The U.K. National Institute for Health and Clinical Excellence (NICE) has published clinical guidelines for the diagnosis, treatment, and monitoring of chronic heart failure in adults in the August 16 issue of the Annals of Internal Medicine. These new guidelines update and make important changes compared with prior recommendations issued by NICE in 2003.
The document contains descriptions of the role of serum natriuretic peptide measurement, echocardiography, and specialist assessment in diagnosing heart failure. It makes recommendations for pharmacologic treatment, rehabilitation, and pacing therapy, as well as guidelines for the monitoring of patients. (Ann Intern Med, August 16, 2011, Vol. 155:4, pp. 252-259).
Patients with no history of myocardial infarction should undergo measurement of natriuretic peptide followed by an echocardiography examination only if natriuretic peptide levels are elevated. However, patients who have had a heart attack should have an echocardiography exam without having peptide levels measured, according to lead author Dr. Jonathan Mant, from the University of Cambridge's General Practice and Primary Care Research Unit.
Patients who are diagnosed by a specialist with heart failure with left ventricular systolic dysfunction should be treated with beta-blockers and angiotensin-converting enzyme (ACE) inhibitors or with aldosterone antagonists, angiotensin receptor blockers (ARBs), or combination therapy with nitrate and hydralazine. Mant and other committee participants also recommend that patients participate in supervised exercise programs.
While the NICE guidelines are broadly consistent with those of the European Society of Cardiology (ESC), they differ in that the NICE guidelines recommend selective use of echocardiography and measurement of serum natriuretic peptide levels. In contrast, the ESC diagnostic guidelines recommend that all patients with symptoms suggestive of heart failure have both diagnostic tests.
In 2010, NICE published an implementation document based on the newly issued guidelines that showed a net savings of 19,000 pounds (21,683 euros) per 100,000 persons if all of its recommendations were implemented.
