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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. CHRONIC HEART FAILURE- NICE GUIDANCE a4medicine.co.uk

  2. Heartfailureiscomplexclinicalsyndromethatresultsfromany structuralorfunctionalimpairmentofventricularfillingorejectionof blood ( Yancyetal2013 ) a4medicine.co.uk

  3. Ejectionfraction- DefinitionofreducedEFvariesinclinical trialsbetweenLVEFof <= 35to40 %
HFwithreduced ejectionfraction ( HF-REF )
HFwithpreservedEF – nearly 1/2ofpeoplewithHFhavepreservedLVEFonechoTime – courseAcuteHFmaybeanewpresentationofHFormay bedeteriorationordecompensationinapersonwith existingHF
Chronic- noagreeddefinition. StableHFused todescribeapersonwithtreatedHFandsymptomswhich areunchangedforat-leastamonth a4medicine.co.uk

  4. MeasureNT-proBNPinpeoplewithsuspectedheartfailureabove2000ng/Lor
236pmol/LorReferurgentlyforMeasureNT-proBNPinpeoplewithsuspectedheartfailureabove2000ng/Lor
236pmol/LorReferurgentlyfor specialistassessmentandTransthoracicechocardiographywithin2weeks400and2000ng/L
47to236pmol/L Specialistassessmentandechocardiography
within6weeksLessthan400mg/ L
47pmol/Linanuntreatedperson Diagnosisunlikely
ReviewforalternativecausesanddiscusswithaphysicianwithsubspecialitytraininginHFifyou
are stillconcernedatedHFandsymptomswhichareunchangedforat-leastamonth. PointstonoteaboutBNPObesityorAfrican-Carribeanfamilyoriginortreatmentwithdiuretics , ACEinhibitors , beta blockers , ARBsorMRAscanreducelevelsofserumnatriureticpeptideHighlevelsofserumnatriureticpeptidecanhave causesotherthanheartfailureforeg○ageover70yrs
○LVH
○ischaemia
○tachycardia
○rightventricular overload
○hypoxaemiainclPE
○renaldysfunction (eGFR < 60 )
○sepsis
○COPD
○diabetes
○livercirrhosis Offerlowtomediumdoseofloopdiureticseg
Furosemideatlessthan80mg / DIftheyfailtorespondtothis→refer forspecialistadvice. ACEinihibitors○Donotofferifclinicalsuspicionofhaemodynamicallysigvalvediseaseuntilthevalvediseasehasbeen assessedbyaspecialist○startatalowdoseandtitrateupwardsever2weeksuntilthetargetmaxtolerateddoseis reached○CheckNa , K+ andrenalfunctionbeforeand1-2weeksafterstartingRxandaftereachdoseincrementand alsocheckBP○OncethetargetmaxtolerateddoseofanACEiisreachedmonitormonthlyfor3monthsandthen atleastevery6Mandatanytimethepersonbecomesacutelyunwell a4medicine.co.uk

  5. Beta blockers Do not withhold treatment with a beta blocker solely because of
○ age
○ peripheral vascular disease
○ erectile dysfunction
○ diabetes
○ interstitial pulmonary disease
○ COPD Start in a start low go slow manner
Assess HR and clinical status after each titration and measure BP after each increment Switch people whose condition is stable and who are already taking a beta blocker for a comorbidity ( for eg angina or hypertension ) and who develop HF with ↓ EF to a beta blocker licensed for HF ie Bisoprolol , carvedilol and nebivolol @ a4medicine.co.uk

  6. OfferanMRAinadditiontoanACEiorARBandbetablockeriftheycontinuetohavesymptomsofheartOfferanMRAinadditiontoanACEiorARBandbetablockeriftheycontinuetohavesymptomsofheart failure
MeasureNaandKandassessrenalfunctionbeforeandafterstartinganMRAandaftereach doseincrementandBP
OncethetargetormaxtolerateddoseofMRAisreachedmonitortreatment monthlyfor3monthsandthenatleastevery6monthsandatanytimethepersonbecomesacutelyunwell Ifremainssymptomaticreferspecialistforconsiderationof

○Sacubitril/ Valsartan○Ivabradine○ Digoxin○Hydralazine + Nitrate○Devicetherapy○Transplant a4medicine.co.uk

  7. REFERENCES 1. 2. 3. 4. 5. CKS NHS heart failure- Chronic Chronic heart failure in adults : diagnosis and management NICE guideline NG 106 September 2018 NICE Pathways Chronic heart failure Heart Failure : Epidemiology Pathophysiology and Diagnosis John McMurray et al Chronic heart failure in adults : summary of updated NICE guidance BMJ 2018 ; 362 a4medicine.co.uk

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