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Management of severe heart failure

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Patients with severe chronic heart failure may be receiving a treatment regime including diuretics, ACE inhibitors, beta-blockers and spironolactone.

NICE have recommended ivabradine as an additional possible treatment

  • in combination with standard therapy including betablocker therapy, angiotensin-converting enzyme (ACE) inhibitors and aldosterone antagonists, or when beta-blocker therapy is contraindicated or not tolerated (1)

Patients with extremely resistant oedema may also be given additional therapies. These may include:

  • loop diuretic potentiated with a thiazide diuretic such as metolazone
  • nitrate vasodilator
  • digoxin

Heart transplantation is a treatment of last resort in selected patients with severe heart failure.

Reference:

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