Heart Failure: Medical Management


exp date isn't null, but text field is


Back to Heart Failure: Assessment and Investigations

Back to Heart Failure: Diagnosis (new)

Back to Heart Failure: Management of decompensation

Highland Formulary - cardiovascular system

* Back to Embolism prophylaxis for patients with non-valvular, persistent or permanent atrial fibrillation (AF)

Monitor Progression

Review of blood tests

Suggest checking:

  • 6 monthly blood check of Renal Function (3 monthly if renal dysfunction present)
  • 6 monthly blood check for HbA1c if on Dapagliflozin
  • Annual blood check for FBC, ferritin and TFT levels
  • Annual ECG (to check QRS width)
  • Medication compliance
  • Self management understanding

Caution must be maintained when considering stopping drugs (e.g. ACE inhibitor, ARBs, entresto, beta blockers, MRA's and digoxin) as this may cause deterioration in symptoms.

Cardiac Devices

The choice of device will be decided by the cardiology team based on the following criteria:

Implantable Defibrillator (ICD) Primary Indications

  • QRS <120mms
  • Ejection fraction < 35% (equivalent to severe LVSD)

Cardiac Resynchronisation Therapy (CRT +/- D)

  • QRS >120mms
  • Ejection fraction <35% (equivalent to severe LVSD)

Referral to nurse-led heart failure service

The Nurse Led Heart Failure Service provides a comprehensive care package for heart failure patients, working in partnership between primary and secondary care.

Referrals can be made by any member of the multidisciplinary team as long as the following criteria are met:

  • Patient must have documented evidence of heart failure due to left ventricular systolic dysfunction (LVSD) (ejection fraction less than 40%) (either by echo, MUGA scan or angiogram).


  • Be symptomatic despite medical therapy


  • Had a recent hospital admission due to heart failure

Ultimately- patient must be willing to be part of the service.

Benefits can include

  • Education- to detect early warning signs and symptoms and to enable self management
  • Medication optimisation
  • On-going support for patient and carer
  • Palliative Care Support

For more details please contact your local Heart Failure Nurse or contact the main Heart Failure Office on 01463 704628 or email nhsh.heartfailureservice@nhs.scot

Patient name and CHI number needed for referrals.


Abbreviation Meaning  
ACE inhibitor Angiotensin-converting-enzyme inhibitors  
ARB Angiotensin receptor blockers  
AF Atrial Fibrillation  
ECG Electrocardiogram Electrocardiogram
FBC Full blood count  
LVSD Left ventricular systolic dysfunction  
MRA Mineralocorticoid receptor antagonists  
NYHA  New York Heart Association  
TFT Thyroid function test  

Last reviewed: 07 May 2020

Next review: 30 May 2023

Author(s): Cardiovascular Improvement Group

Approved By: TAM subgroup of ADTC

Reviewer Name(s): Consultant Cardiologist and Lead Heart Failure nurse

Document Id: TAM131