{"id":8692,"date":"2025-09-20T19:38:36","date_gmt":"2025-09-20T16:38:36","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=8692"},"modified":"2025-09-20T19:38:36","modified_gmt":"2025-09-20T16:38:36","slug":"chronic-heart-failure-in-adults-diagnosis-and-management-primary-care-summary","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/chronic-heart-failure-in-adults-diagnosis-and-management-primary-care-summary\/","title":{"rendered":"Chronic Heart Failure in Adults: Diagnosis and Management \u2013 Primary Care Summary"},"content":{"rendered":"
Chronic Heart Failure in Adults: Diagnosis and Management \u2013 Primary Care Summary<\/div>\n
<\/div>\n
Source:NICE guideline<\/div>\n
Reference number: NG106<\/div>\n
Published:<\/div>\n
12 September 2018<\/div>\n
Last updated:<\/div>\n
03 September 2025.<\/div>\n
<\/div>\n
1. Team working (MDT and Primary Care)<\/span><\/div>\n
\u2022 MDT (Multidisciplinary Team) = a specialist team including:<\/span><\/div>\n
\u2022 Cardiologist with HF expertise.<\/span><\/div>\n
\u2022 Heart failure specialist nurse.<\/span><\/div>\n
\u2022 Pharmacist or prescriber with HF expertise.<\/span><\/div>\n
\u2022 The MDT works in close collaboration with primary care.<\/span><\/div>\n
\u2022 Roles: MDT makes diagnosis, starts complex therapies, and manages advanced cases.<\/span><\/div>\n
\u2022 Primary care ensures continuity: communication, record updates, recalls every 6 months, and linking all services.<\/span><\/div>\n
2. Extended first consultation<\/span><\/div>\n
\u2022 Newly diagnosed patients should be offered a long, detailed first appointment (not a quick visit).<\/span><\/div>\n
\u2022 Purpose: explain the diagnosis, prognosis, treatment options, sudden death risk, and answer all patient\/family questions.<\/span><\/div>\n
\u2022 Followed by a second consultation (ideally within 2 weeks).<\/span><\/div>\n
3. Written summary and care plan<\/span><\/div>\n
\u2022 The MDT prepares a written summary including: diagnosis, medications, monitoring, functional status, and social needs.<\/span><\/div>\n
\u2022 This becomes the individualised care plan, which must cover:<\/span><\/div>\n
\u2022 Follow-up schedule.<\/span><\/div>\n
\u2022 Warning signs for deterioration.<\/span><\/div>\n
\u2022 Urgent contact details and named coordinator (often the HF nurse).<\/span><\/div>\n
\u2022 Social support and rehab access.<\/span><\/div>\n
\u2022 The care plan must be shared with the patient, family\/carers, GP, and all professionals involved.<\/span><\/div>\n
4. Diagnosis in primary care<\/span><\/div>\n
\u2022 Take history, exam, and test NT-proBNP.<\/span><\/div>\n
\u2022 >2000 ng\/L: urgent referral \u2192 echo within 2 weeks.<\/span><\/div>\n
\u2022 400\u20132000 ng\/L: referral \u2192 echo within 6 weeks.<\/span><\/div>\n
\u2022 <400 ng\/L (if untreated): HF unlikely.<\/span><\/div>\n
\u2022 Remember: BNP can be lowered by obesity or some drugs, and raised by renal\/lung\/liver disease.<\/span><\/div>\n
5. Transition after hospitalisation<\/span><\/div>\n
\u2022 Discharge patients only when stable and with a written plan.<\/span><\/div>\n
\u2022 Primary care should take over routine management once stability is achieved.<\/span><\/div>\n
6. Treatment \u2013 HFrEF (reduced EF)<\/span><\/div>\n
\u2022 Core therapy: ACE inhibitor + beta-blocker + MRA + SGLT2 inhibitor.<\/span><\/div>\n
\u2022 If symptoms persist: switch ACE inhibitor \u2192 ARNI.<\/span><\/div>\n
\u2022 If intolerance: consider ARB\/ARNI depending on cause.<\/span><\/div>\n
7. Treatment \u2013 HFmrEF (mildly reduced EF)<\/span><\/div>\n
