TherapyTherapyТерапия2412-40362713-1823Bionika Media69415310.18565/therapy.2025.7.147-163HELPING PRACTICING PHYSICIANВ ПОМОЩЬ ПРАКТИКУЮЩЕМУ ВРАЧУReview ArticleUpdating of Russian clinical guidelines for chronic heart failure 2024: analysis of key changesОбновление российских клинических рекомендаций по хронической сердечной недостаточности 2024 г.: разбор ключевых измененийKobalavaZhanna D.КобалаваЖанна Давидовна
Russian Federation

MD, Dr. Sci. (Medicine), professor, corresponding member of RAS, head of the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseyev, chief researcher, director of the Institute of clinical medicine, V.V. Vinogradov University Clinical Hospital (branch)

д.м.н., профессор, член-корреспондент РАН, зав. кафедрой внутренних болезней с курсом кардиологии и функциональной диагностики имени академика В.С. Моисеева, главный научный сотрудник, директор Института клинической медицины, Университетская клиническая больница им. В.В. Виноградова (филиал)

zkobalava@mail.ruhttps://orcid.org/0000-0002-0950-74875954-7828NazarovIvan S.НазаровИван Сергеевич
Russian Federation

MD, junior researcher at the Institute of clinical medicine

младший научный сотрудник Института клинической медицины

nazarovradomla@mail.ruRUDN UniversityФГАОУ ВО «Российский университет дружбы народов им. Патриса Лумумбы»241020251171471632410202524102025Copyright ©; 2025, Bionika MediaCopyright ©; 2025, ООО «Бионика Медиа»2025Bionika MediaООО «Бионика Медиа»https://journals.eco-vector.com/2412-4036/article/view/694153

Presented clinical guidelines of the Russian Society of Cardiology for chronic heart failure (CHF) 2024 have been completed with many innovations that are important for everyday clinical practice. The approach to identifying CHF and influencing its course at early stages is intensified, and understanding of the severe stage of the disease is structured. Concept of optimal drug therapy for all CHF phenotypes is updated, and position of basic drugs for acute CHF decompensation is strengthened. Recommendations for surgical treatment and concomitant diseases are significantly expanded. The article provides an overview of the main updates of 2024 recommendations comparatively to 2020 in order to focus the attention of practicing physicians on modern opportunities and problems in managing patients with CHF.

В представленные клинические рекомендации Российского кардиологического общества по хронической сердечной недостаточности (ХСН) 2024 г. добавлено множество нововведений, имеющих значение для повседневной клинической практики. Углублен подход к выявлению ХСН и воздействию на ее течение на ранних этапах, структурировано понимание тяжелой стадии заболевания. Обновлено понятие «оптимальная медикаментозная терапия» для всех фенотипов ХСН, упрочено положение базисных препаратов при острой декомпенсации ХСН. Существенно расширены рекомендации по хирургическому лечению и сопутствующим заболеваниям. В статье предлагается обзор основных обновлений рекомендаций 2024 г. по сравнению с 2020 г. с целью акцентирования внимания практикующих врачей на современных возможностях и проблемах ведения пациентов с ХСН.

