Chronic Care - Professor Richard Kirk 2023

Heart Failure Management
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Chronic Care

Clinic Follow Up Schedule*
Ejection Fraction	NT-proBNP (pg/ml)
< 35% - every 3 months > 45% - if less than 12 yrs age every 6 months, if older annually	< 1,000 every 3 months 1,000-4,000 every 1-2 months > 5,000 monthly >10,000 Admit to hospital

* Once the heart rate reduction strategy has been achieved by following Figure 1 when the predominant physiology is HFrEF or Figure 2 when the physiology is HFpEF

If heart rate reduction is achieved and NT-proBNP >660 pg/ml adjust ACEi dose

If EF remains < 35% after 1 year on treatment consider ICD

Chronic Phase Medications
Patients	Class Medication	Details
All	ACE inhibitors	< 1 yr age captopril > 1 yr Enalapril/Ramipril
EF < 45%	MRA β Blockers	Eplerenone/Aldactone Carvedilol/Bisoprolol*
EF < 40%	HCN channel blocker	**Ivabridine
EF < 40% & NTproBNP>660 pg/ml	ARNi	**Sacubritril/Valsartan
EF < 30%	Antiplatelet	Asprin
VT or Atrial Arrhythmia	Class III antiarrhythmic	Amiodarone ? ICD if VT
* if diastolic pressure is low ** Reduce diuretics to prevent hypotension

Undertake

Annual CPET once older than 8 years. (the first 2 consecutive tests with similar results I dont understand)
Cardiac MRI after 1 yr of maximum therapy to assess presence of LGE

Figure 1. HFrEF Physiology

Figure 2. HFpEF Physiology

Last Updated: April 2023