Acute heart failure diagnosing and managing acute heart failure in adults.

Issued: October 2014 NICE clinical guideline 187

guidance.nice.org.uk/cg187

Gavin Denton (@dentongavin) breaks down some of the issues raised by the NICE guidance on heart failure. Thanks mate!!

Gavin Denton @dentongavin

My interpretation and summary of guideline.

The guideline is broken into the following sections. The evidence grade is not presented for the recommendations (not untypical of NICE).

Organisation of care.

  • All hospitals should provide a heart failure, cardiology based service.

  • All suspected AHF patients should have early input from a heart failure outreach team.

  • HF outreach review within 2 weeks of discharge from hospital.

Diagnosis,assessment and monitoring.

  • Use single test of BNP or pro-BNP in all suspected AHF patients.

  • All Patients with a positive BNP/PBNP tests should have cardiac Echo.

  • Consider cardiac echo in all suspected AHF patients.

Initial pharmacological Management

  • Don’t routinely use opiates.

  • Don’t routinely use nitrates.

  • Don’t use sodium nitropuriside.

  • If IV nitrates are used, this should be done in a level 2 care environment.

  • Monitor urine, weight and renal function.

  • Don’t routinely use inotrope.

  • Consider using inotrope when shock is present.

Non-pharmaceutical treatment.

  • Do not routinely use NIV (CPAP or Bipap).

  • Use NIV without delay if severe dyspnea or acidosis.

  • Use NIV if patient fails to respond to initial therapy or deteriorates.

  • Don’t routinely use ultrafiltration.

  • Consider ultrafiltration if diuretic resistant.

Treatment and stabilisatIon.

  • Do not stop B-blockers unless HR less than 50 or AV block.

  • Start or re-introduce B-blockers when stable and off IV diuretics.

  • Keep as inpatient for 48hrs after starting or restarting B-blockers.

  • Add ACE/ARB + aldosterone antagonist, if ACE/ARB not tolerated, give aldosterone antagonist.

Research recommendations.

      • Dopamine, yes that old chestnut, not a recommendation, but some of the old school I’m sure couldn’t let go of this dogma, but at least it has been relegated to an area of recommended research. The NICE renal failure guideline is categorical that there is no evidence to justify its use.

      • Thiazides. Recommended as an issue for research in patient that are diuretic resistant.

      • Ultrafiltration. Now there is growing interest in using ultrafiltration over diuretics and there are a number of small studies on this issue.

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Originally posted 2014-10-17 15:10:56. Republished by Blog Post Promoter

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