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Heart failure - chronic - Management
Basis for recommendation
These recommendations are based on guidelines from the Scottish Intercollegiate Guidelines Network (SIGN) [SIGN, 2007] and information published by the manufacturers [ABPI Medicines Compendium, 2010g; ABPI Medicines Compendium, 2010l].
- It is important to control fluid retention, because anti-anginal medication may produce little benefit unless fluid retention is controlled with diuretics [ACC and AHA, 2005]. The decrease in ventricular volume and pressures produced by diuretics may also exert independent anti-anginal effects.
- Ivabradine
- Although the manufacturers of ivabradine state that it is contraindicated in stage III or stage IV heart failure, a recently published large randomized controlled trial (SHIFT [Systolic Heart failure treatment with the If inhibitor ivabradine Trial]) found that ivabradine reduces the risk of cardiovascular death and hospitalization for worsening heart failure in people with moderate to severe heart failure [Swedberg et al, 2010].
- Ivabradine may be initiated in secondary care by a specialist to treat heart failure.
Specialist
- NICE defines the term 'specialist' as a physician with sub-speciality interest in heart failure (often a consultant cardiologist) who leads a specialist multidisciplinary heart failure team of professionals with appropriate competencies from primary and secondary care. The team will involve, where necessary, other services (such as rehabilitation, tertiary care, and palliative care) in the care of individual persons.
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