[2018] 1.6 Managing all types of heart failure When managing pharmacological treatment, follow the recommendations in the NICE guidelines on medicines adherence and medicines optimisation. Pharmacological treatment Diuretics 1.6.1 Diuretics should be routinely used for the relief of congestive symptoms and fluid retention in people with heart failure, and titrated (up and down) according to need following the initiation of subsequent heart failure 1.6.2 People who have heart failure with preserved ejection fraction should usually be offered a low to medium dose of loop diuretics (for example, 18 of less than 80 mg furosemide per day). People whose heart failure does not respond to this treatment will need further specialist advice. [2003, Calcium-channel blockers 1.6.3 Avoid verapamil, diltiazem and short-acting dihydropyridine agents in people who have heart failure with reduced ejection fraction. [2003, Amiodarone 1.6.4 Make the decision to prescribe amiodarone in consultation with a 1.6.5 Review the need to continue the amiodarone prescription at the 1.6.6 Offer people taking amiodarone liver and thyroid function tests, and a review of side effects, as part of their routine 6-monthly clinical review. Anticoagulants 1.6.7 For people who have heart failure and atrial fibrillation, follow the recommendations on anticoagulation in the NICE guideline on atrial fibrillation. Be aware of the effects of impaired renal and liver function on anticoagulant therapies. [2018] 1.6.8 In people with heart failure in sinus rhythm, anticoagulation should be considered for those with a history of thromboembolism, left ventricular aneurysm or intracardiac thrombus. [2003] Vaccinations 1.6.9 Offer people with heart failure an annual vaccination against influenza. 19 of 1.6.10 Offer people with heart failure vaccination against pneumococcal disease (only required once). [2003] Contraception and pregnancy 1.6.11 In women of childbearing potential who have heart failure, contraception and pregnancy should be discussed. 