Heart failure Management - 2018 Australian guidelines

National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand has released 2018 clinical practice guidelines for heart failure diagnosis and treatment. The guideline for the management of heart failure (HF) provides guidance regarding the clinical care of adult patients with HF in Australia based on current evidence. It replaces the 2011 National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand (NHFA/CSANZ) Guidelines for the prevention, detection and management of chronic heart failure in Australia.

Key Recommendations-

• Blood pressure and lipid-lowering decrease the risk of developing HF. Sodium-glucose cotransporter 2 inhibitors decrease the risk of HF hospitalisation in patients with type 2 diabetes and cardiovascular disease.


• Blood pressure and lipid-lowering decrease the risk of developing HF. Sodium-glucose cotransporter 2 inhibitors decrease the risk of HF hospitalisation in patients with type 2 diabetes and cardiovascular disease.


• Angiotensin-converting enzyme inhibitors, β-blockers and mineralocorticoid receptor antagonists improve outcomes in patients with HF associated with a reduced left ventricular ejection fraction. Additional treatment options in selected patients with persistent HF associated with reduced left ventricular ejection fraction include switching the angiotensin-converting enzyme inhibitor to an angiotensin receptor neprilysin inhibitor; ivabradine; implantable cardioverter defibrillators; cardiac resynchronisation therapy; and atrial fibrillation ablation.


• A 12-lead ECG is recommended in patients with suspected or new diagnosis of heart failure to assess cardiac rhythm, QRS duration, and underlying conditions such as myocardial ischemia or LV hypertrophy.


• A chest radiograph is recommended in patients with a suspected or new diagnosis of heart failure to help identify pulmonary congestion and alternative cardiac or noncardiac causes of symptoms.


• An echocardiogram is recommended if HF is suspected or newly diagnosed.


• If an echocardiogram cannot be arranged in a timely fashion, measurement of plasma B-type natriuretic peptides improves diagnostic accuracy.


• Transthoracic echocardiography should be considered in patients with heart failure with reduced ejection fraction (HFrEF) 3 to 6 months after the start of optimal medical therapy or if there has been a change in clinical status, to assess appropriateness of other treatments such as device therapy (eg, implantable cardioverter defibrillator [ICD] or cardiac resynchronization therapy [CRT])


• Invasive coronary angiography should be considered in patients with heart failure associated with refractory angina, resuscitated cardiac arrest, sustained ventricular arrhythmias, or evidence of ischemic heart disease to determine the need for coronary revascularization.


• Monitoring of peripheral arterial oxygen saturation is recommended in patients with acute heart failure.


• Multidisciplinary HF disease management facilitates the implementation of evidence-based HF therapies. Clinicians should also consider models of care that optimise medication titration (eg, nurse-led titration).

Full guidelines can be accessed via the Heart Foundation website at:
https://www.heartfoundation.org.au/for-professionals/clinical-information/heart-failure