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Heart failure - chronic - Management
How should I manage someone with angina as a comorbidity in heart failure?

  • Ischaemic heart disease is a common cause of heart failure, and people with heart failure often have angina.
  • Consider referral for a specialist opinion on treatment, including revascularization.
  • Ensure that angina symptoms are well controlled, with optimum use of medical management.
    • Beta-blockers are recommended for the treatment of both heart failure and angina.
    • Nitrates have a good safety profile for use in heart failure.
    • Calcium-channel blockers are effective at controlling angina symptoms, but some may aggravate heart failure.
      • Amlodipine is recommended, as randomized controlled trial evidence indicates that it has a good safety profile in people with heart failure.
      • Verapamil, diltiazem, and short-acting dihydropyridines should be avoided.
    • Nicorandil is contraindicated in people with heart failure with low filling pressure. Seek specialist advice if considering prescription of nicorandil.
    • Ivabradine is contraindicated in people with New York Heart Association class III or IV heart failure; however it may be considered for treatment by some specialists in secondary care.
  • Ensure that fluid retention is well controlled with diuretics.
  • Low-dose aspirin is recommended for people with angina and heart failure.
  • For information on the management of angina, see the CKS topic on Angina.

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