Tag Archives: NICE guidelines

NICE heart failure guidelines The latest National Institute for Health and Care Excellence (NICE) guidelines for management of chronic heart failure (NG 106)1 were presented by Dr Abdallah Al-Mohammed (Sheffield Teaching Hospitals). It was fascinating to hear Dr Al-Mohammed describe his work on producing the guidelines with respect to what recommendations the authors are permitted to include and how recommendations may be presented. Key changes include the removal of a history of a previous myocardial infarction from the initial assessment of a patient with suspected chronic heart failure. Other changes include the guidelines now using the te

While most of the recommendations in the new guideline remain unchanged, there are some key updates including the use of the new lipid modifying drugs- PCSK9 inhibitors (for which NICE technology appraisal guidance exists), treatment of children and recommendations to search medical records for those who may be at risk. The guideline also recommends that those at risk of FH should be offered DNA tests to confirm they have the condition. Previously, low-density lipoprotein cholesterol (LDL-C) levels have been used but they are not always accurate. At the moment only 15% of the estimated 260,000 people in the UK with FH have been diagnosed, inc

Drug therapies include anticoagulants to reduce the risk of stroke and anti-arrhythmics to restore/maintain the normal heart rhythm or slow the heart rate in patients who remain in AF. Non-pharmacological management options include electrical cardioversion, which may be used to ‘shock’ the heart back to its normal rhythm. The high risk of stroke associated with electrical cardioversion can be reduced by oral anticoagulation. Although effective in reducing the risk of thromboembolism, the limitations of warfarin present considerable challenges for its use in clinical practice. The challenges of maintaining warfarin within an appropriate th

Understanding the mechanisms of AF lies at the heart of its treatment. AF occurs when structural and/or electrophysiological abnormalities alter atrial tissue to promote abnormal impulse formation and/or propagation (figure 1).3 Multiple clinical risk factors, electrocardiographic/echocardiographic features and biochemical markers are associated with an increased risk of AF (table 1), and, AF can be described in terms of the duration of episodes using a simplified scheme (table 2).3 Figure 1. Mechanisms of atrial fibrillation Table 1. Risk factors3 The aim of treatment is to prevent stroke and alleviate symptoms.4 Drug therapies include antic

Introduction There are 2.3 million people living with coronary heart disease in the UK, which results in a healthcare burden of 1% of all GP and 40% of all accident and emergency (A&E) visits.1 It is estimated that 20–40% of the general population will experience chest pain during their life. Chest pain caused by coronary artery disease has a potentially poor prognosis, emphasising the importance of prompt and accurate diagnosis. Treatments are available to improve symptoms and prolong life, hence, the need for the development of the National Institute for Health and Care Excellence (NICE) guidelines for the diagnosis of chest pain.1 NI

Do the NICE guidelines for chest pain add up? Dear Sirs, The recent articles by Purvis and Hughes1 and Kelly et al.2 question the issued guidance from the National Institute of Health and Clinical Excellence (NICE) on the investigation of patients with recent onset chest pain.3 Purvis and Hughes focused on the investigation of patients in the low risk category for coronary artery disease (CAD), who under the NICE guidelines would be referred directly for computed tomography (CT) calcium scores (CTC) rather than exercise tolerance tests (ETTs), as is current practice in many hospitals. Their results were inconclusive, indicating that there may

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