Offer the treatment outlined in section 6.2.7 and If the person s eGFR is 45 ml/min/1.73 m2 or below, consider lower doses and/or slower titration of dose of ACE inhibitors or ARBs, mineralcorticoid receptor antagonists and digoxin. [2018] 62. For people who have heart failure with reduced ejection fraction and chronic kidney disease with an eGFR below 30 ml/min/1.73 m2 the specialist heart failure MDT should consider liaising with a renal physician [2018] 63. Monitor the response to titration of medicines closely in people who have heart failure with reduced ejection fraction and chronic kidney disease, taking into account the increased risk of hyperkalaemia. [2018] 64. Do not routinely offer coronary revascularisation to people who have heart failure with reduced ejection fraction and coronary artery disease. [2018] 65. Specialist referral for transplantation should be considered for people with severe refractory symptoms or refractory cardiogenic shock [2003] 66. Offer people with heart failure a personalised, exercise-based cardiac rehabilitation programme, unless their condition is unstable. The programme: should be preceded by an assessment to ensure that it is suitable for the person should be provided in a format and setting (at home, in the community or in the hospital) that is easily accessible for the person should include a psychological and educational component may be incorporated within an existing cardiac rehabilitation programme should be accompanied by information about support available from healthcare professionals when the person is doing the programme. 67. All people with chronic heart failure need monitoring. This monitoring should include: a clinical assessment of functional capacity, fluid status, cardiac rhythm (minimum of examining the pulse), cognitive status and nutritional status a review of medication, including need for changes and possible side effects Chronic Heart Failure Guideline summary NICE 2018. All rights reserved. Subject to Notice of rights. 