People with heart failure should no longer be offered cardiac rehabilitation programmes that are group-based, according to the National Institute for Health and Care Excellence.
Instead, NICE said that patients whose condition is stable should be offered a personalised, exercise-based cardiac rehabilitation programme in a format and setting that is easily accessible for them.
This might be at home, in the community or in a hospital, according to updated guidance published this week by the institute.
The NICE guidance covers diagnosing and managing chronic heart failure in people aged 18 and over. The aim is to improve diagnosis and treatment so as to increase the length and quality of life for people with heart failure.
The new guidance includes recommendations on the composition and role of the specialist heart failure multi-disciplinary team (MDT).
The MDT should always include a specialist heart failure nurse, as well as a lead physician and a healthcare professional with expertise in specialist prescribing for heart failure, according to NICE.
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The guidance said that the primary care team working with the MDT should take over routine management of heart failure as soon as it has been stabilised and its management optimised.
People newly diagnosed with heart failure should be offered an extended first consultation, followed by a second consultation within two weeks if possible.
It also recommended that people with chronic heart failure should be given a detailed care plan. This should include plans for follow-up care, rehabilitation and access to social care.
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It should also contain symptoms to look out for in case of deterioration, contact details for a named healthcare co-ordinator – usually a specialist heart failure nurse – and alternative local heart failure specialist care providers, for urgent care or review.
The update guideline now recommends measuring levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the blood rather than B-type natriuretic peptide (BNP).
This is because it is more accurate for diagnosing chronic heart failure and, unlike with BNP testing, the blood sample doesn’t need to be analysed within hours of being taken and so is better suited for primary care.