Patients benefit from frequent formal evaluation in a specialised centre or monitoring in a management programme.[2]Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013 Oct 15;62(16):e147-239.
http://www.onlinejacc.org/content/62/16/e147
http://www.ncbi.nlm.nih.gov/pubmed/23747642?tool=bestpractice.com
Assessment should be made at each visit of the ability of a patient to perform routine and desired activities of daily living. Assessment should be also made of the fluid status and weight of the patient. Careful history of current use of alcohol, tobacco, illicit drugs, alternative therapies, and chemotherapy drugs, as well as diet and sodium intake, should be obtained at each visit. Repeat measurement of ejection fraction and assessment of the severity of structural remodelling can provide useful information in patients with heart failure who have had a change in clinical status, or who have experienced or recovered from a clinical event, or received treatment that might have had a significant effect on cardiac function. The value of serial measurements of B-type natriuretic peptide to guide therapy for patients is still not well established.
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What are the benefits and harms of natriuretic peptide–guided treatment for people with heart failure?/cca.html?targetUrl=https://www.cochranelibrary.com/cca/doi/10.1002/cca.2678/fullShow me the answer Data suggest that natriuretic-guided therapy reduces hospitalisation due to heart failure and that in patients younger than 75 years of age, it also provides a survival benefit.[238]Troughton RW, Frampton CM, Brunner-La Rocca HP, et al. Effect of B-type natriuretic peptide-guided treatment of chronic heart failure on total mortality and hospitalization: an individual patient meta-analysis. Eur Heart J. 2014 Jun 14;35(23):1559-67.
https://academic.oup.com/eurheartj/article/35/23/1559/459004
http://www.ncbi.nlm.nih.gov/pubmed/24603309?tool=bestpractice.com
However, one randomised trial found that in high-risk patients with heart failure, natriuretic-guided therapy was not more effective than optimal medical therapy alone in improving outcomes.[239]Felker GM, Anstrom KJ, Adams KF, et al. Effect of natriuretic peptide-guided therapy on hospitalization or cardiovascular mortality in high-risk patients with heart failure and reduced ejection fraction: a randomized clinical trial. JAMA. 2017 Aug 22;318(8):713-20.
https://jamanetwork.com/journals/jama/fullarticle/2649188
http://www.ncbi.nlm.nih.gov/pubmed/28829876?tool=bestpractice.com
The use of telemonitoring to monitor patients remotely is an emerging strategy but requires further evaluation.[240]Chaudhry SI, Phillips CO, Stewart SS, et al. Telemonitoring for patients with chronic heart failure: a systematic review. J Card Fail. 2007 Feb;13(1):56-62.
http://www.ncbi.nlm.nih.gov/pubmed/17339004?tool=bestpractice.com
[241]Clark RA, Inglis SC, McAlister FA, et al. Telemonitoring or structured telephone support programmes for patients with chronic heart failure: systematic review and meta-analysis. BMJ. 2007 May 5;334(7600):942.
https://www.bmj.com/content/334/7600/942.long
http://www.ncbi.nlm.nih.gov/pubmed/17426062?tool=bestpractice.com
[242]Inglis SC, Clark RA, McAlister FA, et al. Which components of heart failure programmes are effective? A systematic review and meta-analysis of the outcomes of structured telephone support or telemonitoring as the primary component of chronic heart failure management in 8323 patients: abridged Cochrane review. Eur J Heart Fail. 2011 Sep;13(9):1028-40.
https://onlinelibrary.wiley.com/doi/full/10.1093/eurjhf/hfr039
http://www.ncbi.nlm.nih.gov/pubmed/21733889?tool=bestpractice.com
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What are the benefits and harms of structured telephone support or non-invasive telemonitoring in patients with heart failure?/cca.html?targetUrl=https://cochranelibrary.com/cca/doi/10.1002/cca.1059/fullShow me the answer
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In people with heart failure, what are the effects of interactive telemedicine?/cca.html?targetUrl=https://cochranelibrary.com/cca/doi/10.1002/cca.1311/fullShow me the answer
Wireless pulmonary haemodynamic monitoring in patients with chronic heart failure results in significant reduction in heart failure hospitalisations.[243]Abraham WT, Adamson PB, Bourge RC, et al. Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial. Lancet. 2011 Feb 19;377(9766):658-66.
http://www.ncbi.nlm.nih.gov/pubmed/21315441?tool=bestpractice.com
Structured telephone support and non-invasive home telemonitoring can reduce the risk of mortality and heart failure-related hospitalisations.[244]Inglis SC, Clark RA, Dierckx R, et al. Structured telephone support or non-invasive telemonitoring for patients with heart failure. Cochrane Database Syst Rev. 2015 Oct 31;(10):CD007228.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007228.pub3/full
http://www.ncbi.nlm.nih.gov/pubmed/26517969?tool=bestpractice.com
Invasive haemodynamic monitoring, however, is not routinely used in clinical practice, but may be of use in individual patients, particularly those with recurrent heart failure.
In one study of patients with New York Heart Association class III heart failure, wireless implantable haemodynamic monitoring compared with control led to a significant reduction of heart failure-related hospitalisations.[243]Abraham WT, Adamson PB, Bourge RC, et al. Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial. Lancet. 2011 Feb 19;377(9766):658-66.
http://www.ncbi.nlm.nih.gov/pubmed/21315441?tool=bestpractice.com
Exercise training and rehabilitation
In patients with heart failure, cardiac rehabilitation and exercise training improves exercise tolerance and quality of life with decreased morbidity and mortality.[245]Ades PA, Keteyian SJ, Balady GJ, et al. Cardiac rehabilitation exercise and self-care for chronic heart failure. JACC Heart Fail. 2013 Dec;1(6):540-7.
http://heartfailure.onlinejacc.org/content/1/6/540
http://www.ncbi.nlm.nih.gov/pubmed/24622007?tool=bestpractice.com
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What are the effects of exercise‐based cardiac rehabilitation for adults with heart failure?/cca.html?targetUrl=https://www.cochranelibrary.com/cca/doi/10.1002/cca.2436/fullShow me the answer Patients with stable heart failure are therefore encouraged to do regular aerobic exercise and it is recommended that they are enrolled in a multidisciplinary care management programme.[1]Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Eur J Heart Fail. 2016 Aug;18(8):891-975.
https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.592
http://www.ncbi.nlm.nih.gov/pubmed/27207191?tool=bestpractice.com
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What are the benefits and harms of disease management interventions for adults with heart failure?/cca.html?targetUrl=https://www.cochranelibrary.com/cca/doi/10.1002/cca.2462/fullShow me the answer One consensus paper provides a detailed description of exercise training in heart failure.[246]Piepoli MF, Conraads V, Corrà U, et al. Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail. 2011 Apr;13(4):347-57.
https://onlinelibrary.wiley.com/doi/full/10.1093/eurjhf/hfr017
http://www.ncbi.nlm.nih.gov/pubmed/21436360?tool=bestpractice.com