Evolution of care pathways in clinical practice guidelines for heart failure: a systematic review with narrative synthesis

This study provides a systematic review with narrative synthesis of Heart Failure (HF) Clinical Practice Guidelines (CPGs) published by the European Society of Cardiology (ESC) and the American Heart Association (AHA) between 2000 and 2023. The objective was to describe the evolution of the HF care pathway and to identify its current key components. The review was conducted according to PRISMA 2020 standards and registered in PROSPERO (CRD42024551462). Methodological quality was assessed using the AGREE II instrument, and Class I recommendations were extracted for thematic analysis. Fourteen CPGs were included. Over the past two decades, guideline quality has progressively improved, and the total number of recommendations increased by 344.6%. Five major components of the HF care pathway were identified: initial assessment and diagnosis; pharmacological and non-pharmacological treatment; comorbidity management; multidisciplinary care; and management of acute HF hospitalization. Although CPGs have significantly expanded and refined the structure of optimal HF care, the growing volume of recommendations may limit their practical applicability, highlighting the need for strategies that facilitate implementation within complex healthcare systems.