Tag Archives: NICE guidance

Mike is a Professor of Medicine at Harvard Medical School, and an interventional cardiologist at the Beth Israel Deaconess in Boston, USA. He is the founder and director of the academic research organization PERFUSE and has been principal investigator or has led core services for over 120 clinical trials, the results of which have been published in leading journals. Mike is also an active user of Twitter (@CMichaelGibson). Amar is a Consultant in Diabetes and Endocrinology at the Good Hope Hospital, Sutton Coldfield, West Midlands. A regular contributor to the journal, Amar has previously been very active in the Young Diabetologists and Endoc

Introduction Invasive coronary angiography (ICA) remains the cornerstone of diagnosis and treatment of patients with a high likelihood of coronary artery disease (CAD), or those with significant or unstable chest pain symptoms. However, there is always a concern that we overutilise ICA and this exposes patients to a small risk.1 Furthermore, ICA is an expensive procedure and overuse of diagnostic ICA can compete with percutaneous coronary intervention (PCI) and device implantations in hospitals with a single catheter lab. The National Institute of Health and Care Excellence (NICE) 2010 guidelines on stable chest pain, recommended that patien

This change followed approaches to Sir Andrew Dillon by the widow of a patient with a replacement aortic valve who died from infective endocarditis (IE) developing after unprotected dental scaling. Her case included: evidence that antibiotic prophylaxis is effective in people at high risk of IE having high-risk dental procedures;3 the observation that the incidence of IE in the UK has accelerated above the global background rise since the original 2008 NICE guidance;4 a change in the law on consent.5-7  It is now necessary for dentists to appraise their patient of the differences between NICE and other guidelines, if it is likely that they

We read with interest Diana Gorog’s recent article on the uptake of non-vitamin K oral anticoagulants (NOACS) in the UK.1 She drew attention to the slow uptake of these agents in the UK as opposed to many countries in Europe, and certainly the USA, and to the role that local medicines management committees (MMCs) may play in this. While the National Institute for Health and Care Excellence (NICE) guidance regarding all three NOACs available in the UK (apixaban, dabigatran and rivaroxaban) is that they should be available as an option for stroke prevention in non-valvular atrial fibrillation (AF), many MMCs in the UK have sought to control p

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We believe that the new guideline2 will be a major advance in stroke prevention in AF. We would suggest that Professor Brady and colleagues, in their focus on non-vitamin K oral anticoagulants (NOACs), have overlooked the importance of a number of crucial aspects of the guideline. It represents a paradigm change in stroke management. The GDG were very keen to promote the concept that, whereas previously risk assessment was undertaken to define patients at high risk of stroke requiring anticoagulation, under the new guideline anticoagulation has become the norm for all but the lowest-risk patients. It represents a considerable simplification

Professor Stephen Westaby NICE’s medical therapy is excellent, until the end game, but drugs alone have limitations.5 Inotropes worsen ischaemia, while vasopressors elevate afterload. Injured myocardium needs rest to promote recovery, not a flogging.6 Consider two real patients. A 21-year-old female with ion-channelopathy is admitted to a tertiary care centre. After 75 DC shocks and cardiac massage she is in shock. She needs extracorporeal membrane oxygenation (ECMO) circulatory support but cannot be transferred.6 She dies. A 56-year-old male with ischaemic cardiomyopathy suffers acute on chronic heart failure. Renal impairment and pulmonar

Latest NICE guidance Acute heart failure New guidance on acute heart failure has been published by the National Institute for Health and Care Excellence (NICE). The new clinical guideline (CG187) covers the diagnosis and management of acute heart failure in adults that are not addressed by the NICE guideline on chronic heart failure (CG108). It recommends all hospitals admitting people with suspected acute heart failure should provide a specialist heart failure team based on a cardiology ward and provides outreach services. It includes the following key clinical areas: the role of early natriuretic peptide testing and echocardiography the ro

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 NICE guidance Dr Andrew Cox (St George’s, University of London) Stroke prevention is the major focus of the new National Institute of Health and Care Excellence (NICE) guidelines on atrial fibrillation (AF), which were discussed by Dr Campbell Cowan (Chair, NICE Guidelines Development Group) in one ‘Hot topics’ session at the meeting. This presentation was in anticipation of the release of the final version of the guidelines a fortnight following the conference. This limited discussion covered the already published draft guidance, but points from this draft which were discussed have since been confirmed in the published guidance