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 an assessment of renal function. Note: This is a minimum. People with comorbidities or co-prescribed medications will need further monitoring. Monitoring serum potassium is particularly important if a person is taking digoxin or an MRA. [2010, amended 1.7.2 More detailed monitoring will be needed if the person has significant comorbidity or if their condition has deteriorated since the previous 1.7.3 The frequency of monitoring should depend on the clinical status and stability of the person. The monitoring interval should be short (days to 2 weeks) if the clinical condition or medication has changed, but is 21 of needed at least 6-monthly for stable people with proven heart failure. 1.7.4 People with heart failure who wish to be involved in monitoring of their condition should be provided with sufficient education and support from their healthcare professional to do this, with clear guidelines as to what to do in the event of deterioration. [2003] Measuring NT-proBNP 1.7.5 Consider measuring NT-proBNP (N-terminal pro-B-type natriuretic peptide) as part of a treatment optimisation protocol only in a specialist care setting for people aged under 75 who have heart failure with reduced ejection fraction and an eGFR above 60 ml/min/1.73 m2 1.8 Interventional procedures Coronary revascularisation 1.8.1 Do not routinely offer coronary revascularisation to people who have heart failure with reduced ejection fraction and coronary artery disease. Cardiac transplantation 1.8.2 Specialist referral for transplantation should be considered for people with severe refractory symptoms or refractory cardiogenic shock. 