Richtlijn 'Chronisch hartfalen'

- A new Dutch clinical practice guideline has been developed for the diagnosis, treatment and supportive care of patients with chronic heart failure. This has been formulated by a multidisciplinary working group, set up by the Netherlands Heart Foundation and the Netherlands Society of Cardiology, in cooperation with the Dutch Institute for Healthcare Improvement. - Heart failure is defined as: 'a complex of complaints and symptoms resulting from an inadequate pumping function of the heart'. - Indications for heart failure are dyspnoea on exertion, reduced exertion tolerance and oedema. - By using data from the medical history, case history, physical examination and simple additional tests (laboratory tests, ECG, chest X-ray photos) it is possible to demonstrate or exclude heart failure in clear-cut cases. Doppler ultrasonography should be performed in all patients where heart failure is suspected but cannot be clearly demonstrated. - The initial treatment for patients with heart failure with reduced systolic LV function generally consists of the administration of a thiazide or loop diuretic together with an angiotensin-converting enzyme inhibitor anda a β-blocker, to which digoxin and/or spironolactone may be added. - For very old patients extra attention should be given to the comorbidity and the medication and dosing scheme should be as simple as possible. - The worse the cardiac function, the more the salt and fluid intake should be limited and the more strictly the weight should be monitored.