Excerpt

The need for this guideline was identified as the NICE guidelines on chronic heart failure were being updated. We recognised at this time that there were important aspects of the diagnosis and management of acute heart failure that were not being addressed by the chronic heart failure guideline, which focussed on long term management rather than the immediate care of someone who is acutely unwell as a result of heart failure. The aim of this guideline is to provide guidance to the NHS on the diagnosis and management of acute heart failure.

Heart failure is a condition in which the heart does not pump enough blood to meet all the needs of the body. It is caused by heart muscle damage or dysfunction, valve problems, heart rhythm disturbances and other rarer causes. Acute heart failure can present as new-onset heart failure in people without known cardiac dysfunction, or as acute decompensation of chronic heart failure.

Acute heart failure is a common cause of admission to hospital (over 67,000 admissions in England and Wales per year) and is the leading cause of hospital admission in people 65 years or older in the UK.

This guideline includes important aspects of the diagnosis and management of acute heart failure that are not addressed by the NICE guideline on chronic heart failure (NICE clinical guideline 108). The guideline on chronic heart failure focused on long-term management rather than the immediate care of someone who is acutely unwell as a result of heart failure.

This guideline covers the care of adults (aged 18 years or older) who have a diagnosis of acute heart failure, have possible acute heart failure, or are being investigated for acute heart failure.

Contents

• Guideline Development Group members
• NCGC technical team members
• Co-optees
• Acknowledgements
• 1. Introduction
  • Patient centred care
• 2. Development of the guideline
  • 2.1. What is a NICE clinical guideline?
  • 2.2. Remit
  • 2.3. Who developed this guideline?
• 3. Methods
  • 3.1. Developing the review questions and outcomes
  • 3.2. Searching for evidence
  • 3.3. Evidence of effectiveness
  • 3.4. Evidence of cost effectiveness
  • 3.5. Developing recommendations
• 4. Guideline summary
  • 4.1. Algorithm
  • 4.2. Key priorities for implementation
  • 4.3. Full list of recommendations
  • 4.4. Key research recommendations
• 5. Organisation of care
  • 5.1. Specialist management units
• 6. Diagnosis, assessment and monitoring
  • 6.1. Natriuretic peptides
  • 6.2. Echocardiography
  • 6.3. Invasive monitoring
• 7. Initial pharmacological treatment
  • 7.1. General considerations
  • 7.2. Opiates
  • 7.3. Diuretic administration strategies
  • 7.4. Vasodilators
  • 7.5. Inotropes and vasopressors
• 8. Initial non-pharmacological treatment
  • 8.1. Ventilatory support
  • 8.2. Invasive ventilation
  • 8.3. Ultrafiltration
• 9. Treatment after stabilisation
  • 9.1. Timing of beta blocker therapy
  • 9.2. Timing of ACE inhibitor and aldosterone antagonist therapy
• 10. Valvular surgery and percutaneous intervention
  • 10.1. Aortic stenosis
  • 10.2. Mitral regurgitation
• 11. Mechanical assist devices
  • 11.1.1. Clinical evidence
  • 11.1.2. Economic evidence
  • 11.1.3. Evidence statements
  • 11.1.4. Recommendations and link to evidence
• 12. Reference list
• 13. Glossary
• Appendix A. Scope
• Appendix B. Declarations of interest
• Appendix C. Review protocols
• Appendix D. Clinical article selection
• Appendix E. Economic article selection
• Appendix F. Literature search strategies
• Appendix G. Clinical evidence tables
• Appendix H. Economic evidence tables
• Appendix I. Forest plots
• Appendix J. Natriuretic peptides: diagnostic meta-analysis methods
• Appendix K. Excluded clinical studies
• Appendix L. Excluded economic studies
• Appendix M. Cost-effectiveness analysis
• Appendix N. Unit costs
• Appendix O. Research recommendations
• References to Appendices

Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.