{"id":8885,"date":"2025-10-10T17:16:08","date_gmt":"2025-10-10T14:16:08","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=8885"},"modified":"2025-10-10T17:16:08","modified_gmt":"2025-10-10T14:16:08","slug":"nice-guidelines-chronic-heart-failure-in-adults-diagnosis-and-management-in-secondary-care-updated-october-1-2025-nice-uk","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/nice-guidelines-chronic-heart-failure-in-adults-diagnosis-and-management-in-secondary-care-updated-october-1-2025-nice-uk\/","title":{"rendered":"NICE Guidelines \u2013 Chronic Heart Failure in Adults: Diagnosis and Management in Secondary Care Updated: October 1 2025\u00a0 |\u00a0 NICE (UK)\u00a0"},"content":{"rendered":"
NICE Guidelines \u2013 Chronic Heart Failure in Adults: Diagnosis and Management in Secondary Care<\/div>\n
Updated: October 1 2025\u00a0 |\u00a0 NICE (UK)<\/div>\n
<\/div>\n
Key Points \u2013 (October 2025 Update)<\/div>\n
1. Purpose:<\/span><\/div>\n
\u2022 Intended mainly for cardiologists and secondary care teams.<\/span><\/div>\n
2. Heart Failure Team (MDT):<\/span><\/div>\n
\u2022 Include a lead cardiologist, specialist nurse, and HF pharmacist.<\/span><\/div>\n
\u2022 Responsibilities: diagnosis, treatment optimization, initiation of specialist drugs, post-device follow-up<\/span><\/div>\n
3. After Acute HF Hospitalization:<\/span><\/div>\n
\u2022 Discharge only when clinically stable and a care plan is in place.<\/span><\/div>\n
\u2022 Primary care resumes follow-up once HF is stable and therapy optimized.<\/span><\/div>\n
4. Written Care Plan:<\/span><\/div>\n
\u2022 Must summarize diagnosis, aetiology, medicines and monitoring, functional status<\/span><\/div>\n
5. Diagnosis:<\/span><\/div>\n
\u2022 Measure NT-proBNP for all suspected HF:<\/span><\/div>\n
\u2022 2000 ng\/L \u2192 urgent echo within 2 weeks.<\/span><\/div>\n
\u2022 400\u20132000 ng\/L \u2192 echo within 6 weeks.<\/span><\/div>\n
\u2022 <400 ng\/L \u2192 HF unlikely.<\/span><\/div>\n
\u2022 Confirm by echocardiography; use MRI or radionuclide imaging if echo is sub-optimal.<\/span><\/div>\n
6. Core Therapy \u2013 HFrEF:<\/span><\/div>\n
\u2022 Offer ACE inhibitor, beta-blocker, MRA, and SGLT-2 inhibitor.<\/span><\/div>\n
\u2022 If symptoms persist \u2192 switch ACEI \u2192 ARNI.<\/span><\/div>\n
\u2022 If ACEI\/ARNI not tolerated \u2192 consider ARB \u00b1 hydralazine + nitrate (especially African\/Caribbean patients).<\/span><\/div>\n
\u2022 Ivabradine and digoxin for persistent\/worsening symptoms (specialist advice).<\/span><\/div>\n
\u2022 Avoid verapamil, diltiazem, and short-acting dihydropyridines.<\/span><\/div>\n
7. Mildly Reduced \/ Preserved EF:<\/span><\/div>\n
\u2022 HFmrEF: consider ACEI (or ARB\/ARNI), beta-blocker, MRA, SGLT-2 inhibitor.<\/span><\/div>\n
\u2022 HFpEF: consider MRA \u00b1 SGLT-2 inhibitor (empagliflozin TA929, dapagliflozin TA902).<\/span><\/div>\n
8. Iron Deficiency (HFrEF):<\/span><\/div>\n
\u2022 Check TSAT, ferritin, haemoglobin.<\/span><\/div>\n
\u2022 Treat if TSAT < 20% or ferritin < 100 ng\/mL using IV iron<\/span><\/div>\n
9. Chronic Kidney Disease:<\/span><\/div>\n
\u2022 If eGFR \u2264 45, start lower doses and titrate slowly;<\/span><\/div>\n
\u2022 If eGFR < 30, liaise with renal specialists.<\/span><\/div>\n
10. Monitoring & Safety:<\/span><\/div>\n
\u2022 If creatinine rises >50% from baseline after starting an ACEI, ARB, ARNI, or MRA, stop or reduce the dose and reassess renal function \u2014 it suggests renal impairment or over-diuresis rather than normal hemodynamic effect.<\/span><\/div>\n
\u2022 Stop or adjust if creatinine \u2191 > 50% or potassium > 5.5 mmol\/L.<\/span><\/div>\n
\u2022 Avoid routine digoxin level monitoring unless toxicity suspected.<\/span><\/div>\n
11. Anticoagulation:<\/span><\/div>\n
\u2022 Follow AF guidelines for patients with heart failure and AF.<\/span><\/div>\n
\u2022 In sinus rhythm, consider anticoagulation if prior embolism, LV aneurysm, or intracardiac thrombus.<\/span><\/div>\n
12. Vaccination & Lifestyle:<\/span><\/div>\n
\u2022 Annual influenza and single pneumococcal vaccine.<\/span><\/div>\n
\u2022 No routine sodium or fluid restriction; advise individually.<\/span><\/div>\n
\u2022 Avoid potassium-containing salt substitutes.<\/span><\/div>\n
\u2022 Discuss contraception\/pregnancy, screen for depression, encourage smoking and alcohol moderation.<\/span><\/div>\n
13. Devices & Interventions:<\/span><\/div>\n
\u2022 No routine coronary revascularization for stable HFrEF + CAD.<\/span><\/div>\n
\u2022 Consider transplant referral for refractory cases.<\/span><\/div>\n
\u2022 ICD\/CRT<\/span><\/div>\n
14. Rehabilitation:<\/span><\/div>\n
\u2022 Offer easy exercise-based cardiac rehab with psychological support<\/span><\/div>\n
15. Palliative Care:<\/span><\/div>\n
\u2022 No long-term home oxygen unless other disease warrants.<\/span><\/div>\n
<\/div>\n
https:\/\/www.nice.org.uk\/guidance\/ng106<\/a><\/div>\n
<\/div>\n","protected":false},"excerpt":{"rendered":"

NICE Guidelines \u2013 Chronic Heart Failure in Adults: Diagnosis and Management in Secondary Care Updated: October 1 2025\u00a0 |\u00a0 NICE (UK) Key Points \u2013 (October 2025 Update) 1. Purpose: \u2022 Intended mainly for cardiologists and secondary care teams. 2. Heart Failure Team (MDT): \u2022 Include a lead cardiologist, specialist nurse, and HF pharmacist. \u2022 Responsibilities: […]<\/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-8885","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8885","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=8885"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8885\/revisions"}],"predecessor-version":[{"id":8886,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8885\/revisions\/8886"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=8885"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=8885"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=8885"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}