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Toblli JE, Lombrana A, Duarte P, Di Gennaro F. Intravenous iron reduces NT-pro-brain natriuretic peptide in anemic patients with chronic heart failure and renal insufficiency. Journal of the American College of Cardiology. 2007; 50(17):1657-65 337. Townsend N, Bhatnagar P, Wilkins E. Cardiovascular disease statistics. London. 2015. Available from: https://www.bhf.org.uk/publications/statistics/cvd-stats-2015 338. Troughton RW, Frampton CM, Brunner-La Rocca HP, Pfisterer M, Eurlings LW, Erntell H et al. Effect of B-type natriuretic peptide-guided treatment of chronic heart failure on total Chronic Heart Failure Reference list NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 mortality and hospitalization: an individual patient meta-analysis. European Heart Journal. 339. Troughton RW, Frampton CM, Yandle TG, Espiner EA, Nicholls MG, Richards AM. Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide (N-BNP) 340. 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Relationship between serum brain natriuretic peptide and heart function in patients with chronic kidney disease. Korean Journal of Internal Medicine. 2008; 23(4):191-200 376. Zamanzadeh V, Valizadeh L, Howard AF, Jamshidi F. A supportive-educational intervention for heart failure patients in iran: the effect on self-care behaviours. Nursing Research and 377. Zannad F, Krum H, McMurray JJ, van Veldhuisen DJ, Swedberg K, Shi H et al. Eplerenone in patients with systolic heart failure and mild symptoms. New England Journal of Medicine. 378. Zannad F, McMurray JJ, Drexler H, Krum H, van Veldhuisen DJ, Swedberg K et al. Rationale and design of the Eplerenone in Mild Patients Hospitalization And SurvIval Study in Heart Failure (EMPHASIS-HF). European Journal of Heart Failure. 2010; 12(6):617-22 379. Zaphiriou A, Robb S, Murray-Thomas T, Mendez G, Fox K, McDonagh T et al. The diagnostic accuracy of plasma BNP and NT-proBNP in patients referred from primary care with Chronic Heart Failure Reference list NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 suspected heart failure: results of the UK natriuretic peptide study. European Journal of 380. Zuber M, Cuculi F, Attenhofer Jost CH, Kipfer P, Buser P, Seifert B et al. Value of brain natriuretic peptides in primary care patients with the clinical diagnosis of chronic heart failure. Scandinavian Cardiovascular Journal. 2009; 43(5):324-9 Chronic Heart Failure Acronyms and abbreviations NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 12 Acronyms and abbreviations Acronym or abbreviation Description 6MWT 6 Minute Walk Test ACA ACC/AHA American College of Cardiology/American Heart Assocation AE Adverse events ACE Angiotensin-converting enzyme ACE-I Angiotensin converting enzyme inhibitors ACS Acute Coronary Syndrome ADHF/AHF Acute decompensated heart failure/Acute heart failure ADMIRE-HF AdreView Myocardial Imaging for Risk Evaluation in Heart Failure AF Atrial fibrillation AKI Acute kidney injury AMCKD Anaemia management in people with chronic kidney disease AUC Area under the curve ARA Action research arm ARB Angiotensin II receptor blockers ARD Assessment Reference Date AROC Australasian Rehabilitation Outcomes Centre BB Beta-blocker BBL BEST Beta-Blocker Evaluation of Survival Trial BHF British Heart Foundation BMI Body Mass Index BMT Best medical therapy BNF British National Formulary BNP B-type natriuretic peptide BP Blood pressure CAD Coronary artery disease CAS Complex Adaptive System CABG Coronary artery bypass grafting CC Comparative cost CCA Cost-consequence analysis CCS CDR Clinical Decision Rule CE Cost effective CEA Cost effectiveness analysis CERQual Confidence in the Evidence from Reviews of Qualitative Research CG Control group CHF Chronic heart failure CI Confidence intervals CINAHL Cumulative Index of Nursing and Allied Health Literature Chronic Heart Failure Acronyms and abbreviations NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Acronym or abbreviation Description CKD Chronic kidney disease CM Cardiomyopathy cMRI Cardiac Magnetic Resonance Imaging COPD Chronic obstructive pulmonary disease CPET Cardiopulmonary exercise testing CR Cardiac rehabilitation CRT Cardiac resynchronisation therapy CUA Cost-utility analysis CV mortality Cardiovascular mortality CXR Chest X-ray DM Diabetes mellitus DRG Diagnosis-related group EBM Evidence based medicine ECHO Extension for Community Healthcare Outcomes EDTA Ethylene diamine tetraacetic acid EF Ejection fraction EGFR Estimated glomerular filtration rate EHO EIMA EME Efficacy and Mechanism Evaluation ELISA Enzyme-linked immunosorbent assay ESC European Society of Cardiology EQ-5D Euroqual (measurement of health outcomes) GC Guideline Committee GFS FCM Ferric carboxymaltose FDA Food and Drug Administration FG Focus group FN False negative FP False positive FVC Forced vital capacity GFR Glomerular filtration rate GRADE Grading of Recommendations Assessment, Development and Evaluation HBT Home-Based Tele-management HCAHPS Hospital Consumer Assessment of Healthcare Providers and Systems HCP Healthcare professional HDS Heart disease and stroke HMRS HeartMate II Risk Score HEED Health Economic Evaluations Database HF Heart failure HFPEF Heart failure with preserved ejection fraction HFREF Heart failure with reduced ejection fraction HLR Heart-to-lung ratio Chronic Heart Failure Acronyms and abbreviations NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Acronym or abbreviation Description HETG Home-based