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National Collaborating Centre for Chronic Conditions (UK). Chronic Heart Failure: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care. London: Royal College of Physicians (UK); 2003. (NICE Clinical Guidelines, No. 5.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

Appendix KInclusion and exclusion of literature

This appendix presents all published papers found by systematic literature searches for the development of the guideline. Alongside each paper, a column shows whether it was included, and if not, gives some brief indication of why not. A reference number is also shown, which is the number of the reference to the given paper in the full guideline.

The following points should be noted:

  • Some papers listed here as included are not referenced in the full guideline. This is because they are additional evidence that was not cited in the guideline.
  • In some instances, studies will be referenced but will have an exclusion criteria. This will be because they were excluded from critical appraisal but were subsequently cited in the guideline. Typically, this is because they helped to set the context provided as part of an introduction, or because they are singled out as individual trials from a systematic review which is itself included.
  • Some references in the full guideline will not be found at all in this appendix, as they relate to the economic analysis and were not found or considered as part of the appraisal of the clinical evidence, or because they were included as part of an expert opinion question.
  • They are grouped by question, as this was the basis for determining whether they were to be included in the appraisal or not. This preceded the translation into useful clinical headings as is now seen in the guideline sections. The list of questions can be seen overleaf.

Clinical questions

Please note: an asterisk denotes a question to be answered by expert opinion, and confirmed by consensus, rather than by full systematic review, owing to nature of question or paucity of evidence on initial search.

* Q1: What is the accepted definition for Heart Failure? (PDF, 41K)

Addressed by an expert discussion paper, drafted by Martin Cowie

* Q2: What is the current burden of Heart Failure in the UK, and trends in prevalence, and what do we know about prognosis and how is it being affected by current management? (PDF, 62K)

Addressed by an expert discussion paper, drafted by Martin Cowie

* Q3: What is the burden of heart failure for the patient? (PDF, 53K)

Addressed by an expert discussion paper, drafted by Martin Cowie

Q4: What is best practice for communication at the initial diagnosis of Heart Failure, and in ongoing management to improve quality of life? (PDF, 84K)

Addressed by systematic search and review

Q5: Does a fully informed patient impact on concordance with treatment, and outcome? (PDF, 83K)

Addressed by systematic search and review

* Q6: What are the aims of Heart Failure treatment for the patient and the healthcare professional, in terms of morbidity and mortality? (PDF, 41K)

Addressed by an expert discussion paper, drafted by Audrey Alimo

Q7: Is there evidence that support and education for carers and relatives of Heart Failure improves patient quality of life, and clinical outcomes? (PDF, 53K)

Addressed by systematic search and review

Q8: What are the most appropriate tests in a patient with suspected Heart Failure to confirm diagnosis? (PDF, 122K)

This was linked with the following sub-questions

  • What Clinical signs of Heart Failure are useful?
  • Is an echocardiogram essential for the diagnosis of Heart Failure?
  • What is the role of BNP (or NT proBNP) in diagnosing Heart Failure?
  • Can a normal ECG rule out Heart Failure?

Addressed by systematic search and review

*

Which Patients with suspected Heart Failure should be referred for specialist diagnosis?

  • What are the symptoms of heart failure?

  • *

    What other Conditions may present with similar symptoms?

    Addressed by an expert discussion paper, drafted by Martin Cowie

    * Q9: What are the key elements for interpreting the results of cardiac imaging, to confirm a diagnosis of Heart Failure? (PDF, 40K)

    Addressed by an expert discussion paper, drafted by Martin Cowie

    * Q10: What is the best method for diagnosis of isolated diastolic dysfunction? (PDF, 40K)

    Addressed by an expert discussion paper, drafted by Martin Cowie

    * Q11: How should the initial management plan be determined? In what circumstances should a previous diagnosis of Heart Failure be reassessed? (PDF, 40K)

    Addressed by an expert discussion paper, drafted by Martin Cowie

    Q12: What are the causes of Heart Failure and how do these affect prognosis and treatment? What tests are indicated to establish underlying cause of Heart Failure? (PDF, 89K)

    Addressed by systematic search and review

    Q13: How are patients with heart failure affected by anxiety and depression? How best is such anxiety and depression diagnosed and treated, and what is the role of pharmacological and non-pharmacological interventions? (PDF, 61K)

