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**** Under review: NICE has issued updated guidance ****
NICE NG106: Chronic heart failure in adults: diagnosis and management (September 2018)
Please refer to guidelines for further information:
Patients with symptomatic heart failure due to left ventricular systolic dysfunction (LVSD) should be treated with the following drugs (if tolerated and not contra-indicated) and in the sequence indicated.
Both an ACE inhibitor (ramipril or lisinopril) and beta-blocker (bisoprolol or carvedilol) should be started as soon as possible after diagnosis:
Consider a loop diuretic to relieve symptoms of congestion and fluid retention
Offer rehabilitation and education
Notes
If symptoms persist despite optimal first-line therapy, seek specialist advice and consider adding one of the following second-line treatments:
If symptoms persist despite first and second line treatments, consider: