Around 3,000 deaths and 5,500 hospital
admissions in England caused by chronic heart failure could be
prevented each year following new NICE draft guidance on medical
treatment of the disease.
The draft guideline recommends
medicines be given up to a year earlier - helping people live
well for longer.
NICE is updating the recommendations
for drug treatments in its clinical guideline on the diagnosis
and management of chronic heart failure first published in 2018.
Clinical practice over the timing of drug treatments for a type
of heart failure called heart failure with a reduced ejection
fraction (HFrEF) is changing.
The four pillars of treatment:
angiotensin-converting enzyme inhibitor (ACEI), a beta-blocker
(BB), a mineralocorticoid receptor antagonist (MRA) and a
sodium-glucose cotransporter-2(SGLT2) inhibitor are being used
earlier on in the treatment pathway without the need to optimise
the dose of any one medicine before introducing
another.
NICE's updated recommendations reflect
this change in practice and in doing so they recommend an earlier
use of the SGLT2 inhibitors empagliflozin and
dapagliflozin than NICE has
recommended before. This means they can now be offered at the
start of the treatment pathway, instead of only when other
medicines have been fully titrated, a process that can take over
a year.
The guideline also recommends that
another type of medicine, an angiotensin receptor neprilysin
inhibitor (ARNI), be offered if a person can't tolerate an ACEI,
rather than only for people who are already taking a stable dose
of ACEI or ARB.
For both SGLT2 inhibitors and ARNIs
the draft guideline now says these can be started by GPs(with
advice from a heart failure specialist) rather than solely by a
heart failure specialist, potentially speeding up access to these
important treatments.
Eric Power, deputy director in
NICE's Centre for Guidelines,
said: “Heart
failure is common, with currently around 614,000 adults in
England living with a diagnosis. Although there's no cure, it is
treatable, and the growing number of people living with heart
failure is testament to the improvements in care introduced over
recent years.
“For this update we've been able to
review the emerging evidence quickly to keep pace with changes in
the treatment landscape and make recommendations that will widen
access to effective treatments. This should have a big impact on
the lives of people living with heart failureas well as freeing
up space in hospitals by reducing their risk of having to go to
hospital for unplanned emergency
treatment.”
HFrEF happens when the left side of the heart doesn't pump
blood out to the body as well as normal. It is
a chronic condition that affects
survival and quality of life.
Based on the Office for National
Statistics population and the NHS
Quality and Outcomes framework
2023-24 around
614,000 adults in England have heart failure. Of these, around
63%(387,000) adults are estimated to have heart failure with
reduced ejection fraction.
Ends
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The draft guideline is available
on the NICE website at: https://www.nice.org.uk/guidance/indevelopment/gid-ng10405/consultation/html-content-6
Anyone wishing to submit comments can do so via the
NICE website between 10 June and 8
July.
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The update is being undertaken as
part of NICE's focus on adopting a whole lifecycle approach
to developing and maintaining its guidance portfolio. This
reflects NICE's long-term ambition to create dynamic,
flexible resources for the NHS that increase overall
population health, identify the best treatments and
interventions as things change over time and maximise value
for the NHS.
