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In response to recent technological advancements in acquisition techniques as well as a growing body of evidence regarding the optimal performance of coronary computed tomography angiography (coronary CTA), the Society of Cardiovascular Computed Tomography Guidelines Committee has produced this update to its previously established 2009 "Guidelines for the Performance of Coronary CTA" (1). The purpose of this document is to provide standards meant to ensure reliable practice methods and quality outcomes based on the best available data in order to improve the diagnostic care of patients. Society of Cardiovascular Computed Tomography Guidelines for the Interpretation is published separately (2). The Society of Cardiovascular Computed Tomography Guidelines Committee ensures compliance with all existing standards for the declaration of conflict of interest by all authors and reviewers for the purpose ofclarity and transparency.

Aim The outcome of patients with chronic heart failure (CHF) following an ischaemic event is poorly understood. We evaluated the management and outcomes of CHF patients presenting with an acute coronary syndrome (ACS) and explored changes in outcomes over time. Method and results A total of 5556 patients enrolled in the Australia–New Zealand population of the Global Registry of Acute Coronary Events (GRACE) between 1999 and 2007 were included. Patients with CHF (n = 609) were compared with those without CHF (n = 4947). Patients with CHF were on average 10 years older, were more likely to be female, had more co-morbidities and cardiac risk factors, and were more likely to have a prior history of angina, myocardial infarction, and revascularization by coronary artery bypass graft (CABG) when compared with those without CHF. CHF was associated with a substantial increase in in-hospital renal failure [odds ratio (OR) 1.76, 95% confidence interval (CI) 1.15–2.71], readmission post-discharge (OR 1.47, 95% CI 1.17–1.90), and 6-month mortality (OR 2.25, 95% CI 1.55–3.27). Over the 9 year study period, in-hospital and 6 month mortality in those with CHF declined by absolute rates of 7.5% and 14%, respectively. This was temporally associated with an increase in prescription of thienopyridines, beta-blockers, statins, and angiotensin II receptor blockers, increased rates of coronary angiography, and 31.8% absolute increase in referral rates for cardiac rehabilitation. Conclusions Acute coronary syndrome patients with pre-existing CHF are a very high risk group and carry a disproportionate mortality burden. Encouragingly, there was a marked temporal improvement in outcomes over a 9 year period with an increase in evidence-based treatments and secondary preventative measures.

Chronic heart failure (CHF) is an increasingly common condition with increasing prevalence in the aging population. It has a significant mortality and is associated with a high incidence of hospitalisation and morbidity.This article describes the aspects of modern therapy that can improve survival, reduce hospitalisation and improve quality of life for CHF patients.A careful history, physical examination and judicious investigation (including chest X-ray, electrocardiogram, complete blood profile and echocardiogram) can often identify the cause of CHF, the severity of CHF and help guide management. Treatments which have been shown to be of significant benefit include angiotensin converting enzyme inhibitors, beta-blockers, aldosterone antagonists and angiotensin receptor blockers. Loop diuretics, nitrates, digoxin, hydralazine and amiodarone may be used when patients do not respond to initial therapy. Review by a cardiologist is often useful to exclude myocardial ischaemia and to perform echocardiography which is a key investigation in assessment of CHF patients. Ongoing regular review with uptitration of medications to achieve target blood pressure and pulse and exclude exacerbating conditions can lead to improvements in care and facilitate successful outcomes in CHF patients who are often very unwell.