exercise training group HFMS Heart Failure Monitoring System HH Human to human interface HTA Health Technology Appraisal HTN Hypertension HR Hazard ratio HRQoL Heath-related quality of life ICD Implantable Cardioverter Defibrillators ICU Intensive care unit ICER Incremental cost-effectiveness ratio IG Interventions group IHD Ischemic heart disease IIM Intrathoracic impedance measurement IN-CHF Italian Heart Failure Registry INR International normalized ratio IPD Individual patient data IQR Interquartile range ISWT Incremental shuttle walk test ITT Intention-to-treat analysis IV Intravenous JVP Jugular venous pressure LTC Long term care LTOT Long term oxygen therapy LV Left ventricle LVAD Left Ventricular Assist Device LVER Left Ventricular Ejection Fraction LVSD Left ventricular systolic dysfunction LY Life year LYG Life years gained MAGGIC Meta-analysis Global Group in Chronic Heart Failure MD Medical devices MDRD Modification of Diet in Renal Disease Study MDT Multidisciplinary team MHRA Medicines and Healthcare products Regulatory Agency MI Myocardial infarction MIBG Meta-iodobenzylguanidine MICE Male, Infarction, Crepitations, Edema MID Minimal important differences Minnesota LWHFQ Minnesota Living With Heart Failure Questionnaire MLWHF Minnesota Living with Heart Failure MCS Mental component summary MRA Mineralocorticoid receptor antagonists MRC London Institute of Medical Sciences Chronic Heart Failure Acronyms and abbreviations NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Acronym or abbreviation Description NSAIDS Non-steroidal anti-inflammatory drugs NGC National Guideline Centre NHLBI National Heart, Lung and Blood Institute NHS EED NHS Economic Evaluation Database NICE National Institute for Health and Care Excellence NIHR National Institute for Health Research NIHSS National Institutes of Health Stroke Scale NMA Network meta-analysis NOT Nocturnal therapy NPT Normalisation Process Theory NP Natriuretic peptides including BNP and NT-proBNP NPV Negative predictive value NR Not reported NRS Numerical rating scale NS Not stated [in study paper] NT-proBNP N-terminus pro B type natriuretic peptide NYHA New York Heart Association Classification OECD Organisation for Economic Co-operation and Development ONS Office for National Statistics PCI Percutaneous coronary intervention PCP Primary care physicians PCS Physical component summary PDA Personal digital assistant PICO Population, intervention, comparison and outcome PND Paroxysmal nocturnal dyspnoea PPV Positive predictive value PROBAST Prediction study Risk of Bias Assessment Tool PSSRU Personal Social Services Research Unit pt People with chronic heart failure QALY Quality-adjusted life years QOL Quality of life QUADAS-2 Quality Assessment of Diagnostic Accuracy Studies version 2 RAS Renin-angiotensin-system RCT Random control trial RENAISSANCE Randomized Enbrel North American Strategy to Study Antagonism of Cytokines ROC Receiver operating characteristics RPE Rating of Perceived Exertion RR Relative risk/Risk ratio SA Sensitivity analysis SBP Systolic Blood Pressure SD Standard deviation SE Standard error Chronic Heart Failure Acronyms and abbreviations NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Acronym or abbreviation Description SETG Supervised exercise training group SHFM Seattle Heart Failure Model SHFM-D Seattle Heart Failure Model-D SMD Standard Mean Difference SPECT Single photon emission computed tomography STS Structured telephone support STS HH Structured telephone support via human to human interface SGA Subgroup analysis TIA Transient ischaemic attack TM Telemonitoring TN True negative TP True positive TSAT Transferrin saturations TTO Time trade off UHFO-IA Utrecht Heart Failure Organisation Initial Assessment VAS Visual analogue scale Acronym or abbreviation Description ABC In full ABC In full ABC In full Chronic Heart Failure Glossary NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 The NICE Glossary can be found at www.nice.org.uk/glossary. 13.1 Guideline-specific terms Term Definition Acute Coronary Syndrome Any group of clinical symptoms compatible with acute myocardial ischemia and includes unstable angina (UA), non ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). Acute decompensated heart failure/Acute heart failure Is a sudden worsening of the signs and symptoms of heart failure. See heart failure for symptoms. Symptoms include: breathlessness after activity or at rest, feeling tired most of the time and finding exercise exhausting, swollen ankles and legs. Some people also experience other symptoms, such as a persistent cough, a fast heart rate, and dizziness. Acute kidney injury Is sudden damage to the kidneys that causes them to not work properly. It can range from minor loss of kidney function to complete kidney failure. AKI normally happens as a complication of another serious illness. Angiotensin II receptor blockers Medications that block the action of angiotensin II by preventing angiotensin II from binding to angiotensin II receptors on the muscles surrounding blood vessels. As a result, blood vessels enlarge (dilate) and blood pressure is reduced. Atrial fibrillation A heart condition that causes an irregular and often abnormally fast heart rate. Beta-blockers Any of a class of drugs which prevent the stimulation of the adrenergic receptors responsible for increased cardiac action, used to control heart rhythm, treat angina, and reduce high blood pressure B-type natriuretic peptide A hormone produced by your heart. Both