What are the current guidelines for managing heart failure in the United Kingdom (UK)?

From the Guidelines

The latest UK guidelines for heart failure management emphasize a comprehensive approach centered on early diagnosis and personalized treatment, with a focus on reducing morbidity, mortality, and improving quality of life. For heart failure with reduced ejection fraction (HFrEF), the core medication regimen includes four foundational drug classes:

• an angiotensin receptor-neprilysin inhibitor (ARNI) such as sacubitril/valsartan or an ACE inhibitor/ARB if ARNI is not tolerated
• a beta-blocker (bisoprolol, carvedilol, or nebivolol)
• a mineralocorticoid receptor antagonist (spironolactone 25mg daily or eplerenone)
• and an SGLT2 inhibitor (dapagliflozin 10mg daily or empagliflozin 10mg daily) 1. These medications should be initiated promptly and titrated to target doses. For heart failure with preserved ejection fraction (HFpEF), SGLT2 inhibitors are now recommended as first-line therapy. Device therapy including implantable cardioverter-defibrillators and cardiac resynchronization therapy should be considered for appropriate patients. The guidelines also emphasize multidisciplinary care involving specialist heart failure nurses, cardiac rehabilitation programs, and regular monitoring of symptoms, fluid status, renal function, and electrolytes. Patient education about self-management, including daily weight monitoring, flexible diuretic regimens, and recognition of worsening symptoms, is essential. These approaches target the neurohormonal pathways and pathophysiological mechanisms that drive heart failure progression, reducing hospitalizations and mortality while improving quality of life.

Some key points to consider in the management of heart failure include:

• The use of diuretics to improve symptoms and reduce fluid retention
• The importance of regular monitoring of serum natriuretic peptide levels to guide therapy
• The consideration of telemonitoring to extend specialist monitoring to a larger proportion of patients
• The role of cardiac rehabilitation programs in improving quality of life and reducing hospitalizations
• The importance of patient education and self-management in heart failure care.

Overall, the management of heart failure requires a comprehensive and personalized approach, with a focus on reducing morbidity, mortality, and improving quality of life. The latest guidelines recommend a core medication regimen that includes an ARNI, beta-blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor, with device therapy and multidisciplinary care considered for appropriate patients.

From the Research

Newest Guidelines on Managing Heart Failure in the UK

The newest guidelines on managing heart failure in the UK are based on several studies that have been conducted in recent years.

• The guidelines recommend the use of certain medications, including renin-angiotensin inhibitors, β-blockers, and mineralocorticoid receptor antagonists, to manage heart failure with reduced ejection fraction (HFrEF) 2.
• Angiotensin receptor-neprilysin inhibitors (ARNIs) have also been shown to be effective in reducing mortality and hospitalization in patients with HFrEF, and may be considered as an alternative to angiotensin-converting enzyme inhibitors (ACEIs) 3, 4.
• The use of ACEIs, ARBs, and MRAs in patients with heart failure with preserved ejection fraction (HFpEF) is still being studied, and the current evidence does not support their use in this population in the absence of an alternative indication 5.
• However, MRAs and ARNIs may be effective in reducing the risk of heart failure hospitalization in patients with HFpEF, although the treatment effect sizes are modest 5.

Medications for Heart Failure

The following medications are commonly used to manage heart failure:

• Renin-angiotensin inhibitors, such as ACEIs and ARBs, which help to relax blood vessels and reduce blood pressure 2, 3.
• β-blockers, which help to slow the heart rate and reduce blood pressure 2, 5.
• Mineralocorticoid receptor antagonists, which help to reduce fluid retention and blood pressure 2, 5.
• Angiotensin receptor-neprilysin inhibitors (ARNIs), which help to relax blood vessels and reduce blood pressure, and may be considered as an alternative to ACEIs 3, 4.

Treatment Approaches

The treatment approach for heart failure will depend on the individual patient's needs and medical history.

• A stepwise approach to treatment, which involves starting with a single medication and adding additional medications as needed, may be effective in managing HFrEF 2.
• The use of ARNIs, which combine the benefits of ACEIs and neprilysin inhibitors, may be considered in patients with HFrEF who are not responding to traditional therapies 4.
• In patients with HFpEF, the use of MRAs and ARNIs may be considered to reduce the risk of heart failure hospitalization, although further research is needed to fully understand their benefits and risks 5.