Nice Chronic Heart Failure- NICE Guidance - A4medicine

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Get info on Chronic Heart Failure- NICE guidance. Our chart helps to know Nice Chronic Heart Failure. This guideline covers diagnosing and managing chronic heart failure in people aged 18 and over. https://www.a4medicine.co.uk/chronic-heart-failure-nice-guidance/

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Nice Chronic Heart Failure- NICE Guidance - A4medicine Heart failure is complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood Yancy et al 2013 Ejection fraction- Definition of reduced EF varies in clinical trials between LVEF of 35 to 40 
 HF with reduced ejection fraction HF-REF 
 HF with preserved EF – nearly 1/2 of people with HF have preserved LVEF on echo Time – course Acute HF may be a new presentation of HF or may be deterioration or decompensation in a person with existing HF 
 Chronic- no agreed definition. Stable HF used to describe a person with treated HF and symptoms which are unchanged for at- least a month Visit US: https://www.a4medicine.co.uk/chronic-heart-failure-nice-guidance/

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Careful and detailed 
history and perform clinical examination and tests to confirm the presence of heart failure CXR Bloods 
○ renal profile 
○ TFT 
○ LFT 
○ Lipid profile 
○ Hba1c 
○ FBC Urinalysis Peak flow and spirometry ECG and rest to evaluate possible aggravating 
factors and / or alternative diagnosis Measure NT-proBNP in people with suspected heart failure above 2000 ng/L or 
 236 pmol/L or Refer urgently for specialist assessment and Transthoracic echocardiography within 2 weeks 400 and 2000 ng/L 
47 to 236 pmol/L Specialist assessment and echocardiography 
 within 6 weeks Less than 400 mg/ L 
47 pmol/L in an untreated person Diagnosis unlikely 
Review for alternative causes and discuss with a physician with subspeciality training in HF if you 
are still concerned Points to note about BNPObesity or African-Carribean family origin or treatment with diuretics ACE inhibitors beta blockers ARBs or MRAs can reduce levels of serum natriuretic peptide 
 High levels of serum natriuretic peptide can have causes other than heart failure for eg 

○ age over 70 yrs 
○ LVH 
○ ischaemia 
○ tachycardia 
○ right ventricular overload 
○ hypoxaemia incl PE 
○ renal dysfunction eGFR 60 
○ sepsis 
○ COPD 
○ diabetes 
○ liver cirrhosis Diuretics 

should be used routinely for the relief of congestive symptoms and fluid retention and titrated according to need following the initiation of subsequent HF therapies 
 Calcium channel blockers 

Avoid verapamil diltiazem and short acting dihydropyridine agents in people with reduced ejection fraction 
 Amiodarone 

○ Discuss with a specialist to make the decision 
 before prescribing 
○ Review the need to continue 6 monthly 
○ Offer LFT and TFT and a review of SEs as 
 part of routine 6 monthly clinical review 
 Anticoagulants 

 Those with AF + HF -follow the NICE guidance 
on AF 
Beware of the affects of

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impaired renal and liver function on AC therapies 
HF + SR → anticoagulation should be be 
considered if h/o thromboembolism left ventricular aneurysm or intracardiac thrombus Offer low to medium dose of loop diuretics eg 
Furosemide at less than 80 mg / D 
 If they fail to respond to this → refer for specialist advice 

ACE inihibitors○ Do not offer if clinical suspicion of haemodynamically sig valve disease until the valve disease has been assessed by a specialist 

○ start at a low dose and titrate upwards ever 2 weeks until the target max tolerated dose is reached

○ Check Na K+ and renal function before and 1-2 weeks after starting Rx and after each dose increment and also check BP 

○ Once the target max tolerated dose of an ACEi is reached monitor monthly for 3 months and then atleast every 6 M and at any time the person becomes acutely unwell 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 Offer an MRA in addition to an ACE i or ARB and beta blocker if they continue to have symptoms of heart failure 
 Measure Na and K and assess renal function before and after starting an MRA and after each dose increment and BP 
 Once the target or max tolerated dose of MRA is reached monitor treatment monthly

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for 3 months and then atleast every 6 months and at any time the person becomes acutely unwell

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