2 Indications and current treatments
2.1 Heart failure occurs when the pumping action of the heart is impaired by structural or functional abnormalities. It can lead to reduced blood flow to the body tissues and increased filling pressure in the heart, which causes congestion and oedema in the lungs (causing breathlessness) and/or the body (causing swelling in the legs). Symptoms include breathlessness, reduced exercise tolerance, oedema, fatigue and malaise.
2.2 Treatment for chronic heart failure involves lifestyle changes and pharmacological treatments such as angiotensin-converting enzyme inhibitors, beta‑blockers, aldosterone antagonists, angiotensin II receptor antagonists, diuretics, hydralazine in combination with nitrate, and digoxin (see Chronic heart failure: management of chronic heart failure in adults in primary and secondary care [NICE clinical guideline 108]). Cardiac resynchronisation therapy is used in some patients.
2.3 Patients with chronic heart failure are monitored to identify signs of deterioration in order to modify treatment, with the aims of improving their quality of life and avoiding admission to hospital. This monitoring typically includes clinical assessment of functional capacity, fluid status (for example by body weight), cardiac rhythm, and cognitive and nutritional status. Clinical monitoring and treatment in the community, usually by nurses, may reduce the incidence of complications and subsequent hospitalisation.