Chronic Heart Failure- NICE guidance

Heart failure is complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood ( Yancy et al 2013 )

Ejection fraction- Definition of reduced EF varies in clinical trials between LVEF of <= 35 to 40 % HF with reduced ejection fraction ( HF-REF ) HF with preserved EF - nearly 1/2 of people with HF have preserved LVEF on echo Time - course Acute HF may be a new presentation of HF or may be deterioration or decompensation in a person with existing HF Chronic- no agreed definition. Stable HF used to describe a person with treated HF and symptoms which are unchanged for at-least a month

Careful and detailed history and perform clinical examination and tests to confirm the presence of heart failure CXR Bloods○ renal profile○ TFT○ LFT○ Lipid profile○ Hba1c○ FBC Urinalysis Peak flow and spirometry ECG and rest to evaluate possible aggravating factors and / or alternative diagnosis

Measure NT-proBNP in people with suspected heart failure above 2000 ng/L or236 pmol/L or Refer urgently for specialist assessment and Transthoracic echocardiography within 2 weeks 400 and 2000 ng/L47 to 236 pmol/L Specialist assessment and echocardiography within 6 weeks...