Key priorities for implementation

The following recommendations have been identified as priorities for implementation. The full list of recommendations is in section 1.

Organisation of care

  • All hospitals admitting people with suspected acute heart failure should provide a specialist heart failure team that is based on a cardiology ward and provides outreach services.

  • Ensure that all people being admitted to hospital with suspected acute heart failure have early and continuing input from a dedicated specialist heart failure team.

Diagnosis, assessment and monitoring

  • In people presenting with new suspected acute heart failure, use a single measurement of serum natriuretic peptides (B‑type natriuretic peptide [BNP] or N‑terminal pro‑B‑type natriuretic peptide [NT‑proBNP]) and the following thresholds to rule out the diagnosis of heart failure.

    • BNP less than 100 ng/litre

    • NT‑proBNP less than 300 ng/litre.

  • In people presenting with new suspected acute heart failure with raised natriuretic peptide levels (see recommendation 1.2.2), perform transthoracic Doppler 2D echocardiography to establish the presence or absence of cardiac abnormalities.

  • In people presenting with new suspected acute heart failure, consider performing transthoracic Doppler 2D echocardiography within 48 hours of admission to guide early specialist management.

Treatment after stabilisation

  • In a person presenting with acute heart failure who is already taking beta‑blockers, continue the beta‑blocker treatment unless they have a heart rate less than 50 beats per minute, second or third degree atrioventricular block, or shock.

  • Start or restart beta‑blocker treatment during hospital admission in people with acute heart failure due to left ventricular systolic dysfunction, once their condition has been stabilised – for example, when intravenous diuretics are no longer needed.

  • Ensure that the person's condition is stable for typically 48 hours after starting or restarting beta‑blockers and before discharging from hospital.

  • Offer an angiotensin‑converting enzyme inhibitor (or angiotensin receptor blocker if there are intolerable side effects) and an aldosterone antagonist during hospital admission to people with acute heart failure and reduced left ventricular ejection fraction. If the angiotensin‑converting enzyme inhibitor (or angiotensin receptor blocker) is not tolerated an aldosterone antagonist should still be offered.

  • National Institute for Health and Care Excellence (NICE)