Background/Objectives: Evidence-based medicine (EBM) shapes most clinical guidelines. Although the advent of EBM marked a significant advancement, failure to include sex differences in the study design and analysis of most trials leads to an under-representation of gender-specific medicine (GM) in EBM-directed guidelines. In this review, we evaluated how the topic of GM was developed in the guidelines produced by the European Society of Cardiology (ESC) from 2018 to 2023. Methods: Two independent reviewers evaluated 24 ESC guidelines. Significant mentions of GM were counted and divided between epidemiology, diagnosis, and therapeutics. The qualitative and semi-quantitative analysis of information relating to GM was performed. Data on the number of citations of papers with a title concerning GM and the prevalence and role of women in guidelines\' authorship were also analyzed. Results: Less than 50% of guidelines had a section dedicated to GM. Only nine guidelines were led by a woman, and 144/567 authors were female. In the most recent guidelines and in those with at least 30% of female authors, there was an increased mention of GM. On average, guidelines had four significant mentions of GM regarding epidemiology, two regarding diagnosis, and one regarding therapy. Articles with titles concerning GM made up, on average, 1.5% of the total number of citations. Conclusions: Although sex differences play a significant role in most clinical scenarios, ESC guidelines still do not sufficiently account for this. The problem does not seem to solely lie in the guidelines, but in the lack of attention to GM in research needed for their preparation.

BACKGROUND: Diagnosing infective endocarditis (IE) poses a significant challenge. This study aimed to compare the diagnostic accuracy of the 2015 and 2023 Duke clinical criteria introduced by the European Society of Cardiology (ESC) in a cohort of patients suspected of having IE.
METHODS: Conducted retrospectively at two Swiss University Hospitals between 2014-2023, the study involved patients with suspected IE. Each hospitals\' Endocarditis Team categorized case as either IE or not IE. The performance of each iteration of the Duke-ESC clinical criteria was assessed based on the agreement between definite IE and the diagnoses made by the Endocarditis Team.
RESULTS: Among the 3127 episodes with suspected IE, 1177 (38%) were confirmed to have IE. Using the 2015 Duke-ESC clinical criteria, 707 (23%) episodes were deemed definite IE, with 696 (98%) receiving a final IE diagnosis. With the 2023 Duke-ESC clinical criteria, 855 (27%) episodes were classified as definite IE, of which 813 (95%) were confirmed as IE. The 2015 and 2023 Duke-ESC clinical criteria categorized 1039 (33%) and 1034 (33%) episodes, respectively, as possible IE. Sensitivity for the 2015 Duke-ESC and the 2023 Duke-ESC clinical criteria was calculated at 59% (95% CI: 56-62%), and 69% (66-72%), respectively, with specificity at 99% (99-100%), and 98% (97-98%), respectively.
CONCLUSIONS: The 2023 ESC criteria demonstrated significant improvements in sensitivity compared to the 2015 version, although one-third of episodes were classified as possible IE by both versions.

Purpose To provide a comprehensive head-to-head comparison and temporal analysis of cardiac MRI indications between the European Society of Cardiology (ESC) and American College of Cardiology/American Heart Association (ACC/AHA) guidelines to identify areas of consensus and divergence. Materials and Methods A systematic review and meta-analysis was conducted. ESC and ACC/AHA guidelines published until May 2023 were systematically screened for recommendations related to cardiac MRI. The class of recommendation (COR) and level of evidence (LOE) for cardiac MRI recommendations were compared between the two guidelines and between newer versus older versions of each guideline using χ2 or Fisher exact tests. Results ESC guidelines included 109 recommendations regarding cardiac MRI, and ACC/AHA guidelines included 90 recommendations. The proportion of COR I and LOE B was higher in ACC/AHA versus ESC guidelines (60% [54 of 90] vs 46.8% [51 of 109]; P = .06 and 53% [48 of 90] vs 35.8% [39 of 109], respectively; P = .01). The increase in the number of cardiac MRI recommendations over time was significantly higher in ESC guidelines (from 63 to 109 for ESC vs from 65 to 90 for ACC/AHA; P = .03). The main areas of consensus were found in heart failure and hypertrophic cardiomyopathy, while the main divergences were in valvular heart disease, arrhythmias, and aortic disease. Conclusion ESC guidelines included more recommendations related to cardiac MRI use, whereas the ACC/AHA recommendations had higher COR and LOE. The number of cardiac MRI recommendations increased significantly over time in both guidelines, indicating the increasing role of cardiac MRI evaluation and management of cardiovascular disease. Keywords: Cardiovascular Magnetic Resonance, Guideline, European Society of Cardiology, ESC, American College of Cardiology/American Heart Association, ACC/AHA Supplemental material is available for this article. © RSNA, 2024.

