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? What is the most accurate prognostic risk toos in predicting 1 year mortality from heart failure at specific clinically relevant thresholds (for example, sensitivity, specificity, negative predictive value and positive predictive value at a threshold of 50% risk of mortality at 1 year)? Chronic Heart Failure Introduction NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 2.1 Diagnosis and definition of chronic heart failure Heart failure is a common complex clinical syndrome of symptoms and signs caused by impairment of the heart s action as a pump supporting the circulation 11, 74, 337 . It is caused by structural or functional abnormalities of the heart. The demonstration of objective evidence of these cardiac abnormalities is necessary for the diagnosis of heart failure to be made. The symptoms most commonly encountered are breathlessness (exertional dyspnoea, orthopnoea and paroxysmal nocturnal dyspnoea), fatigue, and oedema. Signs in heart failure could be due to pulmonary and systemic congestion, or the structural abnormalities either causing or caused by heart failure. There is no single diagnostic test for heart failure, and diagnosis relies on clinical judgement based on a combination of history, physical examination and appropriate investigations. Patients may present acutely with heart failure45 which is the subject of separate guidance (NICE Acute Heart Failure: diagnosis and management. Clinical Guideline 187) 234 , or have a more insidious presentation. Most acute presentations are due to patients with chronic heart failure suffering an acute decompensation ( 65%), while the remainder are new presentations of acute heart failure ( 35%). 