The China Heart Failure Guidelines 2014 (the new guidelines) cover the examination and diagnosis of heart failure (heart failure), the various types and treatment of chronic and acute heart failure, comprehensive management of heart failure, rehabilitation and follow-up. Treatment includes pharmacologic and nonpharmacologic device therapy, as well as the evaluation and management of the underlying causes of heart failure, common concomitant diseases, and comorbidities. The new guideline reflects the new progress and results of research in this field, and draws on the experience and findings of many Chinese physicians, with distinctive Chinese characteristics. The new guidelines include plasma B-type natriuretic peptide (BNP)/N-terminal B-type natriuretic peptide (NT-proBNP) as routine examination items for heart failure, together with electrocardiogram, two-dimensional echocardiography and Doppler ultrasonography, troponin, and X-ray chest radiograph. NT-proBNP <300 pg/ml and BNP <100 pg/ml are the cut-off points for exclusion of acute heart failure. In suspected patients, it can be used to identify symptoms of shortness of breath as cardiogenic or pulmonary. (2) For chronic heart failure assessment: lower diagnostic sensitivity and specificity, but can be used to rule out a heart failure diagnosis (BNP <100 pg/ml does not support the diagnosis). (3) Risk stratification and prognostic assessment: BNP/NT-proBNP has a certain predictive value in assessing the survival rate of patients with acute decompensated heart failure, and those with significantly or persistently elevated levels are at high risk and have a poorer prognosis. (4) Guidance for clinical treatment: A decrease of ≥30% in BNP/NT-proBNP after treatment compared with baseline indicates that treatment is effective. Second, the diagnostic criteria of diastolic heart failure The new guidelines rename chronic systolic heart failure and diastolic heart failure as heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). The former diagnostic criteria remain unchanged, and the new guidelines update the diagnostic criteria for HFpEF, with the following key points: (1) the main clinical manifestations are: (1) typical signs and symptoms of heart failure; (2) normal or mildly decreased left heart ejection fraction (LVEF) (≥45%) and normal heart (especially left ventricular) size; (3) structural heart disease changes (such as left atrial enlargement or left ventricular hypertrophy) and/or echocardiographic evidence of diastolic dysfunction, but with no evidence of diastolic dysfunction; and (4) the presence of a structural heart disease (e.g., left atrial enlargement or left ventricular hypertrophy). evidence of diastolic dysfunction, but heart valve disease, pericardial disease, hypertrophic cardiomyopathy, restrictive (infiltrative) cardiomyopathy, etc. can be excluded. (2) In line with the epidemiological and demographic characteristics of the disease: most of the elderly, the main cause of hypertension or a history of hypertension, mostly in women, some patients with diabetes mellitus, atrial fibrillation, obesity or metabolic syndrome. (3) BNP/NT-proBNP measurements are mildly to moderately elevated, or at least in the "gray zone". (1) Drugs that can improve the prognosis: applicable to all chronic HFrEF patients with cardiac function class II to IV: ① angiotensin-converting enzyme inhibitor (ACEI) (Ⅰ, A); ② β-blocker (Ⅰ, A); ③ aldosterone antagonist (Ⅰ, A); ④ angiotensin receptor antagonist (ARB) (Ⅰ, A). (2) Drugs that can improve symptoms: recommended for all chronic HFrEF patients with cardiac function grades Ⅱ to Ⅳ: ① diuretics (Ⅰ, C): the effect on the mortality and morbidity of chronic heart failure has not been clinically investigated, but it can reduce shortness of breath and edema, and it is recommended to be used in patients with signs and symptoms of heart failure, especially those with significant fluid retention. (ii) Digoxin (IIa, B). (3) Drugs that may be harmful and are not recommended: ① thiazolidinyl hypoglycemic agents, which may worsen heart failure; ② most calcium antagonists, which have negative inotropic effects and worsen heart failure. Amlodipine and felodipine are excluded and available when necessary; (iii) nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase (COX)-2 inhibitors, which can lead to water and sodium retention, worsening heart failure and impairing renal function; and (iv) ACEIs and aldosterone antagonists combined on the basis of the addition of ARBs, which in combination with the three drugs increase the risk of renal impairment and hyperkalemia. 1, recommended purely to reduce the heart rate of the drug Ivabradine The drug can significantly reduce the rate of re-hospitalization in patients with HFrEF, the new guidelines recommend the application of the indications for the use of evidence-based doses of ACEI or angiotensin receptor blockers (ARB), β-blockers, aldosterone antagonists have been used after the still symptomatic and resting sinus rate of ≥ 70 beats / min patients (Ⅱa, B), or instead of the intolerance of the β-blockers (IIb, C). Slowing the heart rate becomes a new target for the treatment of chronic heart failure. 