BNP and NT-proBNP are released in response to changes in pressure inside the heart. Cardiac resynchronisation therapy An implanted cardiac resynchronization device is a medical device used in cardiac resynchronization therapy (CRT). It resynchronizes the contractions of the heart's ventricles by sending tiny electrical impulses to the heart muscle, which can help the heart pump blood throughout the body more efficiently. Cardiopulmonary exercise testing Provides assessment of the integrative exercise responses involving the pulmonary, cardiovascular, haematopoietic, neuropsychological, and skeletal muscle systems, which are not adequately reflected through the measurement of individual organ system function. Cardiomyopathy Refers to diseases of the heart muscle. Chronic heart failure Heart failure progressively worsens over time. Chronic kidney disease A condition characterized by a gradual loss of kidney function over time Chronic obstructive pulmonary disease Is a type of obstructive lung disease characterized by long-term breathing problems and poor airflow. Coronary artery disease When a waxy substance called plaque builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart muscle Diabetes mellitus Type 1 diabetes mellitus occurs when the body cannot produce sufficient insulin to absorb blood sugar. Ejection fraction A measurement of the percentage of blood leaving your heart each time it contracts. Glomerular filtration rate A measure for level of kidney function to determine the stage of kidney Chronic Heart Failure Glossary NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Term Definition disease. Heart failure The heart is unable to pump blood around the body properly. It usually occurs because the heart has become too weak or stiff. Heart failure with preserved ejection fraction A form of congestive heart failure where in the amount of blood pumped from the heart's left ventricle with each beat (ejection fraction) is greater than 50%. HFREF The heart muscle is not able to contract adequately and, therefore, expels less oxygen-rich blood into the body Hypertension Also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. Implantable Cardioverter Defibrillators Small devices to treat abnormal heart rhythms Ischemic heart disease When arteries are narrowed, less blood and oxygen reaches the heart muscle. This is also called coronary artery disease and coronary heart disease. Jugular venous pressure Indirectly observed pressure over the venous system via visualization of the internal jugular vein. Myocardial infarction Commonly known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle. Natriuretic peptides The excretion of sodium by the kidneys. N-terminus pro B type natriuretic peptide A non-active prohormone that is released from the same molecule that produces BNP. See B-type natriuretic peptide Paroxysmal nocturnal dyspnoea Attacks of severe shortness of breath and coughing that generally occur at night. Percutaneous coronary intervention is a non-surgical procedure used to treat narrowing (stenosis) of the coronary arteries of the heart found in coronary artery disease. Systolic Blood Pressure The top number refers to the amount of pressure in your arteries during contraction of your heart muscle. Transferrin saturations The value of serum iron divided by the total iron-binding capacity. Transient ischaemic attack A temporary disruption in the blood supply to part of the brain. 13.2 General terms Term Definition Abstract Summary of a study, which may be published alone or as an introduction to a full scientific paper. Algorithm (in guidelines) A flow chart of the clinical decision pathway described in the guideline, where decision points are represented with boxes, linked with arrows. Allocation concealment The process used to prevent advance knowledge of group assignment in an RCT. The allocation process should be impervious to any influence by the individual making the allocation, by being administered by someone who is not responsible for recruiting participants. Applicability How well the results of a study or NICE evidence review can answer a clinical question or be applied to the population being considered. Arm (of a clinical study) Subsection of individuals within a study who receive one particular intervention, for example placebo arm. Association Statistical relationship between 2 or more events, characteristics or other variables. The relationship may or may not be causal. Chronic Heart Failure Glossary NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Term Definition Base case analysis In an economic evaluation, this is the main analysis based on the most plausible estimate of each input. In contrast, see Sensitivity analysis. Baseline The initial set of measurements at the beginning of a study (after run-in period where applicable), with which subsequent results are compared. Bayesian analysis A method of statistics, where a statistic is estimated by combining established information or belief (the prior ) with new evidence (the likelihood ) to give a revised estimate (the posterior ). Before-and-after study A study that investigates the effects of an intervention by measuring particular characteristics of a population both before and after taking the intervention, and assessing any change that occurs. Bias Influences on a study that can make the results look better or worse than they really are. (Bias can even make it look as if a treatment works when it does not.) Bias can occur by chance, deliberately