Diagnostic algorithm and therapeutic options in chronic heart failure: updated review of clinical practice guidelines.

The development of diagnostic and therapeutic algorithms is becoming more and more popular in medicine. Their advantage is simplicity which enables wide use in everyday medical practice. The algorithms may have limitations mainly due to simplifications, which not always appear to be helpful in solving complex clinical problems of an individual patient. To serve as a "signpost" in clinical practice, the algorithm should be worked out strictly according to the appropriately interpreted data obtained from reliable, current and published medical evidence. This aim is achieved by clinical practice guidelines, being developed by scientific societies. The present paper deals with diagnostic and therapeutic algorithms in chronic heart failure based on the current clinical practice guidelines. The current guidelines by the European Society of Cardiology have been compared with similar documents issued by the American College of Cardiology/American Heart Association, the Heart Failure Society of America and the Canadian Cardiovascular Society. Similarities and divergences between the guidelines of different societies in respect of treatment for chronic heart failure have been discussed. The detailed description of their role in the treatment has been provided for: non-pharmacological measures (guidelines for lifestyle), drug therapy (angiotensin-converting enzyme inhibitors, beta-adrenolytics, aldosterone receptor antagonists, angiotensin receptor blockers, cardiac glycosides and diuretics), implantation of cardioverter-defibrillators and (or) resynchronization device, mechanical support and surgical treatment. The paper also focuses on diagnostic problems and treatment modalities for heart failure with a preserved systolic function of the left ventricle.