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Heart failure - chronic - Management
Basis for recommendation
These recommendations reflect the National Institute for Health and Clinical Excellence (NICE) guideline Chronic heart failure: national clinical guideline for diagnosis and management in primary and secondary care [National Clinical Guideline Centre for Acute and Chronic Conditions, 2010] and are in line with international guidelines [ICSI, 2007; SIGN, 2007; European Society of Cardiology, 2008].
Functional capacity
- The New York Heart Association (NYHA) classification of functional capacity has been widely used over many decades, both in research and clinical practice. The current version is the result of a series of updates to the 1928 classification [American Heart Association, 1994]. It aims to provide a standard and more objective way of describing severity of symptoms.
- A UK survey of 30 cardiologists found that they had no consistent method for assessing NYHA class [Raphael et al, 2006]. The same report included a study of inter-operator variability among four cardiologists assessing 50 people. The average concordance between any pair of cardiologists was 54%, and there was very poor agreement in differentiating between class II and class III. The authors considered the NYHA classification to be useful despite these limitations and recommended that the objectivity of the classification be improved by clarifying how 'ordinary physical activity', 'slight limitation', and 'marked limitation' are elicited from people.
Fluid status
- Fluid status should be determined because this allows response to treatment to be assessed and guides further management.
Assessing cardiac rhythm
- It is important to regularly and routinely assess cardiac rhythm because people with heart failure frequently have treatable arrhythmias (especially atrial fibrillation), and these can be discovered at any time before, at, or after the initial presentation with heart failure.
- If symptoms deteriorate and the pulse is regular, electrocardiography should be considered because atrial tachycardia can be regular and may be missed on clinical examination.
- For more information, see Complications.
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