2.Expanded the applicable population of aldosterone antagonist application The new guideline recommended for use in the applicable population expanded from NYHA class III to IV to class II patients (Ⅰa, A), and it is recommended that aldosterone antagonists should be added as early as possible after the application of diuretics, ACEIs, and β-blockers as long as there are no contraindications (estimated creatinine clearance ＜30 ml/L and blood potassium ＞5 mmol/L). 3, ARB usage and status The new guidelines clarify that ARBs are not the first recommended drugs, but are used as an alternative to ACEIs (e.g., if the patient is unable to tolerate ACEIs), or are added to replace aldosterone antagonists when symptoms remain after ACEIs and β-blockers have been applied and aldosterone antagonists are not tolerated. Although all kinds of ARB can be used, but chlorosartan, valsartan and candesartan three have more sufficient evidence of reducing the rate of disease and death. ARB is not absolutely can not be combined with ACEI, but must be careful and limited, because the two together will significantly make the blood potassium, blood creatinine levels, as well as increased renal impairment and other adverse effects of the incidence of. Regarding the clinical application of digoxin, digoxin is suitable for: (1) chronic systolic heart failure with diuretics, ACEI (or ARB), β-blockers and aldosterone antagonists, but still persist in symptomatic, cardiac function class Ⅱ ~ Ⅲ patients (Ⅱa, B); (2) atrial fibrillation patients with rapid ventricular rate is particularly suitable; (3) low blood pressure can be considered as the basis of early application of treatment; (4) already applied digoxin should not be used in patients; (4) the use of digoxin should not be used in patients who have been treated for heart failure, but should be carefully and limited, because the combination of the two will significantly increase the blood potassium level of creatinine and increase the incidence of adverse reactions such as renal impairment. (4) Digoxin should not be easily discontinued in those who have already used it. Cardiac function NYHA class I, HFpEF heart failure patients are not suitable for application. The new guideline expands the applicability of CRT. NYHA class II heart failure patients can also use cardiac synchronization therapy (CRT). The new guidelines list the main recommendations for CRT as: patients with left bundle branch block (LBBB) with significant ventricular excitation asynchrony. First, QRS wave time on the ECG should be >150 ms in NYHA class II patients with or without LBBB; second, QRS wave time with LBBB should be >130 ms in the population of NYHA class III-IV patients, and must be >150 ms in the non-LBBB population; third, it is limited to patients in sinus rhythm; and fourth, it requires a standardized medication period of 3-6 months prior to decision-making, and then, after optimization of the treatment LVEF, NYHA classification, and the patient’s cardiac function status and survival must be assessed and meet the appropriate criteria. Coronary artery revascularization for heart failure with coronary artery disease emphasizes that patients with heart failure whose underlying cause is coronary artery disease should undergo coronary artery revascularization. For chronic heart failure combined with coronary artery disease, coronary artery bypass grafting (CABG) is applicable to left main stem lesions (Ⅰ, C) or double-branch or triple-branch lesions (Ⅰ, B), and the life expectancy of the patient should be > 1 year. Percutaneous coronary intervention (PCI) is indicated for patients with the above indications who are not candidates for surgical intervention. Those who have no angina or no surviving myocardium should not undergo revascularization. Refractory and end-stage heart failure patients who are still in end-stage heart failure after optimized drug and device therapy are recommended to have a left ventricular assist device or a biventricular assist device (I,B) as a transition if they are suitable for heart transplantation. Seven, acute heart failure The new guidelines in this part of the content is generally consistent with China’s acute heart failure guidelines (2010), the modifications include: (1) the design of a new treatment process, remove the limb exchange pressurization, bronchial antispasmodic agent recommendations; (2) on the application of beta-blockers in the acute phase, the new method of intravenous application of the description, the exacerbation of heart failure, such as the beta-blocker is not related to do not need to stop or reduce the amount of, before discharge should be put in the hospital, the beta-blocker is not a good idea. Reduction of the dose, the dose should be adjusted upward before discharge; (3) Recommendation of a new diuretic tolvaptan, which can be used in patients with poor results of conventional diuretics, hyponatremia, or with renal function impairment.