wide-ranging debates from various perspectives, based on the best available scientific evidence. In this document, DEIC/SBC provides reviews and detailed updates to its Chronic Heart Failure Guidelines. The work started in July 2020, with the choice of the Editorial Board, which established priorities, divided the 52 participants into working groups, and developed a schedule of activities. These working groups, each consisting of five to seven participants, began intense online discussions that led to the elaboration of preliminary tables, widely circulated before their subsequent review by the 11-member Review Board. The final discussions took place during a virtual plenary session on December 4, 2020, with all collaborators, who had the opportunity to vote on the main recommendations. Decisions regarding classes of recommendation required a three-quarters supermajority vote. Class of Recommendation and Level of Evidence follow the same definitions used in the last guideline, as established by SBC/CONDir. See below. The therapeutic recommendations proposed in this document are based on the latest available scientific evidence, considering not only the aspects of clinical efficacy from large clinical trials. We have sought to summarize the primary recommendations in flowcharts and algorithms that are easy to understand and to apply in clinical practice, proposing approaches for the diagnosis and treatment of heart failure. Our commitment to the scientific community, linked to research and assistance to heart failure patients, public and private managers, and policy-makers, will certainly have the benefit of a document that sought to present scientific interventions in an accessible format, facilitating its implementation in the various spheres where heart failure patients receive care. Classes of Recommendation Class I Conditions for which there is conclusive evidence or, if not, there is general agreement that the procedure is safe and useful/effective. Class II Conditions for which there is conflicting evidence and/or divergence of opinion about the safety and usefulness/efficacy of the procedure. Class IIA Weight or evidence/opinion in favor of the intervention. Most approve. Class IIB Less well-established safety and usefulness/efficacy, without predominance. Class III Conditions for which there is evidence and/or general agreement that the procedure is not useful/effective, and in some cases may be harmful. Levels of Evidence Level A Data derived from multiple consistent randomized controlled clinical trials, and/or a robust meta-analysis of randomized clinical trials. Level B Data derived from a less robust meta-analysis, one single randomized trial or non-randomized trials (observational). Level C Data derived from consensual expert opinion. Open in a separate window Dr. Evandro Tinoco Mesquita