Management of Chronic Heart Failure SIGN 95

Chronic Heart Failure (CHF) Diagnosis Treatment drugs after ACEI/BB devices models of care

Diagnostic algorithm for patients with suspected CHF Symptoms or signs suggestive of CHF Clinical examination (full blood count, fasting blood glucose, serum urea and electrolytes, urinalysis, thyroid function and chest X-ray) BNP (or NT pro-BNP) and/or ECG

BNP and/or ECG Low BNP (or NT pro-BNP) and normal ECG Raised BNP (or NT pro-BNP) or abnormal ECG CHF Excluded CHF Possible Consider alternative cause for symptoms Refer for echocardiography ECG (if not already done, to determine cause of CHF)

Which drugs to prescribe by NYHA class Class Prescribe ______________________________________________________________________________ NYHA I (no limitation of physical activity) ACE inhibitor beta blocker NYHA II-III (slight limitation) ACE inhibitor beta blocker candesartan (requires specialist) NYHA III-IV (marked limitation or inability) ACE inhibitor beta blocker spironolactone (requires specialist)

Other New Drugs ACEI intolerant ARB African-American Hydralazine/ Isosorbide dinitrate

Cardiac Resynchronisation Therapy LVSD (LVEF <35%) NYHA III-IV CRT QRS >120m/s Above plus ICD implantation criteria CRT-D

Models of Care Comprehensive discharge planning Multidisciplinary follow up Nurses Home Visits Telephone Pharmacist

Summary BNP/ECG prior to echo Echo service capacity ACEI Blockers Spironolactone/Candesartan CRT CRT-D Nurse Follow Up