Latest NICE guidelines on chronic heart failure

The National Institute for Health and Care Excellence (NICE) has issued guidance week on the diagnosis, treatment, and aftercare of adult patients with chronic heart failure. It aims to improve diagnosis and treatment to increase the length and quality of life for people with heart failure.

Diagnosis, treatment, and management of chronic heart failure

• The primary care team working with the specialist heart failure multi-disciplinary team (MDT) should take over routine management of heart failure as soon as it has been stabilized and its management optimized.


• The updated guideline now recommends measuring the levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the blood rather than B-type natriuretic peptide (BNP). The NT-proBNP test is more accurate and better suited to primary care.


• Patients newly diagnosed with heart failure should be offered an extended first consultation, followed by a second consultation within 2 weeks wherever possible.


• People with chronic heart failure should be given a detailed care plan.


• People whose condition was stable should be offered a personalized, exercise-based cardiac rehabilitation programme at home or in an easily accessible location, not necessarily in a group setting.


• The level of serum natriuretic peptide does not differentiate between heart failure with reduced ejection fraction and heart failure with preserved ejection fraction. [2018]


• Transthoracic echocardiography should be performed on high‑resolution equipment by experienced operators trained to the relevant professional standards. Need and demand for these studies should not compromise quality. [2003, amended 2018]


• Consider alternative methods of imaging the heart (for example, radionuclide angiography [multigated acquisition scanning], cardiac MRI or transoesophageal echocardiography) if a poor image is produced by transthoracic echocardiography. [2003, amended 2018]


• Perform an ECG and consider the following tests to evaluate possible aggravating factors and/or alternative diagnoses:


• Chest X-ray


• Blood tests:
  
  
  

  
  
  • renal function profile
  
  
  • thyroid function profile
  
  
  • liver function profile
  
  
  • lipid profile
  
  
  • glycosylated haemoglobin (HbA_1c)
  
  
  • full blood count
  
  

  
  

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  Ivabradine is recommended as an option for treating chronic heart failure for people:

  
  
  
  
  

  
  
  • with New York Heart Association (NYHA) class II to IV stable chronic heart failure with systolic dysfunction and
  
  
  • who are in sinus rhythm with a heart rate of 75 beats per minute (bpm) or more and
  
  
  • who are given ivabradine in combination with standard therapy including beta-blocker therapy, angiotensin-converting enzyme (ACE) inhibitors and aldosterone antagonists, or when beta‑blocker therapy is contraindicated or not tolerated and with a left ventricular ejection fraction of 35% or less.
  
  

  
  


• Sacubitril valsartan is recommended as an option for treating symptomatic chronic heart failure with reduced ejection fraction, only in people:
  
  
  
  • with New York Heart Association (NYHA) class II to IV symptoms and
  
  
  • with a left ventricular ejection fraction of 35% or less and
  
  
  • who are already taking a stable dose of angiotensin‑converting enzyme (ACE) inhibitors or ARBs.
  
  
  • who are already taking a stable dose of angiotensin‑converting enzyme (ACE) inhibitors or ARBs.
  
  
  • who are already taking a stable dose of angiotensin‑converting enzyme (ACE) inhibitors or ARBs.