Comments on focused update 2023 of the ESC on the ESC guidelines 2021 on the diagnosis and treatment of acute and chronic heart failure

Since 2021 there have been numerous large randomized studies that would alter the practice of chronic heart failure for the benefit of patients. The most important changes were summarized in an update of the 2021 ESC guidelines published in 2023. The SGLT2 inhibitors empagliflozin and dapagliflozin now received a class IA recommendation for all forms of heart failure across the entire spectrum of ejection fractions. Furthermore, for the prevention of heart failure in patients with type 2 diabetes mellitus and chronic kidney failure (eGFR < 60 ml/min/1.73 m2) the use of the SGLT2 inhibitors and finerenone (in cases of diabetic nephropathy with corresponding albuminuria) is recommended. A rapid implementation of the medicinal heart failure treatment after acute decompensation should already be initiated in the hospital and should be intensified in regular and timely follow-up outpatient control examinations. Finally, the intravenous iron treatment with ferric carboxymaltose and ferric isomaltose to improve the symptoms received a class IA recommendation and the reduction of hospitalization a class IIaA recommendation. With the consistent implementation of these recommendations an improvement of the treatment of patients with heart failure and therefore also the prognosis can be expected.