Acute HF NICE 2024 Flashcards
Diagnosis, assessment and monitoring
- In people presenting with new suspected acute heart failure, use a single measurement of serum natriuretic peptides (B-type natriuretic peptide [BNP] or N-terminal pro-B-type natriuretic peptide [NT-proBNP]) and the following thresholds
to rule out the diagnosis of heart failure.
－ BNP less than 100 ng/litre
－ NT-proBNP less than 300 ng/litre. - In people presenting with new suspected acute heart failure with raised natriuretic peptide levels (see recommendation 1.2.2), perform transthoracic Doppler 2D echocardiography to establish the presence or absence of cardiac abnormalities.
- In people presenting with new suspected acute heart failure, consider performing transthoracic Doppler 2D echocardiography within 48 hours of admission to guide early specialist management.
Treatment after stabilisation
- In a person presenting with acute heart failure who is already taking beta-blockers, continue the beta-blocker treatment unless they have a heart rate less than 50 beats per minute, second or third degree atrioventricular block, or shock.
- Start or restart beta-blocker treatment during hospital admission in people with acute heart failure due to left ventricular systolic dysfunction, once their condition has been
stabilised – for example, when intravenous diuretics are no longer needed. - Ensure that the person’s condition is stable for typically 48 hours after starting or restarting beta-blockers and before discharging from hospital.
- Offer an angiotensin-converting enzyme inhibitor (or angiotensin receptor blocker if there are intolerable side effects) and an aldosterone antagonist during hospital admission to people with acute heart failure and reduced left ventricular ejection
fraction. If the angiotensin-converting enzyme inhibitor (or angiotensin receptor blocker) is not tolerated an aldosterone antagonist should still be offered. - Closely monitor the person’s renal function, electrolytes, heart rate, blood pressure and overall clinical status during treatment with beta-blockers, aldosterone antagonists or angiotensin-converting enzyme inhibitors.
Initial pharmacological treatment
Do not routinely offer opiates to people with acute heart failure.
1.3.3 Offer intravenous diuretic therapy to people with acute heart failure. Start
treatment using either a bolus or infusion strategy.
1.3.4 For people already taking a diuretic, consider a higher dose of diuretic than that
on which the person was admitted unless there are serious concerns with patient
adherence to diuretic therapy before admission.
1.3.5 Closely monitor the person’s renal function, weight and urine output during
diuretic therapy.
1.3.6 Discuss with the person the best strategies of coping with an increased urine
output.
1.3.7 Do not routinely offer nitrates to people with acute heart failure.
1.3.8 If intravenous nitrates are used in specific circumstances, such as for people with
concomitant myocardial ischaemia, severe hypertension or regurgitant aortic or
mitral valve disease, monitor blood pressure closely in a setting where at least
level 2 care can be provided.
1.3.9 Do not offer sodium nitroprusside to people with acute heart failure.
1.3.10 Do not routinely offer inotropes or vasopressors to people with acute heart
failure.
1.3.11 Consider inotropes or vasopressors in people with acute heart failure with
potentially reversible cardiogenic shock. Administer these treatments in a cardiac
care unit or high dependency unit or an alternative setting where at least level 2
care can be provided.
