Guideline of the month - chronic heart failure

The guideline

NICE has updated its 2010 chronic heart failure guidance to include recommendations on diagnosis. It also covers holistic care, including improving communication between care providers and providing patients with balanced information.

Key points for GPs

Lead care reviews and recall patients every six months to update their record.
Take over routine management once a patient’s condition has been stabilised following an acute event.
Discuss prognosis with the patient in a sensitive manner, being honest that the course of the disease may be uncertain.
Measure NT-proBNP in people with suspected heart failure. Refer those with a level above 2000ng/l for urgent specialist assessment within two weeks.
Measure blood pressure before and after each ACE inhibitor dose titration.
Do not offer long-term home oxygen therapy for advanced heart failure.
Discuss palliative care needs with the specialist multidisciplinary team if symptoms worsen despite optimal treatment.
Ensure effective communication between all services involved.

Practical issues

With the emphasis on holistic care and interdisciplinary communication, GPs will need to ensure there is ongoing dialogue between the multidisciplinary team and primary care and that the patient is kept fully informed about their condition. NICE suggests GPs might have to consider advanced communications training for this purpose.

Expert comment

Dr Alan Begg, GPSI in cardiology in Montrose, Scotland, commented: ‘This guideline envisages a key role for the primary care team alongside the work of a specialist heart failure MDT.

‘Regular review and monitoring of symptoms, biochemistry and medication can be considered good clinical practice. Appropriate titration of drugs is also very important.

‘The evidence for the benefit of a specialist heart failure nurse in the management of these patients is strong. This is especially the case within the role envisaged for the primary care team.’