Key priorities for the implementation of the NICE acute HF guidance. Adapted with permission.7
| Organisation of care |
|---|
| > Hospitals admitting people with suspected AHF should provide specialist HF services based on a cardiology ward and additional outreach services. |
| > All patients admitted to hospital with suspected AHF should receive early and continuing input from dedicated specialist HF teams. |
| Diagnosis, assessment and monitoring |
| > Use a single measurement of serum natriuretic peptides (BNP or NT-proBNP) to rule out the diagnosis of HF in people presenting with new suspected AHF. |
| > Where natriuretic peptide level is raised, perform transthoracic Doppler 2D echocardiography to establish the presence or absence of cardiac abnormalities within 48 h of admission to enable early specialist management. |
| Treatment after stabilisation |
| > In a person presenting with AHF who is already taking beta-blockers, continue the beta-blocker treatment unless they have a heart rate <50 bpm, second- or third-degree atrioventricular block, or shock. |
| > Start (or restart) beta-blocker treatment during the hospital admission for LVSD once condition has stabilised (ie once iv diuretics are no longer required). |
| > Offer an ACEi and MRA to patients with AHF and LVSD during their hospital admission. |
| > Ensure that the person's condition is stable for 48 h before discharging from hospital and/or after starting or restarting beta-blockers. |
| > Plan a person's discharge from hospital after the acute phase. Communicate information about a person's condition, treatment, prognosis and subsequent management plan to primary and secondary care (including HF MDT). |
| > Ensure that a follow-up appointment is made with the specialist HF team within two weeks of discharge from hospital. |
ACEi = angiotensin-converting enzyme inhibitor; AHF = acute heart failure; BNP = B-type natriuretic peptide; HF = heart failure; MDT = multidisciplinary team; MRA = mineralocorticoid receptor antagonist; NICE = National institute for Health and Care Excellence; LVSD = left ventricular systolic dysfunction; NT-proBNP = N-terminal pro-B-type natriuretic peptide.