European Heart Journal (2015) 36, 1958–1966 CURRENT OPINION

doi:10.1093/eurheartj/ehv066

Recommendations on pre-hospital and early

hospital management of acute heart failure: a
consensus paper from the Heart Failure
Association of the European Society of Cardiology,

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the European Society of Emergency Medicine and
the Society of Academic Emergency Medicine –
short version
Alexandre Mebazaa 1*, M. Birhan Yilmaz2, Phillip Levy 3, Piotr Ponikowski 4,
W. Frank Peacock 5, Said Laribi 6, Arsen D. Ristic 7, Ekaterini Lambrinou 8, Josep Masip 9,
Jillian P. Riley10, Theresa McDonagh 11, Christian Mueller 12, Christopher deFilippi 13,
Veli-Pekka Harjola 14, Holger Thiele15, Massimo F. Piepoli 16, Marco Metra17,
Aldo Maggioni 18, John J.V. McMurray19, Kenneth Dickstein 20, Kevin Damman 21,
Petar M. Seferovic22,23, Frank Ruschitzka 24, Adelino F. Leite-Moreira25,26,
Abdelouahab Bellou 27,28, Stefan D. Anker29,30, and Gerasimos Filippatos 31
1
University Paris Diderot, Sorbonne Paris Cité, U942 Inserm, Hôpitaux Lariboisière Saint Louis University Hospitals, Paris, France; 2Department of Cardiology, Cumhuriyet University
Faculty of Medicine, Sivas 58140, Turkey; 3Department of Emergency Medicine and Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, USA;
4
Wroclaw Medical University, 4th Military Hospital, Weigla 5, Wroclaw 50-981, Poland; 5Baylor College of Medicine, Ben Taub General Hospital, 1504 Taub Loop, Houston, TX 77030,
USA; 6Inserm U942, APHP Groupe Hospitalier Saint Louis Lariboisière, Paris, France; 7Department of Cardiology, Clinical Center of Serbia and Belgrade University School of Medicine,
Belgrade, Serbia; 8Nursing Department, Cyprus University of Technology, School of Health Sciences, Limassol, Cyprus; 9Consorci Sanitari Integral, Hospital Sant Joan Despı́ Moisès Broggi
and Hospital General Hospitalet, University of Barcelona, Barcelona, Spain; 10Imperial College, London, UK; 11King’s College Hospital, London, UK; 12Department of Cardiology,
University Hospital Basel, Switzerland; 13School of Medicine, Division of Cardiovascular Medicine, University of Maryland, Baltimore, MD, USA; 14Emergency Medicine, University of
Helsinki, Helsinki University Hospital, Helsinki, Finland; 15University of Luebeck, University Hospital of Schleswig-Holstein, Medical Clinic II, Luebeck, Germany; 16Heart Failure Unit,
Cardiac Dept., Guglielmo da Saliceto Hospital, AUSL Piacenza, Italy; 17Cardiology, The Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University
of Brescia, Brescia, Italy; 18ANMCO Resarch Center, Firenze, Italy; 19BHF Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, UK; 20University of
Bergen, Stavanger University Hospital, Bergen, Norway; 21University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; 22Medical Faculty, University of
Belgrade, Belgrade, Serbia; 23Department of Cardiology, University Medical Center, Belgrade, Serbia; 24Department of Cardiology, University Heart Center, Rämistrasse 100, Zürich
8091, Switzerland; 25Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal; 26Department of Cardiothoracic Surgery, Centro
Hospitalar São João, Porto, Portugal; 27Harvard Medical School and Emergency Medicine Department of Beth Israel Deaconess Medical Center, Boston, USA; 28Faculty of Medicine,
University Rennes 1, Rennes, France; 29Division of Applied Cachexia Research, Department of Cardiology, Charité Medical School, Berlin, Germany; 30Division of Innovative Clinical Trials,
Department of Cardiology, University Medical Center Göttingen (UMG), Göttingen, Germany; and 31Department of Cardiology, Attikon University Hospital, University of Athens
Medical School, Athens, Greece

