NICE updates chronic heart failure guidance

The UK's National Institute for Health and Clinical Excellence (NICE) has published draft recommendations on the management of chronic heart failure in adults. The document is available for public consultation and feedback until March 10, 2010.

This document is an update to NICE's original guidance, which was published in 2003. Since publication, new evidence from various trials in diagnosis, treatment and monitoring of patients with chronic heart failure has become available. By publishing this partial update, NICE will ensure this new evidence is included in the recommendations.

The draft guidance includes recommendations that:
· Patients with suspected heart failure and very high levels of serum natriuretic peptides should be referred for urgent cardiography and specialist assessment within two weeks
· Patients with suspected heart failure and previous myocardial infarction (MI) should be referred urgently and receive cardiography and specialist assessment within two weeks
· All patients with heart failure due to left ventricular systolic dysfunction to be offered both angiotensin converting enzyme (ACE) inhibitors and beta- blockers licensed for heart failure
· Black patients who remain symptomatic with ACE inhibitors and beta-blockers to be offered isosorbide/hydralazine.

Coronary artery disease is the most common cause of heart failure in the UK, with many patients having suffered a myocardial infarction (heart attack) in the past.

Dr Fergus Macbeth, director, Centre for Clinical Practice at NICE said: "The prevalence of heart failure is expected to rise in the future as more people live longer generally, people survive longer with coronary artery disease and there are better treatments for heart failure. Currently some 900,000 people in the UK have had a diagnosis of heart failure, with almost as many again who may have damaged hearts but as yet no symptoms.

"It's clearly very important that clinicians working in this area have a guideline that is based on the most up-to-date evidence of what works best. This new draft guideline outlines a comprehensive approach to the management of heart failure, and ultimately seeks to improve the length and quality of life of people with the condition."