1. Management of Chronic Heart Failure SIGN 95

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

3. 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

4. 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)

5. Which drugs to prescribe by NYHA class
Class Prescribe
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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)

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

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

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

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