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Chronic Heart Failure

National clinical guideline for diagnosis and management in primary and secondary care

Developed by The National Collaborating Centre for Chronic Conditions at the Royal College of Physicians

This comprehensive guideline sets out clearly evidence based recommendations for best practice in the diagnosis and treatment of heart failure in adults - and of those with suspected heart failure. The guideline is one of a series commissioned by the National Institute for Clinical Excellence (NICE) which aims to ensure that standards of care throughout England and Wales are uniformly high.

Appendix J: Evidence tables

These tables (in PDF format) show a summary of the evidence base considered by the guideline developers. Each paper considered is shown in a separate table, typically the size of one landscape A4 page.

Each table contains the following headings:

Paper - gives the citation of the paper in Vancouver style.
Description - gives a brief standardised description of the experimental design, e.g. randomised controlled trial.
N - gives the number of people enrolled in the study, or in the relevant sub-group reported in the paper in question. Where the paper describes a systematic review or meta-analysis, the number of constituent primary papers is also given. The setting of the study is also given here if possible.
Intervention - describes the intervention (diagnostic procedure, drug, etc.) which the study sought to learn about.
Outcomes - gives the measures used to determine the effect of the intervention.
Results - shows the results as described in the paper (unless discrepancies required statistical re-calculation - in which case, this will be noted).
Comments - notes from the consideration of the paper, showing methodological limitations, applicability to a UK NHS heart failure population, etc.
Reference - gives a number by which the paper is referenced in the full guideline, if applicable.
Papers included - briefly names papers which are included in systematic reviews or meta-analyses.

Sometimes information is lacking from the original papers and may therefore be missing from the evidence tables. Only information which was important to the conclusions to be drawn was sought from the authors.

In addition to systematic literature searches, papers were suggested by individual Guideline Development Group and Consensus Reference Group members. Only those papers which were critically appraised for presentation to the group are shown in evidence tables. Therefore, not every paper referenced in the guideline appears in the evidence tables.

Some papers were considered in more than one section of the guideline. These tables are grouped by section but reflect the results of underlying literature searches. Papers will therefore only appear once.

The following evidence tables are available from this website:

Section 6 - Diagnosing heart failure
Diagnosing heart failure (233k pdf)

Section 7.1 - Lifestyle
Lifestyle (130k pdf)

Section 7.2 - Pharmacological treatment of heart failure due to LV (left ventricular) systolic dysfunction:
Diuretics (58k pdf)
ACE Inhibitors (61k pdf)
Beta Blockers (64k pdf)
Aldosterone Antagonists (46k pdf)
Digoxin (51k pdf)
Angiotensin II Receptor Antagonists (63k pdf)
Other Pharmacological Therapies (371k pdf)
Dosing Sequencing Communication and Adherence (289k pdf)

Section 7.4 - Invasive Procedures:
Revascularisation (69k pdf)
Cardiac Transplantation (27k pdf)
Ventricular Assist Devices (52k pdf)
Cardiac Resynchronisation Therapy (47k pdf)
Implantable Cardioverter-Defibrillators (51k pdf)
Other Invasive Procedures (83k pdf)

Section 7.5 - Oxygen therapy and continuous positive airways pressure treatment
Oxygen and CPAP (51k pdf)

Section 7.6 - Treatment of heart failure not due to LV systolic dysfunction
HF not due to LVSD (92k pdf)

Section 8 - Monitoring
Monitoring (66k pdf)

Section 9 - Referral and approach to care
Referral and Approach to care (118k pdf)

Section 10 - Supporting the patient and carer
Supporting Patient and Carer (164k pdf)

Section 11 - Anxiety and depression
Anxiety and Depression (105k pdf)

Appendix K: Inclusion and exclusion of literature

This appendix presents all published papers found by systematic literature searches for the development of the guideline. It is presented here as a PDF file for downloading. Alongside each paper, a column shows whether it was included, and if not, gives some brief indication of why not. A reference number is also shown, which is the number of the reference to the given paper in the full guideline.

The following points should be noted:

Some papers listed here as included are not referenced in the full guideline. This is because they are additional evidence that was considered but not cited in the guideline.
In some instances, studies will be referenced but will have an exclusion criterion. This will be because they were excluded from critical appraisal but were subsequently cited in the guideline. Typically, this is because they helped to set the context provided as part of an introduction, or because they are singled out as individual trials from a systematic review which is itself included.
Some references in the full guideline will not be found at all in this appendix, as they relate to the economic analysis and were not found or considered as part of the appraisal of the clinical evidence, or because they were included as part of an expert opinion question.
They are grouped by question, as this was the basis for determining whether they were to be included in the appraisal or not. This preceded the translation into useful clinical headings as is now seen in the guideline sections. The list of questions can be seen on page 3 of the appendix

Appendix K (877k pdf)

This page last updated on June 25, 2004