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Heart failure guidelines recommend ACE inhibitors

Published on 31/10/03 at 10:57am

ACE inhibitors have been recommended as first line treatment for chronic heart failure as part of a comprehensive set of NICE guidelines for diagnosing and treating the disease.

The condition is a complex syndrome and is frequently undiagnosed, and was dubbed the 'Cinderella' of heart disease by heart czar Roger Boyle because of the lack of resources dedicated to its identification and treatment.

Approximately 900 000 people in the UK have heart failure, with almost the same number with damaged hearts but as yet no symptoms of heart failure.

ACE inhibitors have long been recommended as first line treatment for patients with asymptomatic left ventricular dysfunction or symptomatic heart failure, but some doctors continue to prescribe digoxin, which does not reduce mortality rates as ACE inhibitors have been proven to.

The NICE guidance is the first to be produced by the National Collaborating Centre for Chronic Conditions, and is also the first to include advice for patients about how they can help themselves.

Dr Mike Pearson, director of the Collaborating Centre for Chronic Conditions said:

"The guideline compiles the latest clinical and economic evidence, the views of people with heart failure, and expert consensus to provide up-to-date recommendations for the NHS".

He added: "Heart Failure is common and is treatable and this guideline sets out how to do just that. The guideline challenges some previously accepted habits, recommending for example using ACE inhibitor drugs as the first line in the expectation that this will prolong life for many. We hope these guidelines will be adopted nationwide so that people with heart failure will benefit".

The guidance contains an algorithm for the drug treatment of the condition, covering diuretics, ACE inhibitors, beta-blockers and spironolactone. The guidance only recommends angiotensin II receptor antagonists if ACE inhibitors are not tolerated because of a severe cough.

In a dedicated 'Lifestyle' section in the guidance specifically for patients, NICE recommends regular exercise, and says GPs will advise quitting smoking and drinking and changes to diet where necessary.

Heart failure accounts for a total of 1 million inpatient bed days 2% of all NHS inpatient bed-days and 5% of all emergency medical admissions to hospital. The NICE guidance is expected to increase NHS spending on the disease, but could save money overall from a reduction in hospital treatment.

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