Clinical update

Updated NICE guideline on diagnosis and management of chronic heart failure

People with chronic heart failure should be given a detailed care plan, updated NICE guideline says

People with chronic heart failure should be given a detailed care plan, updated NICE guideline says


NICE recommends personalised cardiac rehabilitation programmes. Picture: iStock

Essential facts

Heart failure is a complex long-term condition characterised by reduced heart efficiency. More than half a million people in the UK live with the condition. While it can occur at any age it is most common in older people.

Symptoms

The main symptoms are:

  • Shortness of breath after activity or at rest.
  • Swollen feet, ankles, stomach and around the lower back area.
  • Feeling unusually tired.

Causes

Conditions that can cause heart failure include myocardial infarction, hypertension and cardiomyopathy. Heart failure can be sudden or develop slowly over months or years.

What’s new?

The primary care team working with the specialist heart failure multidisciplinary team should take over routine management of patients with heart failure as soon as the condition has been stabilised and its management optimised, according to a National Institute for Health and Care Excellence (NICE) guideline.

The updated guideline also recommends that people with chronic heart failure should be given a detailed care plan. This should include:

  • Plans for follow-up care, rehabilitation and access to social care.
  • Symptoms to look out for in case of deterioration.
  • Contact details for a named healthcare coordinator, usually a specialist heart failure nurse.
  • Alternative local heart failure specialist care providers, for urgent care or review.

People with heart failure whose condition is stable should be offered a personalised, exercise-based cardiac rehabilitation programme in an accessible format and setting, that is, home, community or hospital. The guideline no longer recommends group-based cardiac rehabilitation programmes.

The updated guideline now recommends measuring levels of N-terminal pro-B-type natriuretic peptide in the blood rather than B-type natriuretic peptide (BNP). This is because it is more accurate for diagnosing chronic heart failure and, unlike with BNP testing, the blood sample does not need to be analysed within hours of being taken and so is better suited for primary care.

How you can help your patient

Concordance with treatment is essential so patient education and positive patient-staff relationships are required.

Support patients to achieve good control of comorbid conditions such as diabetes, hypercholesterolaemia and kidney disease.

Encourage exercise and lifestyle modification such as smoking cessation.

Expert comment

Christopher Nicholson is integrated respiratory service team leader at East Lancashire Hospitals NHS Trust, Burnley

‘Heart failure remains an important long-term condition affecting hundreds of thousands of UK patients. The National Heart Failure Audit shows a median patient age of 80 so heart failure is mainly, although not exclusively, a syndrome occurring in older adults.

'Heart failure causes 5% of unplanned hospital admissions per year and is a significant cause of mortality. Patients living with heart failure often cope with disabling symptoms and unpredictable deteriorations.

‘The NICE guideline provides clear expectations of the services and treatments required. The update recommends further improvements: increasing uptake of key disease-modifying treatments (ACE-inhibitors; beta-blockers; mineralocorticoid receptor antagonists); improving multidisciplinary team working; and accessing cardiac rehabilitation.

‘Heart failure is a condition all staff looking after older patients will know. It is important that decisions are taken with good communication between patients, carers, primary care, community and hospital teams.

‘Concordance with treatment is crucial as non-adherence is the most common reason for hospital readmission.

‘Specialist heart failure teams provide an important expert resource, but care is shared among other experts, including older adult and palliative care teams, at the appropriate times.’

 

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