Heart failure : management and monitoring NICE summary

This table provides a quick reference guide for primary care clinicians managing patients with all types of heart failure. It summarizes the key pharmacological and non-pharmacological measures as per the NICE guidelines. This enables clinicians to make evidence-based decisions in optimizing therapy for heart failure patients.

Pharmacological and Non-Pharmacological Measures	Recommendations and Points to Consider
Diuretics	♦ Routinely used for relief of congestive symptoms and fluid retention. ♦ Titrate up or down as needed. ♦ For heart failure with preserved ejection fraction, usually offer a low to medium dose of loop diuretics (e.g., <80 mg furosemide/day).
Calcium-Channel Blockers	♦ Avoid verapamil, diltiazem, and short-acting dihydropyridine agents in heart failure with reduced ejection fraction.
Amiodarone	♦ Prescribe only in consultation with a specialist. ♦ Review the prescription at 6-monthly clinical reviews. ♦ Perform liver and thyroid function tests and review side effects at 6-month clinical reviews.
Anticoagulants	• For heart failure with atrial fibrillation, follow NICE guidelines on atrial fibrillation. • Consider impaired renal and liver function. • In sinus rhythm, consider anticoagulation for those with a history of thromboembolism, left ventricular aneurysm, or intracardiac thrombus.
Vaccinations	♦ Offer annual influenza vaccination ♦ Offer pneumococcal disease vaccination (required only once).

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