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 To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?'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
When should I refer someone with heart failure and left ventricular systolic dysfunction?
- Refer to a specialist multidisciplinary heart failure team (where available) or cardiology service for:
- The initial diagnosis of heart failure.
- The management of:
- Severe heart failure (New York Heart Association [NYHA] class IV).
- Heart failure that does not respond to treatment.
- Heart failure that can no longer be managed effectively in the home setting.
- Refer for specialist advice:
- Women who are planning a pregnancy or who are pregnant.
- Consider referral for assessment for cardiac resynchronization therapy and an implantable cardioverter-defibrillator people who meet either of the following criteria:
- Left ventricular ejection fraction 35% or less and previous myocardial infarction.
- NYHA class III or IV symptoms and left bundle-branch block.
- Specialist advice may be appropriate when managing people with heart failure and a comorbidity, such as:
- Angina.
- Renal impairment (for example serum creatinine level greater than 200 micromol/L).
- Anaemia.
- Thyroid disease.
- Severe peripheral arterial disease.
- Asthma or chronic obstructive pulmonary disease.
- Gout.
- Valve disease.
© NHS Institute for Innovation and Improvement