New Guidance on Heart Failure and Other NICE Decisions

Peter Russell

September 14, 2018

The National Institute for Health and Care Excellence (NICE) issued guidance this week on the diagnosis, treatment, and aftercare of adult patients with chronic heart failure.

One multiple sclerosis (MS) charity called NICE's decision not to recommend ocrelizumab for people with primary progressive MS "disappointing".

Other areas covered this week included serious eye disorders, child abuse, and suicide prevention.

Chronic Heart Failure

Final published guidance for assessing, diagnosing, and managing chronic heart failure in adults was published this week.

The new guideline included recommendations on the composition and role of the specialist heart failure multi-disciplinary team (MDT). It said that the primary care team working with the specialist heart failure MDT should take over routine management of heart failure as soon as it has been stabilised and its management optimised.

The updated guideline now recommends measuring levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the blood rather than B-type natriuretic peptide (BNP). NICE said the NT-proBNP test was more accurate and better suited to primary care.

Also, patients newly diagnosed with heart failure should be offered an extended first consultation, followed by a second consultation within 2 weeks wherever possible.

It also recommended that people with chronic heart failure should be given a detailed care plan.

The guideline said that people whose condition was stable should be offered a personalised, exercise-based cardiac rehabilitation programme at home or in an easily accessible location, not necessarily in a group setting.

Ocrelizumab for MS

In draft guidance, NICE rejected ocrelizumab (Ocrevus, Roche) for treating early primary progressive multiple sclerosis (MS) with imaging features characteristic of inflammatory activity in adults.

It said clinical trial results show that ocrelizumab can slow the worsening of disability in people with the condition. However, the size and duration of this effect were uncertain and approval for the drug could not be justified on cost-effectiveness grounds, it said.

Genevieve Edwards, director of external affairs at the MS Society, commented: "This is a deeply disappointing decision, denying many desperate people access to a treatment which may slow down their disability progression."

Final guidance is expected later this year.

Nivolumab for Melanoma

Nivolumab (Opdivo, Bristol-Myers Squibb) was not recommended in draft guidance for the adjuvant treatment of completely resected melanoma in adults with lymph node involvement or metastatic disease.

An appraisal consultation document said there was uncertainty about the drug's clinical effectiveness.

The committee said that nivolumab could not be recommended for England's Cancer Drugs Fund because it was not possible to assess its cost-effectiveness.

In 2015 there were around 15,906 new cases of melanoma. Five-year survival estimates are approximately 50-55% for stage III disease and 8-24% for stage IV disease.

The appraisal is open for public consultation until September 28 2018.

Serious Eye Disorders

NICE produced a draft quality standard on the diagnosis and management of cataracts, glaucoma, and age-related macular degeneration (AMD).

Among the new recommendations:

  • Adults with cataracts should not be refused surgery based on visual acuity alone

  • Adults with late AMD (wet active) should start treatment within 14 days of referral to the macular service

  • Adults with late AMD (wet active) have ongoing monitoring for both eyes

Final guidance is expected in February 2019.

Neuropad Test for Diabetic Foot Neuropathy

A 'sticking plaster' test, Neuropad, designed to detect signs of diabetic foot neuropathy was rejected for routine NHS use in England and Wales.

Neuropad can detect sub-normal sweating in patients with diabetes and display the results with a blue/pink colour coding after 10 minutes.

In final guidance, NICE said there was limited evidence on its clinical effectiveness.

Suicide Prevention

In 2016, almost 6000 people in the UK took their own lives. People in certain groups are known to be more at risk. These include:

  • Men aged 35 to 49

  • People in prison, police custody or young offender institutions

  • People who misuse drugs or alcohol

  • Family and friends of those who have died

NICE has issued final guidance on helping the NHS, social care, local authorities, emergency services, criminal justice, and other services to work together on ways to spot people most at risk.

It also calls for training for those most likely to come into contact with people likely to contemplate suicide to spot suicidal tendencies and for the erection of barriers on bridges or cliffs where people may be most likely to attempt suicide.

Child Abuse and Neglect

Children and young people talking about abuse or neglect should have their experiences recorded in their own words, NICE said in a draft quality statement. They should also be able to receive support from a consistent group of staff, it said.

A consultation on the issue is being held until October 8 prior to a final version on child abuse and neglect being published in February 2019.

School-Based Interventions

A draft quality standard covering interventions in primary and secondary education has been issued for consultation.

It is intended to support the delivery of a whole-school approach, which extends beyond learning and teaching, for promoting health and mental wellbeing throughout children and young people's primary and secondary education.

The consultation process runs until October 9, with a final quality standard scheduled for February 2019.


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