Heart Failure: Medical Management

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Monitor Progression

Suggest checking:

  • 6 monthly blood check of Renal Function
  • Annual blood check for FBC, ferritin and TFT levels
  • Annual ECG (to check QRS width)
  • Medication compliance
  • Self management understanding

Review of blood tests

Caution must be maintained when considering stopping drugs (e.g. ACE inhibitor,ARBs, entresto, beta blockers, sprionolactone and digoxin) as this may cause deterioration ijn symptoms.

Cardiac Devices

The choice of device will be decided by the cardiology team based on the following criteria:

Implantable Defibrillator (ICD) Primary Indications

  • QRS <120mms
  • Ejection fraction < 35% (equivalent to moderate/severe LVSD)

Cardiac Resynchronisation Therapy (CRT +/- D)

  • QRS >120mms
  • Ejection fraction <35% (equivalent to moderate/severe LVSD)
Referral to nurse-led heart failure service

The Nurse Led Heart Failure Service provides a comprehensive care package for heart failure patients, working in partnership between primary and secondary care.

Referrals can be made by any member of the multidisciplinary team as long as the following criteria are met:

  • Patient must have documented evidence of heart failure due to left ventricular systolic dysfunction (LVSD) (moderate/severe) (either by echo, MUGA scan or angiogram).

And

  • Be symptomatic despite medical therapy

Or

  • Had a recent hospital admission due to heart failure

Ultimately- patient must be willing to be part of the service.

Benefits can include

  • Education- to detect early warning signs and symptoms and to enable self management
  • Medication optimisation
  • On-going support for patient and carer
  • Palliative Care Support

For more details please contact your local Heart Failure Nurse or contact the main Heart Failure Office on 01463 704628 or email High-UHB.heartfailureservice@nhs.net

Patient name and CHI number needed for referrals.

Glossary
Abbreviation Meaning
ACE inhibitor Angiotensin-converting-enzyme inhibitors
NYHA  New York Heart Association
ARB Angiotensin receptor blockers
AF Atrial Fibrillation
FBC Full blood count
ECG Electrocardiogram
TFT Thyroid function test
LVSD Left ventricular systolic dysfunction
Editorial Information

Last reviewed: 31 January 2018

Next review: 31 January 2020

Author(s): Cardiovascular Improvement Group

Approved By: High-UHB.tam@nhs.net

Reviewer Name(s): Prof S Leslie, Mandi Smith

Document Id: TAM131