Updated advice on heart devices from NICE

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In final draft guidance, the National Institute for Health and Care Excellence (NICE) has clearly defined which heart devices – implantable cardiac devices – are the most clinically and cost effective. The fresh guidance will help people with a variety of heart conditions including those with an irregular heartbeat (arrhythmia). Arrhythmia causes four out of five deaths from sudden heart attack in England and Wales.

The draft guidance is an update of two existing pieces of NICE Guidance:
• NICE guidance on the use of implantable cardioverter defibrillators (ICDs) in people who have arrhythmias in the lower chambers of the heart (ventricular arrhythmias).
• NICE guidance on cardiac resynchronisation therapy for people with heart failure.

Only the recommendations about the use of the different implantable cardiac devices for people at risk of sudden cardiac death because of heart failure have been updated in this draft guidance. There was no new evidence on the use of ICDs for people who have survived an episode of ventricular tachycardia or ventricular fibrillation, for people with specific inherited cardiac conditions who have a high risk of sudden death or who have undergone surgical repair of congenital heart disease.

Professor Carole Longson, NICE Health Technology Evaluation Centre director, says: “Heart problems, particularly of the severity covered by this guidance where there is a high risk of sudden death caused by irregular heartbeats, kills or injures tens of thousands of people each year.

“There are drugs that can prevent arrhythmias but they are often not effective, can have unpleasant side-effects and sometimes need frequent dose adjustments which can be demanding for patients and lead to missed doses, taking the wrong dose or overdose.

“Heart devices can be used to treat and prevent potentially life threatening arrhythmias and heart failure.

“This draft guidance defines which of the different implantable cardiac devices is a clinically and cost effective treatment option for people who are at risk of sudden cardiac death because of left ventricular dysfunction.”

The draft guidance is now with consultees, who have the opportunity to appeal against it. Until NICE issues final guidance, National Health Service (NHS) bodies should make decisions locally on the funding of specific treatments.

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