management of severe heart failure
Last edited 05/2023 and last reviewed 05/2023
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:
lifestyle and risk factor management in heart failure
thiazide and loop diuretic combinations
ACE inhibitors in heart failure
monitoring response to therapy
cardiac resynchronization in advanced heart failure
NICE guidance - implantable cardioverter defibrillator and heart failure
NICE guidance - ivabradine in chronic heart failure