Heart failure guideline update: a guide for general practice

INTRODUCTION

Heart failure (HF) is a clinical syndrome caused by a structural or functional cardiac abnormality and results in reduced cardiac output or elevated intracardiac pressures. It affects approximately 900 000 patients in the UK.¹ In recent years, both the European Society of Cardiology (ESC) and the American Heart Association (AHA) updated their HF guidelines simultaneously, with a reassuringly large overlap in most recommendations.^2,3 Furthermore, updated National Institute for Health and Care Excellence (NICE) guidelines (NG106) were published in September 2018, and are largely based on the same evidence.⁴

This article describes updates to seven principal topics, with particular emphasis on areas of most relevance to primary care, including HF definitions, a new ‘time to therapy’ approach, diagnosis, pharmacological treatment, cardiac resynchronisation therapy (CRT) indications, prevention, and multidisciplinary team working. In addition, the management of HF with preserved ejection fraction (HFpEF) is discussed.