The National Institute for Health and Clinical Excellence (NICE) has published new guidance on the management of chronic heart failure. This updates and replaces the previous guideline in this area (NICE clinical guideline 5). The new guideline, which covers the management of heart failure in adults in primary and secondary care, contains new and updated recommendations on diagnosis, pharmacological treatment, monitoring and rehabilitation.

Key priorities for implementation in the guidance include:

• Referring patients with suspected heart failure and previous myocardial infarction (MI) to transthoracic Doppler 2D echocardiography and specialist assessment within two weeks.
• Measuring serum natriuretic peptides in patients with suspected heart failure without previous MI; referring those with very high levels of serum natriuretic peptides to urgent transthoracic Doppler 2D echocardiography and specialist assessment within two weeks.
• First-line treatments for heart failure due to left ventricular systolic dysfunction are angiotensin converting enzyme (ACE) inhibitors and beta blockers licensed for heart failure. The latter should be offered to older patients and other special groups.
• If symptoms persist despite optimal first-line treatment, specialist advice should be sought and a second-line treatment should be added such as an aldosterone antagonist, an angiotensin receptor blocker (also an alternative first-line treatment) or hydralazine in combination with nitrate.
• Monitoring all patients to include a clinical review.
• Patients with heart failure should be offered a supervised group exercise-based rehabilitation programme if they are stable.
• Patients from hospital should be discharged only when their condition is stable and their management plan optimised, taking into account patient/carer wishes and the level of support and care in the community

Full guidance can be found at http://guidance.nice.org.uk/CG108