Update information

Update information

September 2018: This guideline updates and replaces NICE clinical guidelineĀ 108 (published August 2010). NICE clinical guideline 108 updated and replaced NICE clinical guidelineĀ 5 (published July 2003).

Recommendations are marked as [2018], [2016], [2012], [2010], [2010, amended 2018], [2003], [2003, amended 2018] or [2003, amended 2010],

[2018] indicates that the evidence was reviewed and the recommendation added, updated or unchanged in 2018.

[2016] refers to NICE technology appraisal guidance published in 2016.

[2012] refers to NICE technology appraisal guidance published in 2012.

[2010] indicates that the evidence was reviewed in 2010.

[2010, amended 2018] indicates that the evidence was reviewed in 2010 but changes were made to the recommendation wording in 2018 that changed the meaning.

[2003] indicates that the evidence was reviewed in 2003.

[2003, amended 2018] indicates that the evidence was reviewed in 2003 but changes were made to the recommendation wording in 2018 that changed the meaning.

[2003, amended 2010] indicates that the evidence was reviewed in 2003 but changes were made to the recommendation wording in 2010 that changed the meaning.

  • 'Heart failure due to left ventricular systolic dysfunction (LVSD)' has been replaced in all recommendations by 'heart failure with reduced ejection fraction' in line with current terminology and the 2018 guideline scope.

  • 'Aldosterone antagonists' has been replaced in all recommendations by 'mineralocorticoid receptor antagonists (MRAs') to clarify the function of the receptor, and in line with the 2018 guideline scope.

  • 'African or African-Caribbean family origin' has been added to recommendation 1.2.7 because of the high incidence of heart failure with preserved ejection fraction in these populations. Recent evidence shows that NT-proBNP levels are lower in people of west African family background and are a confounder in the diagnosis of heart failure.

  • Doppler 2D has been deleted from recommendations 1.2.8, 1.2.9 and 1.2.11 because all transthoracic echocardiography would have doppler 2D as a minimum and it is no longer necessary to specify this.

  • 'Multigated acquisition scanning' has been added to recommendation 1.2.11 to reflect current imaging technology.

  • Measurement of urea has been deleted from recommendations 1.2.12, 1.4.8 and 1.7.1 because the guideline committee agreed that it is not needed and is not part of renal function profiles in most centres in the UK.

    Blood tests for electrolytes, creatinine and eGFR have been grouped together under the term 'renal function profile' because they are provided as a unified set of analyses in the NHS. The term 'profile' is applied to a group of tests (assays). Thus these tests are more accurately described as 'profiles' as they contain multiple individual assays and have replaced thyroid function test, liver function test and lipid measurement.

    'Fasting glucose' has been replaced by 'glycosylated haemoglobin (HbA1c)' in line with the NICE guidelines on diabetes.

  • Measurement of serum urea has been deleted from recommendation 1.4.4 because the guideline committee agreed that it is not needed and is not part of renal function profiles in most centres in the UK.

    Measurement of potassium has been added to ensure that monitoring is consistent across treatments.

  • Recommendations 1.4.6 and 1.4.10 have been added to clarify the timing of monitoring after treatment starts.

  • In recommendation 1.4.8, monitoring for hyperkalaemia has been replaced by potassium measurement for clarity.

  • Blood pressure measurement has been clarified in recommendation 1.4.13 and made consistent with other treatments.

  • As a result of new evidence the treatment pathway for heart failure with reduced ejection fraction in recommendation 1.4.26 has been amended. Second line treatment has been replaced by specialist treatment.

    A sentence has been added to clarify that specialist advice should be sought before starting treatment with digoxin.

  • The first part of recommendation 1.6.2 has been removed because it is now covered in section 1.1 on team working in the management of heart failure.

  • Amlodipine to treat hypertension has been deleted from recommendation 1.6.3 because it has been superseded by the NICE guideline on hypertension in adults.

  • 'Regularly' has been replaced by 'at the 6-monthly clinical review' in recommendation 1.6.5 for clarification.

  • The wording in recommendation 1.6.6 has been amended in line with recommendation 1.6.5.

Minor changes since publication

April 2022: In section 1.4 we added links to NICE's technology appraisal guidance on dapagliflozin and empagliflozin for treating chronic heart failure with reduced ejection fraction.

November 2021: We added a link to the NICE guideline on heart valve disease in recommendations 1.2.8, 1.2.15 and 1.4.2.

ISBN: 978-1-4731-3093-7

  • National Institute for Health and Care Excellence (NICE)