Please refer to the NICE guidelines on chronic kidney disease (CG182) and on acute kidney injury (CG169). Cardiac re-synchronisation therapy (CRT-P/D) in accordance with Heart Failure with Reduced Ejection Fraction (HFREF) Consider ARB if intolerant of ACEI Consider hydralazine & nitrate if intolerant of ACEI & ARB First line: Offer ACEI and BB Offer an MRA if symptoms continue Replace ACEI (or ARB) with Sacubitril-Valsartan in accordance ICD in accordance with Specialist re-assessment Offer diuretics for the relief of congestive symptoms and fluid retention All heart failure: Offer a personalised, exercise-based cardiac rehabilitation programme, unless condition is unstable Add Ivabradine if in sinus rhythm, with a HR >75 bpm and LVEF <35% in accordance Add Hydralazine & nitrate (especially if of African/Caribbean descent) Digoxin for If the person s eGFR is 30-45 ml/min/1.73 m2, consider lower doses and/or slower titration of dose of ACE inhibitors or ARBs, mineralocorticoid receptor antagonists, sacubitril valsartan, and digoxin. If the person s eGFR is <30 ml/min/1.73 m2, consider liaising with a renal physician. Heart Failure with Preserved Ejection Fraction (HFPEF) Chronic Heart Failure Guideline summary NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 What is the optimal NT-proBNP threshold for the diagnosis of heart failure in people with atrial fibrillation? What are the optimal NT-proBNP thresholds for diagnosing heart failure in people with IIIb, IV or V chronic kidney disease? What is the optimal threshold for NT-proBNP for the diagnosis of heart failure in people with suspected heart failure: 400 ng/ml or 125 ng/ml? What is the optimal imaging technique for the diagnosis of heart failure? No recommendation No recommendation In people with advanced heart failure and significant peripheral fluid overload, what is the clinical and cost effectiveness of oral, subcutaneous and intravenous diuretic therapy in the community? 