Received 24 July 2014; revised 9 January 2015; accepted 2 March 2015; online publish-ahead-of-print 22 May 2015

A longer version of this article has been published in European Journal of Heart Failure and is available at http://onlinelibrary.wiley.com/doi/
10.1002/ejhf.289/full1

Despite several critical steps forward in the management of chronic frequently make treatment decisions without adequate evidence,
heart failure (CHF), the area of acute heart failure (AHF) has usually on the basis of expert opinion consensus.2 Specifically, the
remained relatively stagnant. As stated in the updated ESC HF guide- treatment of acute HF remains largely opinion-based with little
lines, clinicians responsible for managing patients with AHF must good evidence to guide therapy.

The opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology.
* Corresponding author. Tel: +33 149958072, Fax: +33 149958071, Email: [email protected]; [email protected]
Published on behalf of the European Society of Cardiology. All rights reserved. & European Society of Cardiology 2015. For permissions please email: [email protected].
Recommendations on pre-hospital and early hospital management of acute heart failure 1959

Acute heart failure is a syndrome in which emergency physicians, admitted with symptoms and/or signs of congestion. This is in contra-
cardiologists, intensivists, nurses, and other healthcare providers diction to the presentation where low cardiac output leads to symp-
have to cooperate to provide ‘rapid’ benefit to the patients. We tomatic hypotension and signs/symptoms of hypoperfusion, a
hereby would like to underscore the wider experience grown in differ- circumstance that is relatively rare, present in coronary care unit/
ent settings of the area of intensive care on acute heart failure, actually intensive care unit (CCU/ICU) but associated with a particularly
larger and more composite than that got in specialized Care Units. The poor outcome. Hence, it is important to note that appropriate
distillate of such different experiences is discussed and integrated in the therapy requires appropriate identification of the specific AHF pheno-
present document. Hence, the authors of this consensus paper believe type.3 The aim of the current paper is not to replace guidelines, but, to
a common working definition of AHF covering all dimensions and provide contemporary perspective for early hospital management
modes of presentations has to be made, with the understanding that within the context of the most recent data and to provide guidance,
most AHF presentations are either acute decompensations of based on expert opinions, to practicing physicians and other health-
chronic underlying HF or the abrupt onset of dyspnoea associated care professionals (Figure 1). We believe that the experience

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with significantly elevated blood pressure. Secondly, recent data accrued in the different settings from the emergency department
show that, much like acute coronary syndrome, AHF might have a through to the ICU/CCU is collectivel valuable in determining how
‘time to therapy’ concept. Accordingly, ‘pre-hospital’ management is best to manage the patients with AHF. Herein, a shortened version
considered a critical component of care. Thirdly, most patients with mainly including group recommendations is provided. Full version of
AHF have normal or high blood pressure at presentation, and are the consensus paper is provided as Supplementary material online.

Figure 1 Algorithm for the management of acute heart failure. AHF, acute heart failure; VAS, Visual Analogue Scale for dyspnea assessment; RR,
respiration rate; SpO2, blood oxygen saturation; HR, heart rate; ICU, intensive care unit; Cathlab, cardiac catheterisation laboratory; CCU, coronary
care unit; IV, intravenous; SBP, systolic blood pressure; cTn, cardiac troponin, th, therapy, ACS, acute coronary syndrome.
1960 A. Mebazaa et al.

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Figure 1 Continued.

