Heart Failure: Non-Drug Management

Key points

• Cardiac resynchronisation therapy (biventricular pacing) for heart failure with a wide QRS.
• CRT improves symptoms and reduces hospitalisation, particularly in NYHA class III.
• Exercise training/cardiac rehabilitation improves symptoms (but not hospitalisation or mortality).
• An implantable cardioverter-defibrillator (ICD) is considered for those at high risk of sudden death (e.g. LVEF 35% or less despite optimal therapy); a CRT-D combines both.
• Also: salt/fluid advice, annual influenza and pneumococcal vaccination, treat reversible causes; consider revascularisation or valve surgery, and transplantation/LVAD in advanced disease.

Decision points in this pathway

• Wide QRS complex?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.