This site is intended for Healthcare professionals only.

Latest NICE guidelines on chronic heart failure


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.

KEY RECOMMENDATIONS

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 (HbA1c)
    • full blood count
  • Urinalysis
  • Peak flow or spirometry. [2010, amended 2018]
  • Offer an angiotensin-converting enzyme (ACE) inhibitor and a beta‑blocker licensed for heart failure to people who have heart failure with reduced ejection fraction. Use clinical judgement when deciding which drug to start first.
  • Measure serum sodium and potassium, and assess renal function, before and 1 to 2 weeks after starting an ACE inhibitor, and after each dose increment. [2010, amended 2018]
  • Measure blood pressure before and after each dose increment of an ACE inhibitor. Follow the recommendations on measuring blood pressure, including measurement in people with symptoms of postural hypotension, in the NICE guideline on hypertension in adults. [2018]
  • Once the target or maximum tolerated dose of an ACE inhibitor is reached, monitor treatment monthly for 3 months and then at least every 6 months, and at any time the person becomes acutely unwell. [2010, amended 2018]
  • Consider an ARB licensed for heart failure as an alternative to an ACE inhibitor for people who have heart failure with reduced ejection fraction and intolerable side effects with ACE inhibitors.
  • Once the target or maximum tolerated dose of an ARB is reached, monitor treatment monthly for 3 months and then at least every 6 months, and at any time the person becomes acutely unwell.
  • Introduce beta-blockers in a ‘start low, go slow’ manner. Assess heart rate and clinical status after each titration. Measure blood pressure before and after each dose increment of a beta‑blocker.
  • Offer an MRA, in addition to an ACE inhibitor (or ARB) and beta-blocker, to people who have heart failure with reduced ejection fraction if they continue to have symptoms of heart failure.
  • 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.
  • Digoxin is recommended for worsening or severe heart failure with reduced ejection fraction despite first-line treatment for heart failure. Seek specialist advice before initiating.
  • People who have heart failure with preserved ejection fraction should usually be offered a low to medium dose of loop diuretics (for example, less than 80 mg furosemide per day). People whose heart failure does not respond to this treatment will need further specialist advice.
  • Avoid verapamil, diltiazem and short-acting dihydropyridine agents in people who have heart failure with reduced ejection fraction.

For further reference log on to:

https://www.nice.org.uk/guidance/ng106/chapter/Recommendations#diagnosing-heart-failure

The following two tabs change content below.
Medha Baranwal

Medha Baranwal

Medha Baranwal joined Medical Dialogues as a Desk Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She can be contacted at medha@medicaldialogues.in. Contact no. 011-43720751
Source: With inputs from NICE

Share your Opinion Disclaimer

Sort by: Newest | Oldest | Most Voted