Management of severe heart failure
Patients with severe chronic heart failure may be receiving a treatment regime including diuretics, ACE inhibitors, beta-blockers and spironolactone.
NICE have recommended ivabradine as an additional possible treatment
- in combination with standard therapy including betablocker therapy, angiotensin-converting enzyme (ACE) inhibitors and aldosterone antagonists, or when beta-blocker therapy is contraindicated or not tolerated (1)
Patients with extremely resistant oedema may also be given additional therapies. These may include:
- loop diuretic potentiated with a thiazide diuretic such as metolazone
- nitrate vasodilator
- digoxin
Heart transplantation is a treatment of last resort in selected patients with severe heart failure.
Reference:
Related pages
- Loop diuretics
- Lifestyle and risk factor management in heart failure
- Thiazide
- Thiazide and loop diuretic combinations
- ACE inhibitors in heart failure
- Nitrate vasodilators
- Digoxin in cardiac failure
- Monitoring response to therapy
- Heart transplantation
- Cardiac resynchronization in advanced heart failure
- NICE guidance - implantable cardioverter defibrillators
- Ivabradine
- SGLT2 inhibitors and heart failure
- Sacubutril
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