Definition and epidemiology Pre-hospital and early

of acute heart failure management strategies in
† Acute heart failure (AHF) is the term used to describe the rapid acute heart failure
onset of or acute worsening of symptoms and signs of HF, asso-
† As for acute coronary syndromes, the ‘time-to-treatment’
ciated with elevated plasma levels of natriuretic peptides. It is a life-
concept may be important in patients with AHF. Hence, all AHF
threatening condition that requires immediate medical attention
patients should receive appropriate therapy as early as possible.
and usually leads to urgent hospital admission.
† In the pre-hospital setting, AHF patients should benefit from:
† Most of the patients with AHF present with normal or high blood
pressure and with symptoms and/or signs of congestion rather – Non-invasive monitoring, including pulse oximetry, blood
pressure, respiratory rate, and a continuous ECG, instituted
than low cardiac output.
within minutes of patient contact and in the ambulance if
Table 1 compares the characteristics among patients whose initial possible.
management was performed in cardiology/CCU, emergency depart- – Oxygen therapy given based on clinical judgment unless
ment (ED), or pre-hospital setting. Clinical characteristics are oxygen saturation ,90% in which case oxygen therapy should
somewhat different; AHF patients seen early, in the pre-hospital be routinely administered.
setting or in the ED not only have higher blood pressure but also – Non-invasive ventilation, in patients with respiratory
are more frequently female and older.4 distress.
Recommendations on pre-hospital and early hospital management of acute heart failure 1961

Table 1 Clinical characteristics of the AHF patients according to the different sites of initial contact and management

Admission site Cardiac ICU/CCU Emergency department Pre-hospital setting

................................ .................................... .........................................
Euro-HF II EFICA ADHERE ATTEND Ducros et al. Sporer et al.
n 5 3580 n 5 599 n 5 159 168 n 5 1100 n 5 207 n 5 319
...............................................................................................................................................................................
Male (%) 61 59 49 59 41 47
Age (years) 70 73 73 72 81 77
SBP . 140 mmHg at admission (%) 63 60 74 71 75 77
CS or SBP , 90 mmHg (%) 3.9 29 3 NA 1 3
Initial SBP 135 126 144 147 170 167

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Of note, EFICA includes only ICU patients.
Euro-HF II,8 EFICA,9 ADHERE,10 ATTEND,11 Ducros et al.,12 Sporer et al.13
SBP, systolic blood pressure; ICU, intensive care unit; CCU, coronary care unit; CS, cardiogenic shock.

– Medical treatment should be initiated based on blood pressure

and/or the degree of congestion using vasodilators and/or
diuretics (i.e. furosemide).
– Rapid transfer to the nearest hospital, preferably to a site with
a cardiology department and/or CCU/ICU.
† On arrival in the ED/CCU/ICU, initial clinical examination, in-
vestigations and treatment should be started immediately and
concomitantly.

Initial clinical evaluation and

investigations at arrival in the
emergency department/coronary
care unit/intensive care unit
† In the initial evaluation of suspected AHF (excluding cardiogenic
shock), the critical first step is determination of the severity of car-
diopulmonary instability based on the level of dyspnoea, haemo-
dynamic status, and heart rhythm. To facilitate this, results of the
following assessments should be recorded (Figure 1):
– Objective measurement of dyspnoea severity, including the re-
spiratory rate, intolerance of the supine position, effort of
breathing, and degree of hypoxia.
– Systolic and diastolic blood pressure.
– Heart rate and rhythm.
– Objective determination of body temperature and signs/symp-
toms of hypoperfusion (cool extremities, narrow pulse pres-
sure, mental status)
† The next step should include a search for congestion including per-
ipheral oedema, audible rales (especially in the absence of fever), Figure 2 (A and B) Thoracic ultrasound images in normal and AHF
and elevated jugular venous pressure, patients. (A) From the pleural line, one repetition of the pleural line, a
† Additional testing that may be useful includes: horizontal line [A line], parallel to the pleural line, is visible, indicating
– ECG, recognizing that in AHF this is rarely normal, and rarely normal lung with no pulmonary oedema. Note some ill-defined vertical
diagnostic but necessary to exclude ST segment elevation myo- comet-tail artefacts, not to be confused with lung rockets. Arrows indi-
cate A lines. (B) Four or five B-lines arise from the pleural line, creating a
cardial infarction
pattern called lung rockets. B lines are vertical, long, well-defined arte-
– Laboratory tests (see below)
facts erasing the A-lines and moving in concert with lung sliding. B lines
– Bedside thoracic ultrasound for signs of interstitial oedema indicate pulmonaryoedema. From Whole Body Ultrasonography in the
(Figure 2) and abdominal ultrasound for inferior vena cava diam- Critically Ill, Springer 2010 (with kind permission of Springer Science).
eter (and ascites) if expertise is available
1962 A. Mebazaa et al.

