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Heart failure - chronic - Management
How should I follow up someone with heart failure and left ventricular systolic dysfunction?

  • All people with heart failure require regular follow up, monitoring, and review of medications to assess any need for changes and to detect possible adverse effects.
  • The frequency of follow up and detail of monitoring needs to be individualized according to the severity of symptoms, stability of clinical status, intensity of treatment, and comorbidities.
    • More frequent follow up and more detailed monitoring will be required if the person has significant comorbidity or if their condition has deteriorated since the previous review. The follow-up interval should be short (days to 2 weeks) if the clinical condition or medication has changed, and at least every 6 months if the person's condition is stable.
    • Encourage people to be involved in monitoring their condition; provide those who wish to do so with the necessary education and support, and with clear advice on what to do if their condition deteriorates (see Self-care advice).
  • Assess and monitor:
    • Psychosocial needs, including depression.
    • Functional capacity — ask about ability to perform everyday activities (some people may benefit from cardiac rehab).
      • The New York Heart Association (NYHA) classification is a useful tool.
    • Intercurrent infection, especially respiratory tract infection.
    • Fluid status — assess:
      • Change in body weight.
      • Jugular venous distention.
      • Lung crackles (crepitations).
      • Hepatomegaly (liver engorgement).
      • Ascites.
      • Oedema (ankles, sacrum, genitalia, abdomen).
      • Change in systolic blood pressure on standing up from a lying position (a postural decrease of more than 20 mmHg suggests hypovolaemia).
    • Cardiac rhythm — ask about syncopal and presyncopal symptoms, and examine the pulse and heart.
      • If the person has syncope or presyncope (unless clearly due to postural hypotension), refer to a cardiologist as this may be due to ventricular tachycardia, particularly in people who have left ventricular systolic dysfunction.
      • If arrhythmia is suspected from the physical examination, do 12-lead electrocardiography (ECG) or arrange 24-hour ECG monitoring.
      • If symptoms have deteriorated and the pulse is regular, consider doing ECG.
    • Biochemistry — for information on the monitoring recommended for particular drugs, see the Prescribing information sections on:

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