heart failurechronic heart failureclinical guidelinesRussian Society of Cardiologyсердечная недостаточностьхроническая сердечная недостаточностьклинические рекомендацииРоссийское кардиологическое обществоТерещенко С.Н., Галявич А.С., Ускач Т.М., Агеев Ф.Т., Арутюнов Г.П., Беграмбекова Ю.Л. с соавт. Хроническая сердечная недостаточность. Клинические рекомендации 2020. Российский кардиологический журнал. 2020;25(11):311–374. [Tereshchenko SN, Galyavich AS, Uskach TM, Ageev FT, Arutyunov GP, Begrambekova YuL et al. 2020 Clinical practice guidelines for Chronic heart failure. Rossiyskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology. 2020;25(11):311–374 (In Russ.)]. EDN: LJGGQV. https://doi.org/10.15829/1560-4071-2020-4083Галявич А.С., Терещенко С.Н., Ускач Т.М., Агеев Ф.Т., Аронов Д.М., Арутюнов Г.П. с соавт. Хроническая сердечная недостаточность. Клинические рекомендации 2024. Российский кардиологический журнал. 2024;29(11):251–349. [Galyavich AS, Tereshchenko SN, Uskach TM, Ageev FT, Aronov DM, Arutyunov GP et al. 2024 Clinical practice guidelines for chronic heart failure. Rossiyskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology. 2024;29(11):251–349 (In Russ.)]. EDN: WKIDLJ. https://doi.org/10.15829/1560-4071-2024-6162Canepa M, De Marzo V, Ameri P, Ferrari R, Tavazzi L, Rapezzi C et al. Temporal trends in evidence supporting therapeutic interventions in heart failure and other European Society of Cardiology guidelines. ESC Heart Fail. 2023;10(5):3019–27. PMID: 37550897. PMCID: PMC10567640. https://doi.org/10.1002/ehf2.14459McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Bohm M et al.; ESC Scientific Document Group. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599–726. PMID: 34447992. https://doi.org/10.1093/eurheartj/ehab368. Erratum in: Eur Heart J. 2021 Dec 21;42(48):4901. https://doi.org/10.1093/eurheartj/ehab670Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79(17):e263–e421. PMID: 35379503. https://doi.org/10.1016/j.jacc.2021.12.012Bozkurt B, Coats AJS, Tsutsui H, Abdelhamid CM, Adamopoulos S, Albert N et al. Universal definition and classification of heart failure: A report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure: Endorsed by the Canadian Heart Failure Society, Heart Failure Association of India, Cardiac Society of Australia and New Zealand, and Chinese Heart Failure Association. Eur J Heart Fail. 2021;23(3):352–80. PMID: 33605000. https://doi.org/10.1002/ejhf.2115Шляхто Е.В. Классификация сердечной недостаточности: фокус на профилактику. Российский кардиологический журнал. 2023;28(1):7–8. [Shlyakhto EV. Classification of heart failure: focus on prevention. Rossiyskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology. 2023;28(1):7–8 (In Russ.)]. EDN: RVHDCY. https://doi.org/10.15829/1560-4071-2023-5351Kubicius A, Gąsior Z, Haberka M. Heart failure with preserved ejection fraction: Diagnostic value of HFA-PEFF score, H-FPEF score, and the diastolic stress echocardiography. Cardiol J. 2024;31(5):708–15. PMID: 38587116. PMCID: PMC11544415. https://doi.org/10.5603/cj.95191Przewlocka-Kosmala M, Butler J, Donal E, Ponikowski P, Kosmala W. Prognostic value of the MAGGIC Score, H2FPEF Score, and HFA-PEFF algorithm in patients with exertional dyspnea and the incremental value of exercise echocardiography. J Am Soc Echocardiogr. 2022;35(9):966–75. PMID: 35605894. https://doi.org/10.1016/j.echo.2022.05.006Ryan M, Petrie MC, Kontopantelis E, Dodd M, Tong G, Marquis-Gravel G et al. Medical therapy and outcomes in REVIVED-BCIS2 and STICHES: An individual patient data analysis. Eur Heart J. 2025;46(22):2052–62. PMID: 40048661. PMCID: PMC12146480. https://doi.org/10.1093/eurheartj/ehaf080Zannad F, Ferreira JP, Pocock SJ, Anker SD, Butler J, Filippatos G et al. SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: A meta-analysis of the EMPEROR-Reduced and DAPA-HF trials. Lancet. 2020;396(10254):819–29. PMID: 32877652. https://doi.org/10.1016/S0140-6736(20)31824-9Monzo L, Cheema B, Ambrosy AP, Girerd N. Iron repletion in heart failure: A symptomatic win, a survival miss. Heart Fail Rev. 2025;30(5):1127–31. PMID: 40448876. https://doi.org/10.1007/s10741-025-10532-zAnker SD, Friede T, Butler J, Talha KM, Placzek M, Diek M et al. Intravenous ferric carboxymaltose in heart failure with iron deficiency: The FAIR-HF2 DZHK05 randomized clinical trial. JAMA. 2025;333(22):1965–76. PMID: 40159390. PMCID: PMC11955906. https://doi.org/10.1001/jama.2025.3833Vaduganathan M, Docherty KF, Claggett BL, Jhund PS, de Boer RA, Hernandez AF et al. SGLT-2 inhibitors in patients with heart failure: A comprehensive meta-analysis of five randomised controlled trials. Lancet. 