New NICE standard of care for people with chronic heart failure

11th April 2016

NICE has updated its quality standard for treating people with chronic (long-lasting) heart failure, including those with cardiomyopathy.

For the first time the standard includes the need for heart care teams to see patients again within two weeks of having their drug treatment changed, and calls for better access for patients to cardiac rehabilitation, including both inside and outside working hours.

The standard, which covers the assessment, diagnosis and management of chronic heart failure in adults, outlines high-priority areas for better patient care in the NHS.

NICE, the National Institute for Health and Care Excellence, says that medication to treat chronic heart failure can cause significant side effects, including dehydration, low blood pressure, a low heart rate and kidney problems.

Some drugs may initially and temporarily make heart failure symptoms worse. So when the dose or type of medication is changed, the person should have a review within two weeks to monitor the effects. The appointment could also include a review of the effectiveness of the medication and whether any further changes or referral to other members of the multidisciplinary team are needed.

On cardiac rehabilitation, which can improve how well people do both clinically and in their quality of life, must be offered cardiac rehabilitation during and outside working hours, and the choice of taking part in a programme at home, in the community or in a hospital.

Another five quality statements have been updated. These comprise:

  • Adults with suspected chronic heart failure who have been referred for diagnosis have an echo and specialist assessment.
  • Adults with suspected chronic heart failure and either a previous heart attack or very high levels of serum natriuretic peptides, who have been referred for diagnosis, have an echocardiogram and specialist assessment within two weeks.
  • Adults with chronic heart failure due to left ventricular systolic dysfunction are started on low dose ACE inhibitor and beta blocker medications that are gradually increased until the target or optimal tolerated doses are reached.
  • Adults with stable chronic heart failure have a review of their condition at least every six months. Adults with stable chronic heart failure are offered an exercise based programme of cardiac rehabilitation.

For more details, see here