or as a result of systematic errors in the design and execution of a study. It can also occur at different stages in the research process, for example, during the collection, analysis, interpretation, publication or review of research data. For examples see selection bias, performance bias, information bias, confounding factor, and publication bias. Blinding A way to prevent researchers, doctors and patients in a clinical trial from knowing which study group each patient is in so they cannot influence the results. The best way to do this is by sorting patients into study groups randomly. The purpose of blinding or masking is to protect against bias. A single-blinded study is one in which patients do not know which study group they are in (for example whether they are taking the experimental drug or a placebo). A double-blinded study is one in which neither patients nor the researchers and doctors know which study group the patients are in. A triple blind study is one in which neither the patients, clinicians or the people carrying out the statistical analysis know which treatment patients received. Carer (caregiver) Someone who looks after family, partners or friends in need of help because they are ill, frail or have a disability. Case control study A study to find out the cause(s) of a disease or condition. This is done by comparing a group of patients who have the disease or condition (cases) with a group of people who do not have it (controls) but who are otherwise as similar as possible (in characteristics thought to be unrelated to the causes of the disease or condition). This means the researcher can look for aspects of their lives that differ to see if they may cause the condition. For example, a group of people with lung cancer might be compared with a group of people the same age that do not have lung cancer. The researcher could compare how long both groups had been exposed to tobacco smoke. Such studies are retrospective because they look back in time from the outcome to the possible causes of a disease or condition. Case series Report of a number of cases of a given disease, usually covering the course of the disease and the response to treatment. There is no comparison (control) group of patients. Clinical efficacy The extent to which an intervention is active when studied under controlled research conditions. Clinical effectiveness How well a specific test or treatment works when used in the real world (for example, when used by a doctor with a patient at home), rather than in a carefully controlled clinical trial. Trials that assess clinical effectiveness are sometimes called management trials. Clinical effectiveness is not the same as efficacy. Chronic Heart Failure Glossary NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Term Definition Clinician A healthcare professional who provides patient care. For example, a doctor, nurse or physiotherapist. Cochrane Review The Cochrane Library consists of a regularly updated collection of evidence- based medicine databases including the Cochrane Database of Systematic Reviews (reviews of randomised controlled trials prepared by the Cochrane Collaboration). Cohort study A study with 2 or more groups of people cohorts with similar characteristics. One group receives a treatment, is exposed to a risk factor or has a particular symptom and the other group does not. The study follows their progress over time and records what happens. See also observational study. Comorbidity A disease or condition that someone has in addition to the health problem being studied or treated. Comparability Similarity of the groups in characteristics likely to affect the study results (such as health status or age). Concordance This is a recent term whose meaning has changed. It was initially applied to the consultation process in which doctor and patient agree therapeutic decisions that incorporate their respective views, but now includes patient support in medicine taking as well as prescribing communication. Concordance reflects social values but does not address medicine-taking and may not lead to improved adherence. Confidence interval (CI) There is always some uncertainty in research. This is because a small group of patients is studied to predict the effects of a treatment on the wider population. The confidence interval is a way of expressing how certain we are about the findings from a study, using statistics. It gives a range of results that is likely to include the true value for the population. The CI is usually stated as 95% CI , which means that the range of values has a 95 in a 100 chance of including the true value. For example, a study may state that based on our sample findings, we are 95% certain that the true population blood pressure is not higher than 150 and not lower than 110 . In such a case the 95% CI would be 110 to 150. A wide confidence interval indicates a lack of certainty about the true effect of the test or treatment often because a small group of patients has been studied. A narrow confidence interval indicates a more precise estimate (for example, if a large number of patients have been studied). Confounding factor Something that influences a study and can result in misleading findings if it is not understood or appropriately dealt with. For example, a study of heart disease may look at a group of people that exercises regularly and a group that does not exercise. If the ages of the people in the 2 groups are different, then any difference in heart disease rates