– Chest X-ray to rule-out alternative causes of dyspnoea, though, in Role of nursing management
nearly 20% of patients, it may be normal, limiting overall sensitivity.
† Immediate echocardiography is not needed during the initial evalu- in acute heart failure
ation in most cases except when haemodynamic instability is † Specific considerations of nursing management include:
present. However, echocardiography is needed after stabilization,
– Triage to appropriate environment for safe clinical care
especially with de novo disease.
– Objective monitoring for change in signs and symptoms sug-
† Urinary catheterization should be avoided unless the benefits out-
gestive of response to treatment.
weigh the risks of infection and longer term complications related
– Discharge planning and referral to multidisciplinary disease
to continence.
management programme.
† Anxiety of the patient should be addressed by promptly answering
Laboratory tests at presentation questions and providing clear information to the patient and family.

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† Relevant changes in clinical status should be promptly addressed
† Upon presentation to the ED or CCU/ICU, a plasma natriuretic and communicated to the physician. Effective and consistent com-
peptide level (BNP, NT-proBNP, or MR-proANP) should be mea- munication should be maintained with the patient and/or family
sured in all patients with acute dyspnoea and suspected AHF,
ideally using a point-of-care assay, to help in the differentiation
of AHF from non-cardiac causes of acute dyspnoea. Oxygen therapy and/or ventilatory
† The following laboratory assessments should be performed at ad-
mission in the blood of all AHF patients: troponin, BUN (or urea), support
creatinine, electrolytes, glucose and complete blood count. † Oxygenation should be monitored with pulse-oximetry (SpO2)
† D-dimer is indicated in patients with suspicion of acute pulmonary (Figure 3)
embolism. † Acid-base balance, complementing SpO2 monitoring, should be
† Routine arterial blood gas is not needed. However, arterial blood obtained on admission, especially in patients with acute pulmonary
gas may be useful when a precise measurement of oxygen and oedema (APE) or previous history of chronic obstructive pulmon-
carbon dioxide partial pressures is needed. Venous sample ary disease, using venous blood or especially in patients with
might acceptably indicate pH and CO2. cardiogenic shock through the arterial line

Figure 3 Oxygen and ventilatory support in acute heart failure. PS-PEEP, pressure support-positive end-expiratory pressure. CPAP, continuous
positive airway pressure; RR, respiration rate; SpO2, oxygen saturation.
Recommendations on pre-hospital and early hospital management of acute heart failure 1963

† Oxygen therapy should be considered in patients with AHF having

SpO2 , 90% Table 2 Dose recommendations for diuretic therapy
† Non-invasive ventilation (NIV) is indicated in patients with New-onset HF or no maintenance Furosemide 40 mg intravenous
respiratory distress and should be started as soon as possible. diuretic therapy
Non-invasive ventilation decreases respiratory distress and also HF on chronic oral therapy Furosemide iv bolus at least
reduces the rate of mechanical endotracheal intubation equivalent to oral dose

Early administration of intravenous

diuretics and vasodilators – No or moderate worsening of renal function (chronic renal
disease might be present)
† Initially, 20–40 mg intravenous furosemide can be considered in † Fast track discharge from ED should be considered in hospitals

