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NICE guidance on heart failure should not be lightly dismissed

Your story 'NICE heart failure advice outdated after two months' (News, September 15) referring to the results of the CHARM study on the role of angiotensin 2 antagonists (A2As) for the treatment of heart failure is not helpful to people with heart failure and those who treat them. The NICE guideline on chronic heart failure covers the whole spectrum of the management of that condition ­ not just the pharmacological aspect. To suggest that the advice is 'outdated' because of the findings of one study concerning a pharmacological intervention is simply not justified.

The CHARM study, although yielding important findings about the use of A2As in treating heart failure, is simply one piece of new evidence in a constantly changing evidence landscape. It is impossible to update this kind of guidance continually and clinicians need to exercise judgment in taking into account new evidence until NICE is able to support their decisions with an update to the original advice. Of course, in exceptional circumstances guidelines can be updated ahead of the planned schedule.

The guideline points out, (see p12) that A2As are not licensed in the UK for heart failure and judging by the statement from the manufacturer of the drug featured in the CHARM study that regulatory filings in the US and Europe are anticipated in the first quarter of 2004, this is unlikely to change in the very near future.

There is much to commend in this guideline, which has the potential to make substantial improvements in the quality and consistency of care for people with heart failure. It should not be so lightly dismissed.

Andrew Dillon

Chief Executive

National Institute for Clinical Excellence

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