Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Heart failure - chronic - Management
What information should I provide about sexual activity and chronic heart failure?

  • Sexual problems may be related to cardiovascular disease, medical treatments (such as beta-blockers), fatigue, or depression.
  • People who can tolerate moderate exertion without cardiovascular symptoms (such as dyspnoea, palpitations, or angina) should be able to engage in sexual activity without provoking these symptoms.
  • People with New York Heart Association (NYHA) class III or IV symptoms may have a slightly increased risk of worsening heart failure triggered by sexual activity.
  • Phosphodiesterase inhibitors (such as sildenafil) are not recommended for use in people with advanced heart failure, and these drugs should not be used by anyone who is taking regular nitrates, or nicorandil.
  • Advise people with stable heart failure who take a phosphodiesterase inhibitor that:
    • They should not use glyceryl trinitrate (GTN) for at least 24 hours before taking sildenafil or vardenafil and for at least 48 hours before taking tadalafil.
    • They should not use GTN for at least 24 hours after taking sildenafil or vardenafil and for at least 48 hours after taking tadalafil.
    • If they have an episode of angina during sexual intercourse, they must not use GTN. They should stop sexual activity and, if their pain does not resolve, they should call for an ambulance.
  • Some people may benefit from referral to a sexual dysfunction clinic.

© NHS Institute for Innovation and Improvement