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all AHF patients with chronic disease management programs, once the trigger
† In cases of volume overload, intravenous diuretic dose should be for decompensation has been identified and early management
tailored to the type of AHF (de novo with lower dose than exacer- commenced
bation of CHF, Table 2). † Patients with de novo AHF should not be discharged home from ED
† When systolic BP is normal to high (.110 mmHg),2 intraven-
ous vasodilator therapy, might be given for symptomatic relief
as an initial therapy. Alternatively, sublingual nitrates may be
considered.
Criteria for hospitalization in ward vs.
intensive care unit/coronary care unit
† Patients with significant dyspnoea or haemodynamic instability
Drugs to be used cautiously in acute should be triaged to a location where immediate resuscitative
support can be provided if needed.
heart failure (excluding cardiogenic † Patients admitted to hospital with AHF should be looked after by
shock) doctors and nurses with specialist knowledge and expertise
† For high-risk patients, initial care should be provided in a high depend-
† Routine use of opioids in AHF patients is not recommended
ency setting (Coronary Care/Cardiac Care Unit). Patients with AHF
† There is only a very limited place for sympathomimetics or
and associated acute coronary syndrome should be referred to CCU.
vasopressors in patients with AHF excluding cardiogenic
shock; they should be reserved for patients who have persistent – Clinical risk algorithms developed to predict the in-hospital mor-
signs of hypoperfusion despite adequate filling status. tality of patients admitted with AHF can assist in determining
which patients in the ED need the highest level of in-patient care
– An ED specific algorithm may further improve risk assessment
compared with prior methods developed in patients admitted
Management of evidence-based with AHF
oral therapies – The criteria for triage at admission for ICU include RR . 25,
SaO2 , 90%, use of accessory muscles for breathing, systolic
† In case of decompensation of CHF, every attempt should be made
BP , 90 mmHg,
to continue evidence-based, disease-modifying, oral therapies in
– Need for intubation (or already intubated) or signs of hypo-
patients with AHF (Table 3).
perfusion: (oliguria, cold peripheries, altered mental status,
† In the case of de novo HF, every attempt should be made to initiate
lactate .2 mmol/L, metabolic acidosis, SvO2 , 65%) are
these therapies after hemodynamic stabilization.
also indications for ICU referral
† For those who are admitted to the ICU/CCU, subsequent care
should be on a cardiology ward if possible
Discharge from emergency † Hospitals should have an AHF pathway so all patients have access
department to cardiology advice.

† Clinical condition can change dramatically within a few hours of ED

arrival. Hence, clinical response to initial treatment is an important
indicator of likely disposition. Monitoring in the hospital
† Indicators of good response to initial therapy that might be consid- † Patient should be weighed daily and have an accurate fluid balance
ered in discharge include: chart completed
– Patient-reported subjective improvement † Standard non-invasive monitoring of pulse, respiratory rate, and
– Resting HR , 100 bpm blood pressure should be performed
– No hypotension when standing up † Renal function and electrolytes should be measured daily
– Adequate urine output † Pre-discharge measurement of natriuretic peptides is useful for
– Oxygen saturation . 95% in room air post-discharge planning
1964 A. Mebazaa et al.

Criteria for discharge from the

.............................. ............................................ ......................................

.............................................................................................................................................................................................................................................
eGFR < 30

No change

No change
No change
hospital and follow-up in

Cr > 2.5,

Review
high-risk period

Stop

Stop
Renal impairment
† Patients admitted with AHF are medically fit for discharge:
eGFR > 30
– when haemodynamically stable, euvolemic, established on

No change

No change
No change
No change
evidence-based oral medication and with stable renal function
Cr < 2.5,

Reduce
Review
for at least 24 h before discharge
– once provided with tailored education and advice about
Review/increase self-care

CCB, calcium channel blockers (mg/dL); Cr, creatinine blood level (mg/dL); eGFR, estimated glomerular filtration rate ml/min/1.73 m2; MRA, mineralocorticoid receptor antagonist; (*) amiodarone.
† Patients should be:
>5.5 mg/dL

