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Nice Heart Failure | Nice Guidelines Heart Failure | A4 Medicine

This guideline covers diagnosing and managing chronic heart failure in people aged 18 and over. It aims to improve diagnosis and treatment. A4 medicine provides the best nice heart guideline.<br>

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Nice Heart Failure | Nice Guidelines Heart Failure | A4 Medicine

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  1. NiceHeartFailure Heartfailureisacomplexclinicalsyndromethatresultsfromanystructuralorfunctionalimpairmentof ventricularfillingorejectionofblood(Yancyetal2013) Ejectionfraction-DefinitionofreducedEFvariesinclinicaltrialsbetweenLVEFof<=35to40% HF with reducedejectionfraction(HF-REF) HFwithpreservedEF–nearly1/2ofpeoplewithHFhavepreserved LVEF on echo Time – course Acute HF may be a new presentation of HF or may be deterioration or decompensationinapersonwithexistingHF Chronic-noagreeddefinition.StableHFusedtodescribea personwithtreatedHFandsymptomswhichareunchangedforat-leastamonth. Carefulanddetailed history and perform clinical examination and tests to confirm the presence of heart failureCXRBloods ○renalprofile ○TFT ○LFT ○Lipidprofile ○Hba1c ○FBCUrinalysisPeakflowand spirometryECGandresttoevaluatepossibleaggravating factorsand/oralternativediagnosis a4medicine.co.uk

  2. MeasureNT-proBNPinpeoplewithsuspectedheartfailureabove2000ng/Lor 236 pmol/L or Refer urgently for specialistassessmentandTransthoracicechocardiographywithin2weeks400and2000ng/L 47 to 236 pmol/L Specialistassessmentandechocardiography within6weeksLessthan400mg/L 47pmol/Linanuntreatedperson Diagnosisunlikely ReviewforalternativecausesanddiscusswithaphysicianwithsubspecialitytraininginHFifyou arestillconcerned PointstonoteaboutBNPObesityorAfrican-Carribeanfamilyoriginortreatmentwithdiuretics,ACEinhibitors,beta blockers,ARBsorMRAscanreducelevelsofserumnatriureticpeptide Highlevelsofserumnatriureticpeptidecan havecausesotherthanheartfailureforeg ○ageover70yrs ○LVH ○ischaemia ○tachycardia ○ right ventricularoverload ○hypoxaemiainclPE ○renaldysfunction(eGFR<60) ○sepsis ○COPD ○diabetes cirrhosis • liver Diuretics shouldbeusedroutinelyforthereliefofcongestivesymptomsandfluidretentionandtitratedaccordingto needfollowingtheinitiationofsubsequentHFtherapies Calciumchannelblockers Avoid verapamil , diltiazem and shortactingdihydropyridineagentsinpeoplewithreducedejectionfraction Amiodarone ○Discusswithaspecialist tomakethedecision (beforeprescribing) ○Reviewtheneedtocontinue6monthly ○ Offer LFT and TFT and a reviewofSEsaspartofroutine6monthlyclinicalreviewAnticoagulantsThosewithAF+HF-followtheNICE guidanceonAFBewareoftheaffectsofimpairedrenalandliverfunctiononACtherapiesHF+SR→anticoagulation shouldbebe consideredifh/othromboembolism,leftventricularaneurysmorintracardiacthrombus a4medicine.co.uk

  3. Offerlowtomediumdoseofloopdiureticseg Furosemideatlessthan80mg/D Iftheyfailto respondtothis→referforspecialistadvice. ACE inihibitors○ Do not offer if clinical suspicion of haemodynamically sig valve disease until the valvediseasehasbeenassessedbyaspecialist ○startatalowdoseandtitrateupwardsever2 weeksuntilthetargetmaxtolerateddoseisreached ○CheckNa,K+andrenalfunctionbefore and1-2weeksafterstartingRxandaftereachdoseincrementandalsocheckBP ○ Once the target max tolerated dose of an ACEi is reached monitor monthly for 3 months and then atleast every6Mandatanytimethepersonbecomesacutelyunwell a4medicine.co.uk

  4. Ifremainssymptomaticreferspecialistforconsiderationof ○Sacubitril/Valsartan○IvabradineIfremainssymptomaticreferspecialistforconsiderationof ○Sacubitril/Valsartan○Ivabradine • Digoxin○Hydralazine+Nitrate○Devicetherapy○Transplant • References • CKSNHSheartfailure-ChronicChronicheartfailureinadults:diagnosisandmanagement NICEguidelineNG106September2018 • NICEPathwaysChronicheartfailure • Heart Failure : Epidemiology Pathophysiology and Diagnosis John McMurray et al Chronicheartfailureinadults:summaryofupdatedNICEguidanceBMJ2018;362 a4medicine.co.uk

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