Comments on the guidelines (2021) of the ESC on the diagnosis and treatment of acute and chronic heart failure

Heart failure is a syndrome with high morbidity and mortality. The new ESC guidelines represent the current standard for recommendations on the diagnostics and treatment of acute and chronic heart failure. The most significant change is the introduction of an altered first-line treatment for heart failure with reduced ejection fraction with a class I recommendation (ACE inhibitors or sacubitril/valsartan, beta blockers, mineralocorticoid receptor antagonists, SGLT-2 inhibitors). It is recommended that all drugs should be started early and not sequentially after titration to the maximum tolerated dose. These comments discuss the innovations of the ESC guidelines and the specific German situation.