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National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of heart failure 2018

John J Atherton, Andrew Sindone, Carmine G De Pasquale, Andrea Driscoll, Peter S MacDonald, Ingrid Hopper, Peter Kistler, Tom G Briffa, James Wong, Walter P Abhayaratna, Liza Thomas, Ralph Audehm, Phillip J Newton, Joan O'Loughlin, Cia Connell and Maree Branagan
Med J Aust || doi: 10.5694/mja18.00647
Published online: 2 August 2018

Abstract

Introduction: Heart failure (HF) is a clinical syndrome that is secondary to an abnormality of cardiac structure or function. These clinical practice guidelines focus on the diagnosis and management of HF with recommendations that have been graded on the strength of evidence and the likely absolute benefit versus harm. Additional considerations are presented as practice points.

Main recommendations:

  • Blood pressure and lipid lowering decrease the risk of developing HF. Sodium–glucose cotransporter 2 inhibitors decrease the risk of HF hospitalisation in patients with type 2 diabetes and cardiovascular disease.
  • An echocardiogram is recommended if HF is suspected or newly diagnosed.
  • If an echocardiogram cannot be arranged in a timely fashion, measurement of plasma B-type natriuretic peptides improves diagnostic accuracy.
  • Angiotensin-converting enzyme inhibitors, β-blockers and mineralocorticoid receptor antagonists improve outcomes in patients with HF associated with a reduced left ventricular ejection fraction. Additional treatment options in selected patients with persistent HF associated with reduced left ventricular ejection fraction include switching the angiotensin-converting enzyme inhibitor to an angiotensin receptor neprilysin inhibitor; ivabradine; implantable cardioverter defibrillators; cardiac resynchronisation therapy; and atrial fibrillation ablation.
  • Multidisciplinary HF disease management facilitates the implementation of evidence-based HF therapies. Clinicians should also consider models of care that optimise medication titration (eg, nurse-led titration).

Changes in management as a result of the guideline: These guidelines have been designed to facilitate the systematic integration of recommendations into HF care. This should include ongoing audit and feedback systems integrated into work practices in order to improve the quality of care and outcomes of patients with HF.

  • John J Atherton1
  • Andrew Sindone2
  • Carmine G De Pasquale3
  • Andrea Driscoll4,5
  • Peter S MacDonald6
  • Ingrid Hopper7
  • Peter Kistler8
  • Tom G Briffa9
  • James Wong10
  • Walter P Abhayaratna11
  • Liza Thomas12
  • Ralph Audehm13
  • Phillip J Newton14
  • Joan O'Loughlin15
  • Cia Connell16
  • Maree Branagan16

  • 1 Royal Brisbane and Women's Hospital and University of Queensland, Brisbane, QLD
  • 2 Concord Repatriation General Hospital, Sydney, NSW
  • 3 Flinders Medical Centre, Flinders University, Adelaide, SA
  • 4 Deakin University, Melbourne, VIC
  • 5 Austin Health, Melbourne, VIC
  • 6 St Vincent's Hospital, Sydney, NSW
  • 7 Monash University, Melbourne, VIC
  • 8 The Alfred Hospital, Melbourne
  • 9 University of Western Australia, Perth, WA
  • 10 Royal Melbourne Hospital, Melbourne, VIC
  • 11 Canberra Hospital, Canberra, ACT
  • 12 Westmead Private Hospital, Sydney, NSW
  • 13 University of Melbourne, Melbourne, VIC
  • 14 Western Sydney University, Sydney, NSW
  • 15 Consumer Representative, Perth, WA
  • 16 National Heart Foundation of Australia, Melbourne, VIC


Competing interests:

A full conflict of interest register is available at: 
https://www.heartfoundation.org.au/for-professionals/clinical-information/heart-failure

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