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No change

No change
No change – enrolled in a disease management program
– seen by their general practitioner within 1 week of discharge
Stop

Stop

– seen by the hospital cardiology team within 2 weeks of dis-

charge if feasible
Review/No change

† Patients with chronic heart failure should be followed up within

Review/increase

Review/increase

Review/stop (*)
<3.5 mg/dL

a multi-professional heart failure service

Potassium

No change

No change

Definition, initial management

No change

No change
No change
No change
<50 bpm

and monitoring of cardiogenic

Stop

Stop

shock including device therapy

Low Heart rate

Reduce/stop

† Cardiogenic shock is defined as hypotension (SBP , 90 mmHg)

No change

No change
No change
No change
>50 bpm

despite adequate filling status and signs of hypoperfusion: (oliguria,

Reduce

cold peripheries, altered mental status, lactate .2 mmol/L, meta-

<60

bolic acidosis, SvO2 , 65%)

† A patient with suspected cardiogenic shock (CS) should undergo
<85 mmHg
.....................................

immediate assessment
† ECG and echocardiography are required immediately in all
Stop
Stop
Stop
Stop
Stop
Stop

patients with suspected CS

† Invasive monitoring with arterial line is needed
Hypotension

† There is no agreement on optimal method of haemodynamic

>85 mmHg

Reduce/stop
Reduce/stop

Reduce/stop
Reduce/stop
No change
Management of oral therapy in AHF in the first 48 h

monitoring in assessing and treating the patient in CS, including

Reduce
<100

pulmonary artery catheter

† Fluid challenge (saline or ringer lactate, .200 mL/15–30 min) is
recommended as the first line treatment if there is no sign of
overt fluid overload
† Dobutamine may be used to increase cardiac output; levosimen-
Normotension/

Review/increase
hypertension

dan may be considered, especially in CHF patients on oral beta-

blockade
No change
No change
Increase
Increase

† Vasopressors should only be used if there is a strict need to

Review

maintain systolic BP in the presence of persistent hypoper-

fusion; if needed, norepinephrine is recommended over
dopamine
(amiodarone, CCB, Ivabradine)

† All CS should be rapidly transferred to a tertiary care centre

Other heart rate slowing drugs

which has a 24/7 service of cardiac catheterization, and a

Other vasodilators (Nitrates)

dedicated ICU with availability of short-term mechanical circula-

tory support
† Intraaortic ballon pump is not routinely recommended in CS
† Short-term mechanical circulatory support may be considered in
Beta-blocker
ACE-I/ARB

refractory CS depending on patient age, comorbidities and neuro-

Table 3

Diuretics

logical function
MRA

† Based on current evidence, we do not recommend one mode of

short-term circulatory support over another
Recommendations on pre-hospital and early hospital management of acute heart failure 1965

Gaps in knowledge and J.M. received honoraria for speaker or advisor from Abbott, Novartis,
Orion, Otsuka, and Sanofi and fee as a member of Steering Committee
perspectives from Corthera, Novartis, and Cardiorentis.
J.R. received honoraria as a member of advisory board: Flora proactive
In AHF, there are several areas which require further investigation.
and Novartis.
The use of biomarkers in risk stratification and to guide treatment, T.M. received honoraria from Novartis and Servier.
which are the most important signs of severity, and which are the C.M. received research grants from the Swiss National Science Foun-
best measures of efficacy need more extensive study. There is still dation and the Swiss Heart Foundation, the Cardiovascular Research
a need to better delineate exactly what constitutes clinical improve- Foundation Basel, 8sense, Abbott, ALERE, Brahms, Critical Diagnostics,
ment with acute therapy, types of rehospitalizations, and mortality Nanosphere, Roche, Siemens, and the University Hospital Basel, as
(both short-term and long-term). There is also an appealing concept well as speaker/consulting honoraria from Astra Zeneca, Abbott,
of ‘home visit’ by ‘HF-teams’ to avoid or to decrease ED visits and ALERE, BG medicine, Biomerieux, Brahms, Cardiorentis, Lilly, Novartis,
hospitalizations. Pfizer, Roche, and Siemens.

