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Practice Guidelines

Diagnosing and managing acute heart failure in adults: summary of NICE guidance

BMJ 2014; 349 doi: (Published 08 October 2014) Cite this as: BMJ 2014;349:g5695
  1. Katharina Dworzynski, senior research fellow1,
  2. Emmert Roberts, research fellow2,
  3. Andrew Ludman, specialist trainee adviser3,
  4. Jonathan Mant, guideline chair, professor of primary care research4
  5. on behalf of the Guideline Development Group
  1. 1National Clinical Guideline Centre, Royal College of Physicians of London, London NW1 4LE, UK
  2. 2Academic Clinical Fellow in Psychiatry, Maudsley Hospital, South London and the Maudsley Mental Health Trust, London, UK
  3. 3Consultant Cardiologist, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
  4. 4Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
  1. Correspondence to: K Dworzynski Katharina.Dworzynski{at}

Acute heart failure may present de novo in people without known cardiac dysfunction, or as an acute decompensation of known chronic heart failure. Acute heart failure is a common cause of admission to hospital (more than 67 000 admissions in England and Wales each year) and is the leading cause of hospital admission in people aged 65 years or more in the United Kingdom.1 European registry data show that nearly 50% of people admitted to hospital with acute heart failure are re-admitted within 12 months,2 and a third of people with acute heart failure die within a year of their first hospital admission.1 The diagnosis of heart failure can be challenging because of non-specific symptoms and clinical signs, and there is evidence of wide variation in the way people with acute heart failure are managed.1 This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE) on acute heart failure.3


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

Organisation of care

  • All hospitals that admit people with suspected acute heart failure should have a specialist heart failure team that is based on a cardiology ward and provides outreach services.

  • All people being admitted to hospital with suspected acute heart failure should have early and continuing input from a dedicated specialist heart failure team.

  • [Based on very low quality evidence from observational studies and a new cost effectiveness analysis]

  • In line with guidelines for chronic heart failure (NICE Clinical Guideline 1084), plan the following with people with …

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