Atrial fibrillation
The National Institute for Health and Care Excellence (NICE) has said that thousands of people with atrial fibrillation (AF) could be prevented from having strokes, disability or death if its new guidance is followed. It says many patients with AF are not being appropriately anticoagulated and highlights how there has not been widespread uptake of novel oral anticoagulant drugs (NOACs) which were approved by NICE in 2012.
Clinical guideline 180 published in June 2014 updates and replaces the 2006 NICE clinical guideline 36. The full guidance can be found at http://www.nice.org.uk/guidance/CG180
NICE Chair, Professor David Haslam writes on the new guidance in this issue (pages 89–90).
Lipid modification
Up to 8,000 lives could be saved every three years by offering statins to anyone with a 10% risk of developing cardiovascular disease (CVD) within a decade, according to NICE.
In an update to its 2006 guidance on lipid modification, NICE recommends that the threshold for starting preventative treatment for CVD should be halved from a 20% risk of developing CVD over 10 years to a 10% risk. Up to 4.5 million people could be eligible for statins under the lower threshold. Offering statins to all eligible people could prevent up to 28,000 heart attacks and 16,000 strokes each year.
The new clinical guideline (CG 181 published July 2014) ‘Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of CVD’ updates and replaces the 2008 NICE clinical guideline 67 and the 2006 NICE technology appraisal guidance 94. It includes new and updated recommendations on risk assessment, lifestyle modifications and the use of lipid-lowering drugs.
Key recommendations in the new guidance include:
• Identifying and assessing CVD risk using the QRISK2 assessment tool for the primary prevention of CVD in people up to the age of 84 years
• Prioritising people for a full formal risk assessment if their estimated 10-year risk of CVD is 10% or more.
• Taking a full lipid profile before starting lipid modification therapy for primary prevention. A fasting sample is not needed.
NICE notes that not everyone with a 10% or greater risk of CVD within 10 years will need to take a statin and the guideline advises that preventative lifestyle measures are adopted first.
The full guidance can be found at http://www.nice.org.uk/guidance/CG181/
Weight management services
Guidance on effective multi-component lifestyle management services for adults who are obese or overweight has been published by NICE (public health guideline 53).
It covers weight management programmes, courses, clubs or groups that aim to change someone’s behaviour to reduce their energy intake and encourage them to be physically active. The focus is on lifestyle weight management programmes that:
• accept self-referrals or referrals from health or social care practitioners
• are provided by the public, private or voluntary sector
• are based in the community, workplaces, primary care or online.
The guideline replaces section 1.1.7 of the 2006 NICE clinical guideline on obesity. Full details of the new guideline can be found on http://www.nice.org.uk/guidance/PH53
The guideline has been welcomed by the Royal College of Physicians (RCP). “Approximately 25% of the UK population is obese and the majority of Britain is expected to be obese by 2050. The NHS plays a key role in reducing obesity,” said RCP President Sir Richard Thompson.
Prasugrel and ACS
Prasugrel has been recommended by NICE as a possible treatment for adults with acute coronary syndrome (ACS) who are having percutaneous coronary intervention (PCI). NICE TA37 is a review of its 2009 guidance and makes prasugrel available for adults with ACS with unstable angina or non-ST-segment elevation myocardial infarction undergoing PCI. The full guidance is available on http://www.nice.org.uk/guidanceTA317.