2022;400(10354):757–67. PMID: 36041474. https://doi.org/10.1016/S0140-6736(22)01429-5Solomon SD, McMurray JJV, Anand IS, Ge J, Lam CSP, Maggioni AP et al. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med. 2019;381(17):1609–20. PMID: 31475794. https://doi.org/10.1056/NEJMoa1908655Vaduganathan M, Mentz RJ, Claggett BL, Miao ZM, Kulac IJ, Ward JH et al. Sacubitril/valsartan in heart failure with mildly reduced or preserved ejection fraction: A pre-specified participant-level pooled analysis of PARAGLIDE-HF and PARAGON-HF. Eur Heart J. 2023;44(31):2982–93. PMID: 37210743. PMCID: PMC10424880. https://doi.org/10.1093/eurheartj/ehad344Ono R, Falcao LM. Supra-normal left ventricular function. Am J Cardiol. 2023;207:84–92. PMID: 37734305. https://doi.org/10.1016/j.amjcard.2023.08.169McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Bohm M et al. 2023 Focused update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2023;44(37):3627–39. PMID: 37622666. https://doi.org/10.1093/eurheartj/ehad195Sohns C, Fox H, Marrouche NF, Crijns HJGM, Costard-Jaeckle A, Bergau L et al. Catheter ablation in end-stage heart failure with atrial fibrillation. N Engl J Med. 2023;389(15):1380–89. PMID: 37634135. https://doi.org/10.1056/NEJMoa2306037Merkely B, Hatala R, Wranicz JK, Duray G, Foldesi C, Som Z et al. Upgrade of right ventricular pacing to cardiac resynchronization therapy in heart failure: A randomized trial. Eur Heart J. 2023;44(40):4259–69. PMID: 37632437. PMCID: PMC10590127. https://doi.org/10.1093/eurheartj/ehad591Baldus S, Doenst T, Pfister R, Gummert J, Kessler M, Boekstegers P et al. Transcatheter repair versus mitral-valve surgery for secondary mitral regurgitation. N Engl J Med. 2024;391(19):1787–98. PMID: 39216093. https://doi.org/10.1056/NEJMoa2408739Anker SD, Friede T, von Bardeleben RS, Butler J, Khan MS, Diek M et al. Transcatheter valve repair in heart failure with moderate to severe mitral regurgitation. N Engl J Med. 2024;391(19):1799–809. PMID: 39216092. https://doi.org/10.1056/NEJMoa2314328Yehya A, Lopez J, Sauer AJ, Davis JD, Ibrahim NE, Tung R et al. Revisiting ICD therapy for primary prevention in patients with heart failure and reduced ejection fraction. JACC Heart Fail. 2025;13(1):1–13. PMID: 39641686. https://doi.org/10.1016/j.jchf.2024.09.014Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C et al.; ESC Scientific Document Group. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J. 2023;44(37):3503–626. PMID: 37622657. https://doi.org/10.1093/eurheartj/ehad194Mebazaa A, Davison B, Chioncel O, Cohen-Solal A, Diaz R, Filippatos G et al. Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): A multinational, open-label, randomised, trial. Lancet. 2022;400(10367):1938–52. PMID: 36356631. https://doi.org/10.1016/s0140-6736(22)02076-1Pagnesi M, Metra M, Cohen-Solal A, Edwards C, Adamo M, Tomasoni D et al. Uptitrating treatment after heart failure hospitalization across the spectrum of left ventricular ejection fraction. J Am Coll Cardiol. 2023;81(22):2131–44. PMID: 37257948. https://doi.org/10.1016/j.jacc.2023.03.426Biegus J, Cotter G, Metra M, Ponikowski P. Decongestion in acute heart failure: Is it time to change diuretic-centred paradigm? Eur J Heart Fail. 2024;26(10):2094–106. PMID: 39169731. https://doi.org/10.1002/ejhf.3423Badwan OZ, Braghieri L, Skoza W, Agrawal A, Menon V, Tang WHW. When should we consider SGLT-2 inhibitors in patients with acute decompensated heart failure? Cleve Clin J Med. 2024;91(1):47–51. PMID: 38167393. https://doi.org/10.3949/ccjm.91a.23034Meekers E, Dauw J, Ter Maaten JM, Martens P, Nijst P, Verbrugge FH et al. Urinary sodium analysis: The key to effective diuretic titration? European Journal of Heart Failure expert consensus document. Eur J Heart Fail. 2025;27(6):940–49. PMID: 40017142. https://doi.org/10.1002/ejhf.3632Meekers E, Martens P, Knevels R, Miseur M, Ezzat A, Croset F et al. Home-based urinary sodium monitoring via point-of-care testing for personalized diuretic titration in heart failure management: The EASY-STOP study. Eur J Heart Fail. 2025;27(6):950–59. PMID: 40389240. https://doi.org/10.1002/ejhf.3693Jeroen D. Clinical applications of urinary sodium in heart failure from prognostic marker to clinical tool. ESC Heart Fail. 2025. Online ahead of print. PMID: 40557839. https://doi.org/10.1002/ehf2.15350