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GPs buried under trusts' workload dump

NICE heart failure advice outdated after two months

The National Institute of Clinical Excellence heart failure guidelines are out of date just two months after their high-profile launch.

Professor Martin Cowie, clinical adviser on the NICE guidelines, said results of the landmark CHARM study, which was presented to the European Society of Cardiology earlier this month, had 'more than doubled' overnight the knowledge of the role of angiotensin 2 antagonists (A2As).

The study revealed A2As are more effective at cutting mortality in heart failure than the drugs recommended by NICE.

Professor Cowie admitted NICE may be forced into a fast-track overhaul of the advice to ensure GPs act to save more lives.

Another study presented to the society showed statins reduced death rates in chronic heart failure by 34-40 per cent compared with patients not taking the drugs. Study leader Professor Stefan Anker said this was the first evidence that treatment with statins predicted lower mortality.

Professor Cowie advised GPs to follow the new CHARM evidence above NICE guidelines. 'Instead of saying consider an A2A, doctors will be saying use this type of drug.'

He said the findings could lead to a fast-track review, originally not planned for another four years. Professor Cowie, professor of cardiology at the National Heart and Lung Institute in London, said: 'The challenge is now to ensure this new evidence is translated into practice as rapidly as possible.'

CHARM showed the A2A candesartan reduced cardiovascular deaths and hospital admissions by 23 per cent when used as an alternative to an ACE inhibitor and by a further 15 per cent when used with an ACE inhibitor.

Without this evidence the NICE guidelines had left the door open to consider drugs such as A2As only to patients intolerant of ACE inhibitors.

NICE said GPs should consider the new evidence when published and follow it if they felt it was 'sufficiently robust'.

Concern over the heart failure advice came as the World Health Organisation prepared this week to publish its inquiry into whether NICE's technology appraisal programe is 'scientifically robust'.

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