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1. Introduction

The Canadian Cardiovascular Society (CCS) heart failure (HF) guidelines program provides guidance to clinicians, policy makers, and health systems as to the evidence supporting existing and emerging management of patients with HF. The 2017 update is a comprehensive set of guidelines that incorporates new evidence and identifies areas of uncertainty and challenges facing health care providers in HF management. It integrates and updates the past decade of HF guidelines, along with a large body of new research and data. The constitution and roles of the primary and secondary panels, systematic review strategy, and methods for formulating the recommendations are available at The recommendations were developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) standards.[1],[2] The primary panelists were principally responsible for the document, with input from secondary panelists and external content experts where needed. The sections on atrial fibrillation (AF), cardiac resynchronization therapy (CRT), and cardio-oncology were developed in collaboration with the respective guidelines committees, and are endorsed by those committees from a HF perspective. Several sections of this document have been made available as Supplementary Material, including a list of abbreviations and acronyms (see the Abbreviations and Acronyms section of the Supplementary Material). clinical symptoms and signs of reduced cardiac output and/or pulmonary or systemic congestion at rest or with stress. Although this has traditionally focused on patients with pre-dominant left ventricular (LV) systolic dysfunction (LVSD), there is an increased awareness of the syndrome spanning patients with acute and chronic HF, right-sided HF, and HF across a spectrum of ventricular or valvular function. We have refrained from using other terms, often older descriptive terms (eg, dilated, congestive), unless a specific definition exists. The term “stable” is not considered to be clinically appropriate because of the inherent risk for future clinical events. We have not adopted a staging system[3] or alternative systems[4] for describing HF. Chronic HF is the preferred term representing the persistent and progressive nature of the disease. Acute HF (AHF) is defined as a gradual or rapid change in HF signs and symptoms resulting in the need for urgent therapy. Advanced HF is the term often used clinically, yet has no widely accepted definition. In the context of the guidelines, we have outlined some of the key considerations for this term in the section 7.1.4. Advanced HF Management Strategies as it pertains to selecting advanced mechanical devices, transplantation, or palliative therapies.


1. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924-6.

2. Grade Working Group. The Grading of Recommendations Assessment, Development and Evaluation (GRADE). 2016. Available at: www. Accessed February 16, 2016.

3. Hunt SA, Baker DW, Chin MH, et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure): Developed in Collaboration With the International Society for Heart and Lung Transplantation; Endorsed by the Heart Failure Society of America. Circulation 2001;104:2996-3007.

4. Arbustini E, Narula N, Dec GW, et al. The MOGE(S) classification for a phenotype-genotype nomenclature of cardiomyopathy: endorsed by the World Heart Federation. J Am Coll Cardiol 2013;62:2046-72.

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