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Acute heart failure patients should be seen by specialist teams, says NICE

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g3072 (Published 06 May 2014) Cite this as: BMJ 2014;348:g3072
  1. Jacqui Wise
  1. 1London

All hospitals admitting patients with suspected acute heart failure should provide a specialist heart failure service based on a cardiology ward, say new draft guidelines from the National Institute for Health and Care Excellence (NICE).1

There are over 67 000 admissions for acute heart failure in England and Wales each year, and it is the leading cause of hospital admission in people aged 65 and over. Current practice is not standardised across hospitals, however. Patients with suspected acute heart failure are usually admitted through emergency departments, and those who are very sick go to intensive care units, high dependency units, or coronary care units, while the rest are admitted to general medical wards or cardiology wards.

Mark Baker, director of the Centre for Clinical Practice at NICE, said, “The treatment patients with acute heart failure receive, and how successful that treatment is, differs depending on the unit they were admitted to. 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.”

The draft guidelines also recommended that the cardiac biomarkers BNP (B-type natriuretic peptide) and NT-proBNP (N-terminal pro-B-type natriuretic peptide) should be measured if acute heart failure is suspected. Normal results would rule out a diagnosis of heart failure, whereas higher levels of these markers are often associated with a worse prognosis.

They said that transthoracic Doppler cross sectional echocardiography should be performed in people with higher than normal natriuretic peptide levels. This should occur within 48 hours of admission to enable early specialist management.

The draft guidelines are now released for consultation, and the final version is expected to be published in September.

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Notes

Cite this as: BMJ 2014;348:g3072

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