What is the role of loop diuretics in heart failure?

managing fluid overload

but they offer no long-term reduction in mortality

Whats the First-line therapy for heart failure?

both an ACE-inhibitor and a beta-blocker

Whats Second-line therapy for heart failure?

aldosterone antagonist

When should starting SGLT-2 inhibitors be considered in heart failure?

In patients with a reduced ejection fraction

Third-line treatment for heart failure should be initiated by a {{c1::specialist}}. Options include {{c2::ivabradine, sacubitril-valsartan, hydralazine in combination with nitrate, digoxin and cardiac resynchronisation therapy}}

Whats the criteria for starting ivabradine in heart failure?

criteria: sinus rhythm > 75/min and a left ventricular fraction < 35%

Whats the criteria for starting sacubitril-valsartan (entresto) in heart failure?

• criteria: left ventricular fraction < 35%
• is considered in heart failure with reduced ejection fraction who are symptomatic on ACE inhibitors or ARBs

Whats the criteria for starting digoxin in heart failure?

• has not been proven to reduce mortality in patients with heart failure. It may however improve symptoms due to its inotropic properties
• it is strongly indicated if there is coexistent atrial fibrillation

Whats the criteria for starting hydralazine in combination with nitrate in heart failure?

this may be particularly indicated in Afro-Caribbean patients

Whats the criteria for starting cardiac resynchronisation therapy in heart failure?

indications include a widened QRS (e.g. left bundle branch block) complex on ECG

What additional vaccines should patients with heart failure be offered?

• annual influenza vaccine
• one-off pneumococcal vaccine

In heart failure Exercise training improves {{c1::symptoms}} but not {{c2::hospitalisation/mortality}}

What is The New York Heart Association (NYHA) Class I?

• no symptoms
• no limitation: ordinary physical exercise does not cause undue fatigue, dyspnoea or palpitations

What is The New York Heart Association (NYHA) Class II?

• mild symptoms
• slight limitation of physical activity: comfortable at rest but ordinary activity results in fatigue, palpitations or dyspnoea

What is The New York Heart Association (NYHA) Class III?

• moderate symptoms
• marked limitation of physical activity: comfortable at rest but less than ordinary activity results in symptoms

What is The New York Heart Association (NYHA) Class IV?

• severe symptoms
• unable to carry out any physical activity without discomfort: symptoms of heart failure are present even at rest with increased discomfort with any physical activity