Heart Failure Treatment

Heart Failure with Reduced Ejection Factor (HFrEF)

CKS Guidance

1. Stop Drugs

  • Stop drugs which may worsen heart failure
    • NSAIDs
    • Calcium Channel Blockers
    • Beta Blockers
    • Alcohol
    • Cocaine

2. Furosemide

  • In fluid overload:
    • Loop diuretic (Furosemide, Bumetanide or Torasemide)

3. Start an ACE & Beta Blocker

  • Start and ACE-I (no ACE if valve disease) and a Beta blocker but only one at a time. (If they can’t tolerate an ACE give an ARB instead)
  • Only start one at a time
  • Start the Beta blocker if they have angina

4. If still symptomatic – refer

  • if they still at NYHA II – IV – referral to cardiology is appropriate

5.  Consider an antiplatelet and Statin

6. Optimise treatment of co-morbiidities

7. Consider Causes, Depression and nutritional status

8. Ref for rehabilitation

Heart Failure with Preserved Ejection Fraction (HFpEF)

CKS Guidance

1. Stop Drugs as above

2. Furosemide

  • Loop diuretic such as Furosemide – up to 80mg may be necessary

3. Refer

  • Unlike with HFrEF – don’t need Beta blockers or ACE – that an be considered by specialist.

4. Anti platelet and statin

5. Optimise treatment of co-morbiidities

6. Consider Causes, Depression and nutritional status

7. Ref for rehabilitation

 

Additional note:

Hydralazine and long-acting nitrate may have a greater magnitude of benefit in the afro-Caribbean population because of slightly lesser importance of renin angiotensin activation in this racial group.