The National Institute for Health and Care Excellence (NICE) has begun a public consultation, covering the immediate care of someone who is acutely unwell as a result of heart failure.

“Acute heart failure is the leading cause of hospital admission in people 65 years or older in the UK. It is usually caused because the heart muscle has become too weak or stiff” says Professor Mark Baker,Director of the Centre for Clinical Practice at NICE. “Acute heart failure is life-threatening so it's important to diagnose the problem correctly so patients get the best treatment.”

People with acute heart failure are usually admitted through the accident and emergency department. Those who are very sick tend to be admitted to intensive care units, high dependency units or the coronary care units.

The remaining patients go into either the general medical wards or to the cardiology wards, depending on what treatment they need.

This practice is not standardised across hospitals and different factors affect the decision, including the person's age, whether they have any other illnesses and where the available beds are.

“The treatment patients with acute heart failure receive, and how successful that treatment is, differs depending on the unit they were admitted to” adds Professor Baker. “We would like to see all patients who are admitted to hospital with suspected acute heart failure seen by specialists through a dedicated service, regardless of the configuration of the hospital.”

Heart failure means that the heart's ability to pump enough blood around the body is impaired. Symptoms and signs of heart failure include breathlessness, fatigue and fluid retention.

In the UK, the most common cause is coronary artery disease, with many patients having suffered a heart attack in the past.

Unlike chronic heart failure, which is more common and which develops slowly over time and worsens gradually, acute heart failure develops suddenly. This can either happen following a heart attack that has caused damage to an area of the heart or, more commonly, because the body can no longer compensate for chronic heart failure (acute decompensated heart failure).

As well as the role of specialist management units the draft guideline considers the role of echocardiographyⁱand early blood tests to diagnose acute heart failure, the use of breathing support, and drug treatments for acute heart failure. The draft guideline also looks at treatment after acute heart failure has been stabilised including surgery and starting drug treatments that are used in the management of chronic heart failure.

The draft acute heart failure clinical guideline is available to view on the NICE website. As with all clinical guideline consultations, only registered stakeholders such as professional and government organisations, patient and carer groups and companies can comment formally on the draft. However, organisations can register as a stakeholder at any time during the development of a guideline. Registered stakeholders have until 13 June 2014 to submit their comments.

ENDS

Notes for editors

Explanation of terms

1. An echocardiogram is a test that uses sound waves to create a moving picture of the heart. The picture is much more detailed than a plain x-ray image and involves no radiation exposure. An echocardiogram allows doctors to see the heart beating, and to see the heart valves and other structures of the heart.
2. BNP and NT-proBNP are cardiac biomarkers released into the blood when the heart is damaged. Measurement of the levels of these biomarkers is used to help diagnose, risk stratify, monitor and manage people with suspected heart failure. The level of BNP or NT-proBNP in the blood is related to its severity. Higher levels of BNP or NT-proBNP are often associated with a worse prognosis for the person. Normal results indicate that the person's symptoms are likely due to something other than heart failure.

About the draft guidance

1. Key recommendations in the draft guideline include:

• All hospitals admitting people with suspected acute heart failure should provide a specialist heart failure service, based on a cardiology ward and providing 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.
• In people presenting with 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])ⁱⁱ to rule out the diagnosis of heart failure.
• Perform transthoracic Doppler 2D echocardiography to establish the presence or absence of cardiac abnormalities in people with natriuretic peptide levels higher than the rule-out thresholds.
• Consider echocardiography within 48 hours of admission to enable early specialist management.

2. Only stakeholders can comment formally on consultations, but organisations can register throughout the development process and contribute from that point onward. For more information please visit:

3. The final guideline is expected to be published in September 2014.

About acute heart failure

1. Acute heart failure is a common cause of admission to hospital (over 67,000 admissions in England and Wales per year), and the leading cause of hospital admission in people 65 years or older in the UK.

2. According to the 2010/11 UK National Heart Failure Audit, most people admitted to hospital with acute heart failure are aged over 60, with 25% aged between 60 and 74 and 68% over 75.

3. Men and women seem to be equally affected by acute heart failure, but men are usually 5 years younger than women at the time of hospital admission (mean age 75 years for men and 80 years for women).

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

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