NICE Guidelines – Chronic Heart Failure in Adults: Diagnosis and Management in Secondary Care Updated: October 1 2025 | NICE (UK)
NICE Guidelines – Chronic Heart Failure in Adults: Diagnosis and Management in Secondary Care
Updated: October 1 2025 | NICE (UK)
Key Points – (October 2025 Update)
1. Purpose:
• Intended mainly for cardiologists and secondary care teams.
2. Heart Failure Team (MDT):
• Include a lead cardiologist, specialist nurse, and HF pharmacist.
• Responsibilities: diagnosis, treatment optimization, initiation of specialist drugs, post-device follow-up
3. After Acute HF Hospitalization:
• Discharge only when clinically stable and a care plan is in place.
• Primary care resumes follow-up once HF is stable and therapy optimized.
4. Written Care Plan:
• Must summarize diagnosis, aetiology, medicines and monitoring, functional status
5. Diagnosis:
• Measure NT-proBNP for all suspected HF:
• 2000 ng/L → urgent echo within 2 weeks.
• 400–2000 ng/L → echo within 6 weeks.
• <400 ng/L → HF unlikely.
• Confirm by echocardiography; use MRI or radionuclide imaging if echo is sub-optimal.
6. Core Therapy – HFrEF:
• Offer ACE inhibitor, beta-blocker, MRA, and SGLT-2 inhibitor.
• If symptoms persist → switch ACEI → ARNI.
• If ACEI/ARNI not tolerated → consider ARB ± hydralazine + nitrate (especially African/Caribbean patients).
• Ivabradine and digoxin for persistent/worsening symptoms (specialist advice).
• Avoid verapamil, diltiazem, and short-acting dihydropyridines.
7. Mildly Reduced / Preserved EF:
• HFmrEF: consider ACEI (or ARB/ARNI), beta-blocker, MRA, SGLT-2 inhibitor.
• HFpEF: consider MRA ± SGLT-2 inhibitor (empagliflozin TA929, dapagliflozin TA902).
8. Iron Deficiency (HFrEF):
• Check TSAT, ferritin, haemoglobin.
• Treat if TSAT < 20% or ferritin < 100 ng/mL using IV iron
9. Chronic Kidney Disease:
• If eGFR ≤ 45, start lower doses and titrate slowly;
• If eGFR < 30, liaise with renal specialists.
10. Monitoring & Safety:
• If creatinine rises >50% from baseline after starting an ACEI, ARB, ARNI, or MRA, stop or reduce the dose and reassess renal function — it suggests renal impairment or over-diuresis rather than normal hemodynamic effect.
• Stop or adjust if creatinine ↑ > 50% or potassium > 5.5 mmol/L.
• Avoid routine digoxin level monitoring unless toxicity suspected.
11. Anticoagulation:
• Follow AF guidelines for patients with heart failure and AF.
• In sinus rhythm, consider anticoagulation if prior embolism, LV aneurysm, or intracardiac thrombus.
12. Vaccination & Lifestyle:
• Annual influenza and single pneumococcal vaccine.
• No routine sodium or fluid restriction; advise individually.
• Avoid potassium-containing salt substitutes.
• Discuss contraception/pregnancy, screen for depression, encourage smoking and alcohol moderation.
13. Devices & Interventions:
• No routine coronary revascularization for stable HFrEF + CAD.
• Consider transplant referral for refractory cases.
• ICD/CRT
14. Rehabilitation:
• Offer easy exercise-based cardiac rehab with psychological support
15. Palliative Care:
• No long-term home oxygen unless other disease warrants.
