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Practice Guidelines

Diagnosis and management of adults with chronic heart failure: summary of updated NICE guidance

BMJ 2010; 341 doi: (Published 25 August 2010) Cite this as: BMJ 2010;341:c4130
  1. Abdallah Al-Mohammad, consultant cardiologist1,
  2. Jonathan Mant, professor of primary care research2,
  3. Philippe Laramee, health economist3,
  4. Sharon Swain, research fellow3
  5. on behalf of the Chronic Heart Failure Guideline Development Group
  1. 1South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU
  2. 2General Practice & Primary Care Research Unit, University of Cambridge CB2 0SR
  3. 3National Clinical Guideline Centre, Royal College of Physicians of London, London NW1 4LE
  1. Correspondence to: A Al-Mohammad{at}

    Heart failure affects 900 000 people in the United Kingdom.1 Its prevalence is increasing owing to improved prognosis of ischaemic heart disease (the major cause of heart failure) and an ageing population.2 3 The two main types of heart failure are left ventricular systolic dysfunction and that associated with preserved left ventricular ejection fraction. Both types have a poor prognosis, although the introduction of effective treatments has led to a fall in mortality from heart failure caused by left ventricular systolic dysfunction (from 26% at six months in 1995 to 14% at six months in 2005).4 New evidence has emerged on diagnosis, treatment, rehabilitation, and monitoring of people with heart failure, and use of this evidence to guide diagnosis and management is likely to improve outcomes further and increase the cost effectiveness of services. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the diagnosis and management of chronic heart failure (which is a partial update of its 2003 guidelines5).6


    NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. The new recommendations are indicated in parentheses. Evidence levels for the recommendations are given in italic in square brackets.

    With the exception of the recommendations on drug treatment, all the recommendations apply to the diagnosis and management of heart failure with left ventricular systolic dysfunction and heart failure with preserved ejection fraction.


    • In patients with suspected heart failure and previous myocardial infarction, refer urgently for transthoracic Doppler two dimensional echocardiography and specialist assessment (both to take place within two weeks of referral). (New recommendation.) [Based on moderate …

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