2023 ICC/ICN/ISC Guideline for the Management of Heart Failure: A Report of the International College of Cardiology/International College of Nutrition and Indian Society of ChronoMedicine, Joint Committee on Guidelines for Developing and Newly Industrialized Countries


Authors: Ram B Singh, Jan Fedacko, Narsingh Verma, Galal Elkilany, Osama Elmarghi, Fateme Nabavizadeh, Krasimira Hritova, Najah Hadi, Saibal Chakravorty, AK Shukla, Ehab Hamdy, Jaipaul Singh, Lyudemila Shogenova, Jan Slezak, Ghazi Halabi, Shaw Watanabe, Oleg Medvedev, and Germaine Cornelissen
Page Range: 127-151
Published in: World Heart Journal, 15#3 (2023)
ISSN: 1556-4002

Table of Contents


The Global Burden of Diseases study estimates indicate that the prevalence of heart failure (HF) in the United States and Canada is 1.5% to 1.9% of the population and in Europe 1% to 2%. In Asia, the prevalence of HF may be 0.5% to 1.0%. There is evidence that HF occurs due to the interaction of cardio-metabolic risk factors with diet and lifestyle related chronobiological factors. This review aims to discuss various guidelines and the role of nutrition and drug therapy in the management of HF. It seems that for the treatment of HF, pharmacotherapy and lifestyle recommendations have been suggested by European and American health agencies, major discussion focused on pharmacotherapy, without much attention on cardiometabolic risk factors and risky behaviors of HF. These guidelines have been updated in the light of recent developments across the spectrum of left ventricular ejection fraction. The most interesting areas across these guidelines include recommendations on quadruple therapy for patients with HF, with reduced ejection fraction (HFrEF). It seems that none of the guidelines proposed an ideal sequence of initiation of therapy, such as treatment of cardiac cachexia and obesity and anemia via intravenous iron among patients with HF, in particular HFrEF and simultaneous deficiency of iron. Restriction of sodium in the diet is also needed among HF patients having lung congestion. There are gaps in knowledge about the role of traditional diets and the role of microbiota in the pathogenesis and management of HF. There are disagreements regarding the management of HF with preserved ejection fraction (HFpEF) and uncertainty regarding the management of HF with mildly reduced ejection fraction (HFmrEF). Novel mechanisms have been proposed to account for the benefits from drug therapy, including: improved cardiomyocyte calcium handling; enhanced myocardial energetics, induced autophagy and reduced epicardial fat, which can occur via lifestyle modification and SGLT2 inhib-itors. In addition, there are opportunities to improve guidelines and harmonization by emphasizing the use of Mediterranean-style diets along with drugs. It seems that there is broad agreement across these guidelines, although some areas of controversy in relation to nutritional factors remain.

Keywords: Acute heart failure, cardiomyocyte damage, cardiac failure, drug therapy

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