    Addressed by systematic search and review

    Q14: What licensed drug therapy can be used to modify the outcome of Heart Failure in terms of quality of life, morbidity and mortality? (Including acute decompensation of chronic heart failure) (PDF, 609K)

    Addressed by systematic search and review

    Q15: What is the best sequence for pharmacological therapy, and how should it be initiated? (PDF, 68K)

    Addressed by systematic search and review

    * Q16: What drugs are to be avoided in patients with Heart Failure? (PDF, 53K)

    Addressed by an expert discussion paper, Kevin O’Shaughnessy, Mojgan Sani and Bibi Greenwood

    Q17: What is the evidence of benefit of lifestyle advice and other therapies (homeopathy, reflexology, hydrotherapy, crystal therapy and acupuncture) in terms of morbidity, mortality, and quality of life? (PDF, 62K)

    Addressed by systematic search and review

    Q17a: What is the evidence for recommending rehabilitation and/or a period of exercise training for patients with chronic heart failure? (PDF, 85K)

    Addressed by systematic search and review

    Q18: What invasive procedures have a role in the treatment of Patients with Heart Failure? How and when should patients best be identified for invasive interventions? (PDF, 349K)

    Addressed by systematic search and review

    Q19: Other than communication, what is the best way to facilitate concordance with drug and lifestyle prescriptions? (PDF, 61K)

    Addressed by systematic search and review

    * Q20: In what circumstances should a patient with an established diagnosis of Heart Failure be referred back to primary care, referred to secondary care, including criteria for hospitalisation, to ensure best possible treatment? (PDF, 90K)

    Addressed by an expert discussion paper, drafted by Jonathan Richards

    *

    What considerations need to be met prior to discharge from hospital after an episode of acute decompensation?

    Addressed by an expert discussion paper, drafted by Martin Cowie

    *

    What evidence is there that a dedicated multi disciplinary team improves care of those diagnosed with Heart Failure above the standard approach?

    Addressed by an expert discussion paper, drafted by Martin Cowie

    Q21: Are there sub groups of Heart Failure patients that should be treated differently? (PDF, 98K)

    Addressed by systematic search and review

    * Q 22: What evidence is there that palliative care improves the care of patients with Heart Failure? When should a patient be referred to such care? (PDF, 53K)

    Addressed by an expert discussion paper, drafted by Louise Gibbs

    * Q23: At what stage is it appropriate to consider end of life issues for Heart Failure Patients? (PDF, 40K)

    Addressed by an expert discussion paper, drafted by Louise Gibbs

    * Q24: Under what circumstances should the optimal treatment of Heart Failure patients involve the work of non-NHS agencies? (PDF, 53K)

    Addressed by an expert discussion paper, drafted by Graham Archard and Rose Anne Kenny

    * Q25: What support groups help patients and families to cope with Heart Failure? (PDF, 41K)

    Addressed by an expert discussion paper, drafted by Derrick Masters

    Q26: Should patients with Heart Failure be given advice on nutrition to improve morbidity and mortality? (PDF, 41K)

    Addressed by systematic search and review

    * Q27: What advice should be given to Patients with, or at risk of, Heart Failure to promote prevention? (PDF, 41K)

    Addressed by an expert discussion paper, drafted by Martin Cowie

    Q28: Can monitoring of digoxin levels facilitate improved therapeutic care for individuals with HF (including acute decompensation)? (PDF, 54K)

    Addressed by systematic search and review

    Q29: Can domiciliary oxygen therapy be used to modify the outcome of heart failure in terms of quality of life, morbidity and mortality (including acute decompensation)? (PDF, 40K)

    Addressed by systematic search and review

    Q29: Can domiciliary oxygen therapy be used to modify the outcome of heart failure in terms of quality of life, morbidity and mortality (including acute decompensation)? (PDF, 54K)

    Addressed by systematic search and review

    Copyright © 2003, Royal College of Physicians of London.
    Cover of Chronic Heart Failure
    Chronic Heart Failure: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care.
    NICE Clinical Guidelines, No. 5.
    National Collaborating Centre for Chronic Conditions (UK).

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