This guideline offers evidence-based advice on the care and treatment of people with chronic heart failure. New and updated recommendations are included on diagnosis, pharmacological treatment, monitoring and rehabilitation.
older adults and
peripheral vascular disease
interstitial pulmonary disease and
chronic obstructive pulmonary disease (COPD) without reversibility.
Seek specialist advice and consider adding one of the following if a patient remains symptomatic despite optimal therapy with an ACE inhibitor and a beta-blocker:
Offer a supervised group exercise-based rehabilitation programme designed for patients with heart failure.
All patients with chronic heart failure require monitoring. This monitoring should include:
When a patient is admitted to hospital because of heart failure, seek advice on their management plan from a specialist in heart failure.
Patients with heart failure should generally be discharged from hospital only when their clinical condition is stable and the management plan is optimised. Timing of discharge should take into account patient and carer wishes, and the level of care and support that can be provided in the community.
Heart failure is a complex clinical syndrome of symptoms and signs that suggest the efficiency of the heart as a pump is impaired. It is caused by structural or functional abnormalities of the heart. Some patients have heart failure due to left ventricular systolic dysfunction (LVSD) which is associated with a reduced left ventricular ejection fraction. Others have heart failure with a preserved ejection fraction (HFPEF). Most of the evidence on treatment is for heart failure due to LVSD. The most common cause of heart failure in the UK is coronary artery disease, and many patients have had a myocardial infarction in the past.
Around 900,000 people in the UK have heart failure. Almost as many have damaged hearts but, as yet, no symptoms of heart failure. Both the incidence and prevalence of heart failure increase steeply with age, with the average age at first diagnosis being 76 years. The prevalence of heart failure is expected to rise in future as a result of an ageing population, improved survival of people with ischaemic heart disease and more effective treatments for heart failure.
Heart failure has a poor prognosis: 30–40% of patients diagnosed with heart failure die within a year – but thereafter the mortality is less than 10% per year.
Heart failure has a poor prognosis: 30–40% of patients diagnosed with heart failure die within a year – but thereafter the mortality is less than 10% per year. There is evidence of a trend of improved prognosis in the past 10 years. The 6-month mortality rate decreased from 26% in 1995 to 14% in 2005.
For both patients and their carers heart failure can be a financial burden and have adverse effects on their quality of life.
NICE guidelines are developed in accordance with a scope that defines what the guideline will and will not cover.
Topics covered include:
You can read the guideline on NICE's website.