Chronic heart failure: non-drug management

Exercise training

• improves symptoms, exercise capacity, and quality of life
• reduces hospitalisation; potential mortality benefit when part of a structured programme
• recommended in NICE guidance as part of a supervised rehabilitation programme

Cardiac resynchronisation therapy

• for patients with heart failure and wide QRS
• biventricular pacing (CRT-P or CRT-D)
• Indicated in patients with LVEF ≤35%, QRS ≥120 ms (especially LBBB), and persistent symptoms despite optimal medical therapy
• shown to improve symptoms, quality of life, reduce hospitalisation and mortality
• most benefit seen in NYHA class II–IV (ambulatory) patients

Implantable cardioverter-defibrillator (ICD)

• prevents sudden cardiac death in selected patients with HFrEF
• consider in patients with LVEF ≤35%, sinus rhythm, NYHA class II–III symptoms, and life expectancy >1 year
• may be used alone or in combination with CRT (CRT-D) based on individual risk profile