一、生物标志物

第一次指南更新是生物标志物的相关内容，这类标志物在心衰诊断中具有重要的作用。医生可能对呼吸困难的患者一无所知，但BNP可以帮你鉴别患者是心脏病变还是肺部病变。

生物标志物的应用

风险分层

二、HFrEF

然后是与射血分数降低性心衰（HFrEF）治疗相关的更新。

C期HFrEF的药物治疗

三、HFpEF

最后是与射血分数保留性心衰相关的治疗更新。这令医生们非常激动，因为这是我们首次看到了HFpEF的明确治疗推荐。

1.C期HFpEF患者的药物治疗

2.C期HFpEF合并冠心病、房颤的治疗

四、合并症处理

对于合并贫血、高血压及睡眠障碍的患者，指南更新的推荐如下。

1.贫血

2.高血压

3.睡眠障碍

参考文献

1.Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol. 2017 Apr 21. 

2.Yancy CW, Jessup M, Bozkurt B, et al; American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62:e147-e239. 

3.McMurray JJ, Packer M, Desai AS, et al; PARADIGM-HF Investigators and Committees. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371:993-1004. 

4.Pitt B, Pfeffer MA, Assmann SF, et al; TOPCAT Investigators. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370:1383-1392. 

5.Yusuf S, Pfeffer MA, Swedberg K, et al; CHARM Investigators and Committees. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet. 2003;362:777-781. 

6.SPRINT Research Group, Wright JT Jr, Williamson JD, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373:2103-2116. 

7.Cowie MR, Woehrle H, Wegscheider K, et al. Adaptive servo-ventilation for central sleep apnea in systolic heart failure. N Engl J Med. 2015;373:1095-1105.