Authors' objectives:

This guideline offers best practice advice on the care of adult patients (aged 18 years or older) who have symptoms or a diagnosis of chronic heart failure. It aims to define the most effective combination of symptoms, signs and investigations required to establish a diagnosis of heart failure, and those which will influence therapy or provide important prognostic information. It also gives guidance on the treatment, monitoring and support of patients with heart failure.

Authors' recommendations: The following recommendations have been identified as priorities for implementation. Diagnosis: 1. The basis for historical diagnoses of heart failure should be reviewed, and only patients whose diagnosis is confirmed should be managed in accordance with this guideline. 2. Doppler 2D echocardiographic examination should be performed to exclude important valve disease, assess the systolic (and diastolic) function of the (left) ventricle and detect intracardiac shunts. Treatment: 3. All patients with heart failure due to left ventricular systolic dysfunction should be considered for treatment with an ACE inhibitor. 4. Beta blockers licensed for use in heart failure should be initiated in patients with heart failure due to left ventricular systolic dysfunction after diuretic and ACE inhibitor therapy (regardless of whether or not symptoms persist). Monitoring: 5. All patients with chronic heart failure require monitoring. This monitoring should include: - a clinical assessment of functional capacity, fluid status, cardiac rhythm, and cognitive and nutritional status - a review of medication, including need for changes and possible side effects - serum urea, electrolytes and creatinine. Discharge: 6. Patients with heart failure should generally be discharged from hospital only when their clinical condition is stable and the management plan is optimised. 7. The primary care team, patient and carer must be aware of the management plan. Supporting patients and carers: 8. Management of heart failure should be seen as a shared responsibility between patient and healthcare professional.

Authors' methods: Clinical guideline

Project Status: Completed

URL for project: http://www.nice.org.uk/cat.asp?c=79725

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: National Institute for Clinical Excellence

Contact Address: MidCity Place, 71 High Holborn, London WC1V 6NA, UK. Tel: +44 020 7067 5800; Fax: +44 020 7067 5801

Contact Name: nice@nice.nhs.uk

Contact Email: nice@nice.nhs.uk

Copyright: National Institute for Clinical Excellence (NICE)