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Heart failure - chronic - Management
Basis for recommendation
- A direct beneficial effect of glucose lowering in reducing the risk of heart failure has not been demonstrated. However, most experts consider this to be good practice [European Society of Cardiology, 2008].
- Lactic acidosis is a rare but potentially fatal event which has been associated with metformin use. To minimize the risk of lactic acidosis, the National Institute for Health and Clinical Excellence (NICE) recommends that metformin treatment should be reviewed if the serum creatinine level is greater than 130 micromol/L or the estimated glomerular filtration rate (eGFR) is less than 45 mL/min/1.73 m2, and treatment should be withdrawn if the serum creatinine level is greater than 150 micromol/L or eGFR is less than 30 mL/min/1.73 m2 or when tissue hypoxia is suspected [NICE, 2008a].
- There is an increased risk of fluid retention with the thiazolidinediones, which can exacerbate or precipitate heart failure. They are therefore contraindicated in all New York Heart Association stages of heart failure [MeReC, 2007; MHRA, 2007a].
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