Periodic review of chronic HF for symptoms, fluid status, GDMT optimisation.
History taking
- • NYHA class, weight log, orthopnoea, PND
- • Adherence, ICD checks, vaccinations
Examination
- • JVP, oedema, lung bases, S3
Red flags
- • Haemodynamic instability
- • Rapid deterioration
- • Severe pain or new neurological deficit
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • NT-proBNP, U&E, eGFR, weight, BP
- • ECG, echo if change
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Treat underlying cause
- • Symptomatic relief
- • Patient education
Drug therapy
- • HFrEF four pillars: ACEi/ARB/ARNI + β-blocker + MRA + SGLT2i
- • Loop diuretic for congestion
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Daily weight, salt <5 g/day, fluid 1.5–2 L
- • Avoid NSAIDs
Referral criteria
- • Refer if diagnostic uncertainty, complications, or failure of first-line therapy
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
