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Heart failure - chronic - Management
Basis for recommendation

These recommendations are based on guidance issued by the National Institute for Health and Clinical Excellence (NICE) [National Clinical Guideline Centre for Acute and Chronic Conditions, 2010] and expert opinion [Sanderson, 2007; European Society of Cardiology, 2008; Heart Failure Society of America, 2010].

Diuretics

  • Indirect evidence from two small clinical trials suggests that diuretics may improve symptoms in people with heart failure with preserved ejection fraction (HFPEF).

Other drug treatments

  • NICE recommends obtaining specialist advice about additional drug treatments for people with HFPEF, as there is considerable uncertainty about optimal drug treatments for HFPEF.
  • Evidence from one trial suggests that there is modest clinical benefits of candesartan as add-on treatment in people with HFPEF. Evidence from another four trials found no benefit or modest clinical benefits from adding angiotensin-converting enzyme (ACE) inhibitors or angiotensin-II receptor antagonists (AIIRAs) to other treatments for HFPEF.
  • There is evidence from one small study that propranolol may reduce the risk of death in older people with HFPEF and history of myocardial infarction.
  • NICE reviewed the evidence on ACE inhibitors and AIIRAs and beta-blockers for treating people with HFPEF and concluded that evidence is insufficient to support their use [National Clinical Guideline Centre for Acute and Chronic Conditions, 2010].
  • ACE inhibitors (or AIIRAs) and beta-blockers may be indicated to treat underlying causes and comorbidities of 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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