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C.D. received speakers honoraria from Roche Diagnostics, Critical
Recent phase III or IV investigations have offered future promise in
Diagnostics and Radiometer, consulting honorarium/advisory board
clinical management of Acute Heart Failure. These include RELAX-
from Siemens Healthcare Diagnostics and Roche Diagnostics and re-
AHF5 (serelaxin), ATOMIC-AHF trial6 (omecamtiv mecarbil),
search support from Roche Diagnostics and Alere.
PRONTO7 (clevidipine), TRUE-AHF14 (clinicaltrials.gov/ct2/show/ V.P.H. received speaker’s fee: Bayer, Orion, Resmed, Roche Diagnos-
NCT01661634?term=TRUE-AHF&rank=1), (clinicaltrials.gov/ct2/ tics, Ratiopharm; consultation fees: Bayer, BMS, Boehringer-Ingelheim,
show/NCT01733134) ARTS-HF15 trials. Novartis, Pfizer, Roche Diagnostics, Servier.
H.A.T. received speaker’s honoraria from Daiichi Sankyo, Lilly, Medi-
cines Company, AstraZeneca, Boehinger Ingelheim. Advisory board
for Maquet Cardiovascular. Institutional research support by Maquet
Supplementary material Cardiovascular, Teleflex, Terumo, Lilly, The Medicine Company.
Supplementary material is available at European Heart Journal online. M.M. received honoraria as Committee member or co-chairman from
Bayer, Novartis, servier.
F.R. received consultant agreement with Cardiorentis, speaker honor-
Funding aria Servier.
K.D. is supported by the Netherlands Heart Institute (ICIN) and an ESC A.L.M. received speaker’s honoraria from Astra Zeneca.
HFA Research Grant. S.D.A. consultant for Bosch GmbH, Impulse Dynamics, BioVentrix,
CardioMems, Thermo Fischer GmbH, Vifor International (clinical
Conflict of interest: A.M. received speaker’s honoraria from Alere, events committee), Servier (Steering Committee), Jansen (Steering
Bayer, Edwards Life Sciences, The Medicines Company, Novartis, Committee), Medical Sensible, Novartis (Steering Committee), Cardior-
Orion, Servier, Thermofisher, Vifor Pharma and also received fee as entis (Steering Committee), BG Medicine (Steering Committee), Psioxus
member of advisory board and/or Steering Committee from Bayer, (Steering Committee), Bayer (Steering Committee); speaker for Servier
Cardiorentis, The Medicine Company, Critical Diagnostics. and Vifor International.
M.B.Y. received speaker’s honoraria and research fee from Novartis G.F. has received research grants and/or has served as Committee
and received fee as Steering Committee member of Cardiorentis, and member or Cochair of studies sponsored by Bayer, Novartis, Cardio-
is supported by TUBITAK. rentis, Vifor Pharma, and the European Union.
P.L. received speaker’s honoraria from Beckman Coulter and Novartis
and also received fees as a member of advisory board and/or Steering
Committee from Bayer, Cardiorentis, The Medicines Company, Corner- References
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P.P. received speaker’s honoraria from Bayer, Novartis, Servier, Vifor Thiele H, Piepoli MF, Metra M, Maggioni A, McMurray JJV, Dickstein K, Damman K,
Petar M. Seferovic, Ruschitzka F, Leite-Moreira AF, Bellou A, Anker SD, Filippatos
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entis, Portola, Roche, The Medicine’s Company, served as a consultant Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Kober L, Lip GY,
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strument Labs, Janssen, Prevencio, The Medicine’s Company, ZS Pharma, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A,
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