Chronic Heart Failure Treating Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 6 Treating Heart Failure The treatment of heart failure involves management of underlying causes and risk factors, treatment of symptoms and long-term pharmacological and non-pharmacological interventions for specific types of disease. The management of heart failure has evolved with increasing interest in preventative therapies which deal with conditions predisposing to heart failure such as ischaemic herat disease with attedant risk-factors such as smoking and diabetes, and the role of hypertension and obesity in exacerbation of heart failure especially if ejection fraction is preserved. Dietary factors such as salt (sodium intake), fatty acids, cholesterol and carbohydrates are involved in promoting the progression of hypertension, hyperlipidaemia, obesity and diabetes which all have implications for the management of heart failure. The management of these outside heart failure is the subject of separate guidance (see NICE CG 181; PH38) but these recommendations may not apply completely in patients with heart failure . As fluid overload is a common feature of heart failure sodium and fluid restriction has been advised and new evidence is available to be able to review whether this is efficacious. The diagnosis of heart failure has implications for activities of daily life as well as affecting the ability to travel or drive. The presence of oedema and reduced activity found with heart failure prediposes to chest infections and thus this group of patients need to receive advice on vaccination for influenza. The update to the heart failure guideline includes topics where new evidence has emerged since the publication in 2010. A review of new evidence published after 2010 was carried out in order to determine whether any changes to current recommendations where likely to be required. 