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Heart failure guidance backs routine ARB use

By Nigel Praities

ARBs have been given a place in the routine treatment of heart failure for the first time, following new guidance issued by the National Prescribing Centre.

Recent trial data supports use of ARBs in patients with severe heart failure, the centre's MeRec bulletin says.

The advice overturns current guidance from NICE that ARBs should only be used in heart failure patients intolerant to ACE inhibitors. NICE is expected to include the revision in the next version of its guidance, which is currently under review.

The NPC says ARBs are a viable alternative to spironolactone in heart failure patients who are still symptomatic after optimised ACE inhibitor and beta-blocker treatment, but GPs should seek specialist advice.

The new recommendation is backed by recently released data from the CHARM-Added trial, which show a significant reduction in cardiovascular deaths or hospital admissions for heart failure with ARBs compared with placebo.

Dr Neil Maskrey, medical director of the National Prescribing Centre, said recent ‘good quality' randomised trial data supported the use of ARBs in heart failure.

‘SIGN currently recommends the addition of candesartan as an option in these circumstances and with specialist advice. No doubt NICE will be considering this approach in guidance that is currently under way,' he said.

Dr Christopher Arden, a cardiology GPSI who runs a heart failure clinic in Southampton, said he preferred to use ARBs fourth-line. ‘Personally, I would use spironolactone first and then add in an ARB. GPs should not be doing this routinely, it should be done with help from a specialist clinic,' he said.

Dr Neil Maskrey of the National Prescribing Centre said recent data supported the use of ARBs in heart failure. Dr Neil Maskrey

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