• Frank Edelmann, Christoph Knosalla, Klaus Mörike, Christiane Muth, Peggy Prien, and Stefan Störk.
• Medical Department, Division of Cardiology and Angiology, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum; Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, German Centre for Cardiovascular Research; Universitätsklinikum Tübingen, Department of Experimental and Clinical Pharmacology and Toxicology; Institute of General Practice, J.W. Goethe University, Frankfurt/Main; German Agency for Quality in Medicine (ÄZQ), Berlin; Comprehensive Heart Failure Center & Deptartment of Internal Medicine I, University and University Hospital Würzburg.
• Dtsch Arztebl Int. 2018 Feb 23; 115 (8): 124-130.

BackgroundChronic heart failure (CHF) is the most common reason for hospital admissions in Germany. For the National Disease Management Guideline (NDMG) on CHF, a multidisciplinary expert panel revised the chapters on drug therapy, invasive therapy, and care coordination, following the methods of evidence-based medicine.MethodsRecommendations are based on international guideline adaptations or systematic literature search. They were developed by a multidisciplinary expert panel, approved in a formal consensus procedure, and tested in open consultation, as specified by the requirements for S3 guidelines.ResultsThe pharmacological treatment is based on ACE inhibitors, beta-blockers and mineralocorticoid receptor antagonists as well as diuretics to treat fluid retention, if present. Sacubitril/Valsartan and ivabradine showed positive effects on mortality in large but methodologically limited RCT. They are recommended if established combination therapy is not sufficient for symptom control, or if drugs are not tolerated/contraindicated. The indications for pacemakers or defibrillators have been confined to patient subgroups in which clinical trials have shown a clear benefit. Moreover, the goals of treatment and the patient's expectations should be aligned with each other. Structured care programs, specialized nurses, remote, or telephone monitoring showed moderate effects on patient related outcomes in RCT.ConclusionAll patients with heart failure are suggested to be enrolled in a structured program (e.g., a disease management program) including coordinated multidisciplinary care and continuous educational interventions. In patients with a poor prognosis, more intensive care is recommended, e.g. specialized nurses, or telephone support.

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