Dronedarone included in new appraisal consultation document
An independent Appraisal Committee has revised NICE’s original recommendation that dronedarone should not be used to treat atrial fibrillation (AF) after considering comments received at public consultation on the previous draft guidance. Recent draft guidance published on 30th March recommends the limited use of the drug as a second-line treatment in people with additional cardiovascular risk factors whose AF has not been controlled by first-line therapy (usually including beta blockers).
The guidance states: “Although the committee did not change their conclusion that dronedarone is not as effective as other anti-arrhythmic drugs in preventing the recurrence of AF, it accepted evidence that the drug did not lead to an increase in the risk of mortality, unlike the anti-arrhythmics with which it was compared. The Appraisal Committee also noted comments from patients and clinical experts received during consultation on the previous draft that all current anti-arrhythmic drugs, but particularly amiodarone, had side effects which had a significant impact on quality of life with long term use. Overall, the Committee concluded that dronedarone was likely to result in fewer adverse effects than amiodarone”.
NICE recommends that until it issues final guidance, NHS bodies should make decisions locally on the funding of specific treatments.
Framingham no longer superior risk assessment tool in lipid modification guideline
The National Institute for Health and Clinical Excellence (NICE) has announced that it is withdrawing advice in its in lipid modification guideline to use the Framingham risk assessment tool for cardiovascular risk assessment, saying that it is not clear that it is superior to other tools. Healthcare professionals will now instead decide which risk assessment tool is most suitable for their needs.
NICE says it was aware when the guideline was published in May 2008 that the evidence on cardiovascular risk estimation was developing rapidly, and so recommended that further research was needed on how best to estimate cardiovascular disease risk. After the publication in 2009 of more evidence comparing the QRISK tool with other risk estimation tools, it has now been decided that there is insufficient evidence to allow for a clear decision in recommending one cardiovascular risk estimation method over another.