\u2022 Consider: ACE inhibitor (or ARB), beta-blocker, MRA, SGLT2 inhibitor.<\/span><\/div>\n
\u2022 NICE specifically recommends empagliflozin or dapagliflozin as SGLT2 options.<\/span><\/div>\n
8. Treatment \u2013 HFpEF (preserved EF)<\/span><\/div>\n
\u2022 Consider: MRA + SGLT2 inhibitor (empagliflozin or dapagliflozin).<\/span><\/div>\n
9. Chronic kidney disease considerations<\/span><\/div>\n
\u2022 If eGFR \u226445 \u2192 start low doses, titrate slowly.<\/span><\/div>\n
\u2022 If eGFR <30 \u2192 involve nephrology.<\/span><\/div>\n
10. Medication monitoring<\/span><\/div>\n
\u2022 Check renal function & electrolytes:<\/span><\/div>\n
\u2022 1\u20132 weeks after starting or changing dose.<\/span><\/div>\n
\u2022 Every 3\u20136 months if stable.<\/span><\/div>\n
\u2022 Monitor blood pressure and rhythm regularly.<\/span><\/div>\n
\u2022 Watch for hyperkalemia, renal dysfunction, postural hypotension.<\/span><\/div>\n
11. Other therapies & advice<\/span><\/div>\n
\u2022 Diuretics: for congestion, lowest dose needed.<\/span><\/div>\n
\u2022 IV iron: consider if HFrEF + iron deficiency.<\/span><\/div>\n
\u2022 Anticoagulation: follow AF\/stroke prevention guidance.<\/span><\/div>\n
\u2022 Vaccination: flu annually, pneumococcal once.<\/span><\/div>\n
\u2022 Lifestyle: avoid potassium salt substitutes, manage smoking\/alcohol, consider travel\/driving safety.<\/span><\/div>\n
\u2022 Pregnancy\/contraception: specialist advice is required.<\/span><\/div>\n
12. Monitoring and follow-up<\/span><\/div>\n
\u2022 Full review in primary care every 6 months: symptoms, fluid status, rhythm, renal function, Hb\/iron, medication review.<\/span><\/div>\n
\u2022 Shorter intervals if unstable or with medication changes.<\/span><\/div>\n
\u2022 Encourage patient self-monitoring with clear guidance.<\/span><\/div>\n
<\/div>\n
Key Points for GPs<\/div>\n
\u2022 Work closely with the MDT; keep communication active.<\/span><\/div>\n
\u2022 Always arrange a long, thorough first consultation for new diagnoses.<\/span><\/div>\n
\u2022 Use NT-proBNP to triage urgency of referral.<\/span><\/div>\n
\u2022 Start and optimise 4-pillars therapy (ACE\/ARNI, beta-blocker, MRA, SGLT2i).<\/span><\/div>\n
\u2022 Provide and share an individualised care plan with all stakeholders.<\/span><\/div>\n
\u2022 Review every 6 months, or sooner if unstable.<\/span><\/div>\n
<\/div>\n
https:\/\/www.nice.org.uk\/guidance\/ng106?utm_source=chatgpt.com<\/a><\/div>\n
<\/div>\n","protected":false},"excerpt":{"rendered":"

Chronic Heart Failure in Adults: Diagnosis and Management \u2013 Primary Care Summary Source:NICE guideline Reference number: NG106 Published: 12 September 2018 Last updated: 03 September 2025. 1. Team working (MDT and Primary Care) \u2022 MDT (Multidisciplinary Team) = a specialist team including: \u2022 Cardiologist with HF expertise. \u2022 Heart failure specialist nurse. \u2022 Pharmacist or […]<\/p>\n","protected":false},"author":145,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-8692","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8692","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/145"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=8692"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8692\/revisions"}],"predecessor-version":[{"id":8693,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8692\/revisions\/8693"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=8692"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=8692"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=8692"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}