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The new guideline on acute coronary syndrome (ACS) of the European Society of Cardiology (ESC) replaces two separate guidelines on ST-elevation myocardial infarction (STEMI) and non-ST-elevation (NSTE) ACS. This change of paradigm reflects the experts view that the ACS is a continuum, starting with unstable angina and ending in cardiogenic shock or cardiac arrest due to severe myocardial ischemia. Secondary, partly non-atherosclerotic-caused myocardial infarctions (\"type 2\") are not integrated in this concept.With respect to acute care in the setting of emergency medicine and the chest pain unit structures, the following new aspects have to be taken into account:1. New procedural approach as \"think A.C.S.\" meaning \"abnormal ECG,\" \"clinical context,\" and \"stable patient\"2. New recommendation regarding a holistic approach for frail patients3. Revised recommendations regarding imaging and timing of invasive strategy in suspected NSTE-ACS4. Revised recommendations for antiplatelet and anticoagulant therapy in STEMI5. Revised recommendations for cardiac arrest and out-of-hospital cardiac arrest6. Revised recommendations for in-hospital management (starting in the CPU/ED) and ACS comorbid conditionsIn summary, the changes are mostly gradual and are not based on extensive new evidence, but more on focused and healthcare process-related considerations.
UNASSIGNED: Die neue Leitlinie zum akuten Koronarsyndrom (ACS) der Europäischen Gesellschaft für Kardiologie (ESC) ersetzt 2 separate Leitlinien zum ST-Hebungs-Infarkt („ST-elevation myocardial infarction“, STEMI) und zum ACS ohne ST-Hebungen („non-ST-elevation“, NSTE-ACS). Dieser Paradigmenwechsel spiegelt die Expertenperspektive wider, dass das ACS ein Kontinuum darstellt, das mit einer instabilen Angina pectoris beginnt und mit einem kardiogenen Schock oder Herzstillstand aufgrund einer schweren Myokardischämie endet. Sekundäre, teilweise nichtatherosklerotisch bedingte Myokardinfarkte („Typ 2“) sind in dieses Konzept nicht integriert. Im Hinblick auf die Akutversorgung im Rahmen der Notfallmedizin und der Chest-Pain-Unit-Strukturen (CPU) sind folgende neue Aspekte zu berücksichtigen:1. Neuer prozessualer Ansatz als „think A.C.S.“, d. h. „abnormales EKG“, „klinischer Kontext“ und „stabiler Patient“2. Neue Empfehlung für einen ganzheitlichen Ansatz bei gebrechlichen Patienten3. Überarbeitete Empfehlungen zur Bildgebung und zum Zeitpunkt der invasiven Strategie bei Verdacht auf NSTE-ACS4. Überarbeitete Empfehlungen zur Thrombozytenaggregationshemmer- und Antikoagulanzientherapie bei STEMI5. Revidierte Empfehlungen für Herzstillstand und außerklinischen Herzstillstand6. Überarbeitete Empfehlungen für das Management im Krankenhaus (beginnend in der Notaufnahme/CPU) und für ACS-KomorbiditätenZusammenfassend lässt sich sagen, dass die Änderungen größtenteils schrittweise erfolgen und nicht auf massiven neuen Erkenntnissen beruhen, sondern eher auf gezielten und prozessbezogenen Überlegungen zum Versorgungsprozess.

In August 2023 the new European guidelines on the management of infective endocarditis were published by the European Society of Cardiology (ESC). Numerous recommendations were revised and supplemented by new ones. This review article outlines the essential modifications of the current ESC guidelines focusing on the prevention including antibiotic prophylaxis, the role of the endocarditis team, the revision of the diagnostic criteria, the paradigm shift towards oral antibiotic treatment, the timing and the indications for surgical treatment as well as the relevance of infections of cardiovascular implantable electronic devices.
UNASSIGNED: Im August 2023 wurden die neuen europäischen Leitlinien zum Management der infektiösen Endokarditis durch die European Society of Cardiology (ESC) publiziert. Zahlreiche Empfehlungen wurden überarbeitet und durch neue ergänzt. Diese Übersichtsarbeit beleuchtet wesentliche Änderungen der aktuellen ESC-Leitlinien mit Fokus auf Prävention inklusive der Antibiotikaprophylaxe, Rolle des Endokarditisteams, Überarbeitung der diagnostischen Kriterien, Paradigmenwechsel hin zur oralen Antibiose, Timing und der Indikation der chirurgischen Therapie sowie Bedeutung der Infektionen von kardialen implantierbaren elektronischen Devices.

Guidelines help clinicians to deliver high-quality care with therapies based on up-to-date evidence. There has been significant progress in the management of heart failure with regards to both medication and cardiac device therapy. These advances have been incorporated into national and international guidelines with varying degrees of success. This article reviews current guidance from the National Institute of Health and Care Excellence in the UK and compares this with European Society of Cardiology guidelines, and evaluates how differences between them may impact on clinical practice.

The expansion of the therapeutic armamentarium available to oncologists and haematologists has led to a significant improvement in cancer survival; however, many of the available treatments carry a risk of toxicity to the heart. Cardio-oncology has emerged as a rapidly developing subspeciality dedicated to improving the cardiovascular care of patients before, during and after cancer treatment. The 2022 European Society of Cardiology guidelines on cardio-oncology provide a comprehensive overview of best-practice recommendations for cardiovascular care aimed at healthcare professionals treating cancer patients. The main focus of the guidelines is to ensure patients can complete their cancer treatment without significant cardiotoxicity and the correct follow-up for the first 12 months following treatment and beyond is instituted. The guidelines provide harmonisation of baseline risk stratification and toxicity definitions and encompass recommendations for all the major classes of therapy used in modern oncology and haematology. This review summarises the key points from the guidelines document.

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