Update on the ESC Guidelines: What are the headline recommendations?
Speakers had six minutes each to highlight the key messages in recent ESC guidelines.
Dr Edmond Walma reviewed the guideline on the diagnosis and management of syncope which was published in the European Heart Journal in 2009. Syncope is ‘a transient loss of consciousness due to transient global cerebral hypoperfusion characterised by a rapid onset and short duration’, said Dr Walma. The cause of syncope in 90% of cases is neuromediated e.g. vasovagal and 7% of cases are due to orthostatic hypotension. Only about 3% of cases are due to cardiac syncope caused by arrhythmia or structural heart disease. The initial evaluation of patients should include a careful history, physical examination, orthostatic blood pressure and an ECG. Features of ‘high risk’ syncope include when symptoms occur during exertion of when supine, a family history of sudden death, first syncope at an elderly age or an abnormal ECG.
The ESC guidelines 2009 for Infective Endocarditis (IE) were presented next by Dr Carlos Brotons (Barcelona, Spain). The areas of prevention and diagnosis were particularly relevant to primary care. Antibiotic prophylaxis during dental procedures is no longer recommended for all patients with valve disease but is only required for patients at high risk of IE. High risk is defined as those with prosthetic heart valves, cyanotic congenital heart disease, a history of IE or dental procedures involving the manipulation of the gingival or periapical region of the teeth. A diagnosis of IE should be suspected in patients with a new murmur, an embolic event of unknown origin, persistent fever or sepsis of unknown origin.
Professor Christos Lionis tackled the issue of thrombosis and travel. Risk of VTE is thought to increase if travel is for more than 7 hours. A meta-analysis has shown compression stocking may be beneficial in those at risk of VTE. The American College of Chest Physicians guideline 2008 suggests the use of stockings and low molecular weight heparin (LMWH) only in patients with additional risk factors for VTE and not for general use. All patients should be advised to stay well hydrated and move around regularly.
The ESC Cardiovascular Disease Prevention guideline is currently being updated. Professor Arno Hoes described the history of the guideline and the increased involvement of GPs and nurses over the years. ‘The ones who are to implement guideline are primarily GPs’ said, Professor Hoes. More recent guidelines have an increased emphasis on exercise, weight and lifestyle advice. He emphasised the need for the multiple guidelines which are currently available (hypertension, lipid and CVD guidelines) to have a consistent message.