Heart Failure: Medical management (Guidelines)

Review of blood tests

Suggest checking:

• 6 monthly blood check of Renal Function (3 monthly if renal dysfunction present)
• 6 monthly blood check for HbA1c if on Dapagliflozin
• Annual blood check for FBC, ferritin and TFT levels
• Annual ECG (to check QRS width)
• Medication compliance
• Self management understanding

Caution must be maintained when considering stopping drugs (e.g. ACE inhibitor, ARBs, entresto, beta blockers, MRA's and digoxin) as this may cause deterioration in symptoms.

The choice of device will be decided by the cardiology team based on the following criteria:

Implantable Defibrillator (ICD) Primary Indications

• QRS <120mms
• Ejection fraction < 35% (equivalent to severe LVSD)

Cardiac Resynchronisation Therapy (CRT +/- D)

• QRS >120mms
• Ejection fraction <35% (equivalent to severe LVSD)

The Nurse Led Heart Failure Service provides a comprehensive care package for heart failure patients, working in partnership between primary and secondary care.

Referrals can be made by any member of the multidisciplinary team as long as the following criteria are met:

• Patient must have documented evidence of heart failure due to left ventricular systolic dysfunction (LVSD) (ejection fraction less than 40%) (either by echo, MUGA scan or angiogram).

And

• Be symptomatic despite medical therapy

Or

• Had a recent hospital admission due to heart failure

Ultimately- patient must be willing to be part of the service.

Benefits can include

• Education- to detect early warning signs and symptoms and to enable self management
• Medication optimisation
• On-going support for patient and carer
• Palliative Care Support

For more details please contact your local Heart Failure Nurse or contact the main Heart Failure Office on 01463 704628 or email nhsh.heartfailureservice@nhs.scot

Patient name and CHI number needed for referrals.