between the 2 groups could be because of age rather than exercise. Therefore age is a confounding factor. Consensus methods Techniques used to reach agreement on a particular issue. Consensus methods may be used to develop NICE guidance if there is not enough good quality research evidence to give a clear answer to a question. Formal consensus methods include Delphi and nominal group techniques. Control group A group of people in a study who do not receive the treatment or test being studied. Instead, they may receive the standard treatment (sometimes called usual care ) or a dummy treatment (placebo). The results for the control group are compared with those for a group receiving the treatment being tested. The aim is to check for any differences. Ideally, the people in the control group should be as similar as possible to those in the treatment group, to make it as easy as possible to detect any Chronic Heart Failure Glossary NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Term Definition effects due to the treatment. Cost benefit analysis (CBA) Cost benefit analysis is one of the tools used to carry out an economic evaluation. The costs and benefits are measured using the same monetary units (for example, pounds sterling) to see whether the benefits exceed the costs. Cost consequences analysis (CCA) Cost consequences analysis is one of the tools used to carry out an economic evaluation. This compares the costs (such as treatment and hospital care) and the consequences (such as health outcomes) of a test or treatment with a suitable alternative. Unlike cost benefit analysis or cost- effectiveness analysis, it does not attempt to summarise outcomes in a single measure (like the quality-adjusted life year) or in financial terms. Instead, outcomes are shown in their natural units (some of which may be monetary) and it is left to decision-makers to determine whether, overall, the treatment is worth carrying out. Cost-effectiveness analysis (CEA) Cost-effectiveness analysis is one of the tools used to carry out an economic evaluation. The benefits are expressed in non-monetary terms related to health, such as symptom-free days, heart attacks avoided, deaths avoided or life years gained (that is, the number of years by which life is extended as a result of the intervention). Cost-effectiveness model An explicit mathematical framework, which is used to represent clinical decision problems and incorporate evidence from a variety of sources in order to estimate the costs and health outcomes. Cost utility analysis (CUA) Cost utility analysis is one of the tools used to carry out an economic evaluation. The benefits are assessed in terms of both quality and duration of life, and expressed as quality-adjusted life years (QALYs). See also utility. Credible interval (CrI) The Bayesian equivalent of a confidence interval. Decision analysis An explicit quantitative approach to decision-making under uncertainty, based on evidence from research. This evidence is translated into probabilities, and then into diagrams or decision trees which direct the clinician through a succession of possible scenarios, actions and outcomes. Deterministic analysis In economic evaluation, this is an analysis that uses a point estimate for each input. In contrast, see Probabilistic analysis Diagnostic odds ratio The diagnostic odds ratio is a measure of the effectiveness of a diagnostic test. It is defined as the ratio of the odds of the test being positive if the subject has a disease relative to the odds of the test being positive if the subject does not have the disease. Discounting Costs and perhaps benefits incurred today have a higher value than costs and benefits occurring in the future. Discounting health benefits reflects individual preference for benefits to be experienced in the present rather than the future. Discounting costs reflects individual preference for costs to be experienced in the future rather than the present. Disutility The loss of quality of life associated with having a disease or condition. See Utility Dominance A health economics term. When comparing tests or treatments, an option that is both less effective and costs more is said to be dominated by the alternative. Drop-out A participant who withdraws from a trial before the end. Economic evaluation An economic evaluation is used to assess the cost effectiveness of healthcare interventions (that is, to compare the costs and benefits of a healthcare intervention to assess whether it is worth doing). The aim of an economic evaluation is to maximise the level of benefits health effects relative to the resources available. It should be used to inform and support Chronic Heart Failure Glossary NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Term Definition the decision-making process; it is not supposed to replace the judgement of healthcare professionals. There are several types of economic evaluation: cost benefit analysis, cost consequences analysis, cost-effectiveness analysis, cost-minimisation analysis and cost utility analysis. They use similar methods to define and evaluate costs, but differ in the way they estimate the benefits of a particular drug, programme or intervention. Effect (as in effect measure, treatment effect, estimate of effect, effect size) A measure that shows the magnitude of the outcome in one group compared with that in a control group. For example, if the absolute risk reduction is shown to be 5% and it is the outcome of interest, the effect size is 5%. 