Excerpt

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.

Contents

• August 2010 Update
• Acknowledgements
• Membership of development groups
• Preface
• Development of the Guideline
  • 1. Introduction
    • 1.1 Definition of heart failure
    • 1.2 Clinical context
    • 1.3 Guideline aims
    • 1.4 For whom is the guideline intended?
    • 1.5 Underlying guideline principles
    • 1.6 Definition of a specialist
    • 1.7 Structure of document
    • 1.8 Guideline limitations
    • 1.9 Scope
    • 1.10 Plans for guideline revision
  • 2. Methodology
    • 2.1 The developers
    • 2.2 Involvement of patients with heart failure
    • 2.3 Searching for the evidence
    • 2.4 Synthesising the evidence
    • 2.5 Health economics evidence
    • 2.6 Unpublished trials
    • 2.7 Drafting the recommendations
    • 2.8 Agreeing the recommendations
    • 2.9 Writing the guideline
  • 3. Hierarchy of evidence and grading of recommendations
  • 4. Glossary of terms
• The Guideline
  • 5. Implementation summary of recommendations
    • 5.1 Algorithm summarising recommendations for the diagnosis of heart failure
    • 5.2 Recommendations for specialist referral
    • 5.3 Algorithm for the pharmacological treatment of symptomatic heart failure due to LV systolic dysfunction
    • 5.4 Suggested audit criteria for implementation
  • 6. Diagnosing heart failure
    • Introduction
    • 6.1 Symptoms, signs and non-cardiac investigation
    • 6.2 Review of existing diagnoses
    • 6.3 Specialist referral
    • 6.4 Algorithm summarising recommendations for the diagnosis of heart failure
  • 7. Treating heart failure
    • Introduction
    • 7.1 Lifestyle
    • 7.2 Pharmacological treatment of heart failure due to LV systolic dysfunction
    • 7.3 Algorithm for the pharmacological treatment of symptomatic heart failure due to LV systolic dysfunction
    • 7.4 Invasive procedures
    • 7.5 Oxygen therapy and continuous positive airways pressure treatment
    • 7.6 Treatment of heart failure not due to LV systolic dysfunction
  • 8. Monitoring
    • 8.1 Clinical review
    • 8.2 Review of management plan – including medication
    • 8.3 Serial cardiac imaging
    • 8.4 Therapeutic drug monitoring of serum digoxin concentrations
    • 8.5 Serial measurement of circulating natriuretic peptide concentration
    • 8.6 Patient self-monitoring and remote monitoring
  • 9. Referral and approach to care
    • 9.1 Referral for more specialist advice
    • 9.2 Discharge planning
    • 9.3 Multidisciplinary team approach to heart failure management
    • 9.4 Care pathways
    • 9.5 Non-NHS agencies
  • 10. Supporting patients and carers
    • 10.1 Communication
    • 10.2 Prognosis
    • 10.3 Support groups
  • 11. Anxiety and depression
    • RECOMMENDATIONS
  • 12. End of life
    • RECOMMENDATIONS
  • 13. Prevention
    • PRINCIPLES OF GOOD PRACTICE
  • 14. Audit criteria
  • 15. Areas for future research
• Appendices
  • Appendix A Clinical questions
  • Appendix B Search strategy
  • Appendix C Searching for health economics evidence
  • Appendix D Health economics of pharmacological therapies
  • Appendix E Health economics of invasive procedures
  • Appendix F Health economics of other non-pharmacological therapies
  • Appendix G A cost effectiveness model for the appropriate use of echocardiography in the diagnosis of heart failure
  • Appendix H Patient focus groups: patients’ views and experiences
  • Appendix I Registered stakeholders consulted via NICE process
  • Appendix J Evidence tables
  • Appendix K Inclusion and exclusion of literature
• References