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NICE heart failure guidelines: the diagnostic algorithm in practice, what is the next step?
  1. Abdallah Al-Mohammad
  1. University of Sheffield and Sheffield Teaching Hospitals, Sheffield, UK
  1. Correspondence to Professor Abdallah Al-Mohammad, University of Sheffield and Sheffield Teaching Hospitals, Sheffield S10 2JF, UK; abdallah.al-mohammad{at}nhs.net

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Diagnostic algorithm of the guidelines

NICE guidelines aim to standardise services implementing evidence-based recommendations. Following the diagnostic algorithm for chronic heart failure (HF) improves the patient’s chance to receive the correct diagnosis in a timely fashion.1 This is a pivotal step preceding the commencement of appropriate therapy. The diagnosis may lead to further investigations to subphenotype the HF. Besides, those with no HF will be reassured, and their further investigations into the causes of their symptoms may be instituted.

The guideline of 2010 introduced measurement of natriuretic peptide (NP) levels as the main gate into the HF diagnostic services and as a triage tool. The patients are thus divided into those who undergo echocardiography and receive specialist clinic assessment within 2 weeks (NTproBNP >2000 pg/mL) or within 6 weeks (NTproBNP 400–2000 pg/mL).1

Based on a health technology appraisal of the diagnosis of HF,2 the guideline introduced another port of entry into the diagnostic algorithm: history of myocardial infarction (MI). The guideline stipulated that in the presence of that history, there would not be a need to check NP. The aim was to reduce the financial burden of having to measure NP in all those with suspected HF. At that time, NP measurement was available to less than a third of the health communities in the UK.

Lessons learned from Zheng et al in this issue of the Journal

Zheng et al provided their real-world experience of the 2010 NICE guideline’s HF diagnostic algorithm.1 In their observational study, they reported the characteristics of the patients referred to the diagnostic HF services in two cities in the South West of England (Portsmouth and Southampton).3

Their patients reflected the community, being older (mean (SD) age 79 (9) years) than we saw in most of the HF trials, with more women (53%) than men.3

Compared with those with no HF, the group with HF had significantly higher …

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Footnotes

  • Twitter @AAlMohammad87

  • Contributors The editorial was conceived and written entirely by me.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests I was a member of the Guidelines Committee for the NICE chronic heart failure guidelines 2010, the NICE acute heart failure guidelines 2014 and the NICE chronic heart failure guidelines 2018.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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