Chronic heart failure in adults: diagnosis and management

'Heart failure due to left ventricular systolic dysfunction (LVSD)' has been replaced in all recommendations by 'heart failure with reduced ejection fraction' in line with current terminology and the 2018 guideline scope.

'Aldosterone antagonists' has been replaced in all recommendations by 'mineralocorticoid receptor antagonists (MRAs') to clarify the function of the receptor, and in line with the 2018 guideline scope.

'African or African-Caribbean family origin' has been added to recommendation 1.2.7 because of the high incidence of heart failure with preserved ejection fraction in these populations. Recent evidence shows that NT-proBNP levels are lower in people of west African family background and are a confounder in the diagnosis of heart failure.

Doppler 2D has been deleted from recommendations 1.2.8, 1.2.9 and 1.2.11 because all transthoracic echocardiography would have doppler 2D as a minimum and it is no longer necessary to specify this.

'Multigated acquisition scanning' has been added to recommendation 1.2.11 to reflect current imaging technology.

Measurement of urea has been deleted from recommendations 1.2.12, 1.4.8 and 1.7.1 because the guideline committee agreed that it is not needed and is not part of renal function profiles in most centres in the UK.

Blood tests for electrolytes, creatinine and eGFR have been grouped together under the term 'renal function profile' because they are provided as a unified set of analyses in the NHS. The term 'profile' is applied to a group of tests (assays). Thus these tests are more accurately described as 'profiles' as they contain multiple individual assays and have replaced thyroid function test, liver function test and lipid measurement.

'Fasting glucose' has been replaced by 'glycosylated haemoglobin (HbA_1c)' in line with the NICE guidelines on diabetes.

Measurement of serum urea has been deleted from recommendation 1.4.4 because the guideline committee agreed that it is not needed and is not part of renal function profiles in most centres in the UK.

Measurement of potassium has been added to ensure that monitoring is consistent across treatments.

Recommendations 1.4.6 and 1.4.10 have been added to clarify the timing of monitoring after treatment starts.

In recommendation 1.4.8, monitoring for hyperkalaemia has been replaced by potassium measurement for clarity.

Blood pressure measurement has been clarified in recommendation 1.4.13 and made consistent with other treatments.

As a result of new evidence the treatment pathway for heart failure with reduced ejection fraction in recommendation 1.4.26 has been amended. Second line treatment has been replaced by specialist treatment.

A sentence has been added to clarify that specialist advice should be sought before starting treatment with digoxin.

The first part of recommendation 1.6.2 has been removed because it is now covered in section 1.1 on team working in the management of heart failure.

Amlodipine to treat hypertension has been deleted from recommendation 1.6.3 because it has been superseded by the NICE guideline on hypertension in adults.

'Regularly' has been replaced by 'at the 6-monthly clinical review' in recommendation 1.6.5 for clarification.

The wording in recommendation 1.6.6 has been amended in line with recommendation 1.6.5.