Section 7 of the National Institute for Health and Care Excellence (Constitution and Functions) and the Health and Social Care Information Centre (Functions) Regulations 2013 requires integrated care boards, NHS England and, with respect to their public health functions, local authorities to comply with the recommendations in this evaluation within 3 months of its date of publication.
The Welsh ministers have issued directions to the NHS in Wales on implementing NICE technology appraisal guidance. When a NICE technology appraisal guidance recommends the use of a drug or treatment, or other technology, the NHS in Wales must usually provide funding and resources for it within 2 months of the first publication of the
When NICE recommends a treatment 'as an option', the NHS must make sure it is available within the period set out in the paragraphs above. This means that, if a patient has acute coronary syndromes and the healthcare professional responsible for their care thinks that glycoprotein (GP) IIb or IIIa inhibitors is the right treatment, they should be available for use, in line with NICE's recommendations.
All clinicians who treat people with an acute coronary syndrome (ACS) should review their current policies and practice in line with the guidance set out in section 1.
Local guidelines or care pathways, particularly those on the management of patients with unstable angina or myocardial infarction (MI), should incorporate the guidance in section 1.
To measure compliance locally with the guidance, the following criteria could be used. Further details of suggestions for audit are in section 10.
The following groups of patients receive an intravenous small-molecule GP IIb/IIIa inhibitor (eptifibatide or tirofiban) as part of their initial medical management (together with aspirin and unfractionated heparin):
patients with unstable angina who are at high risk of subsequent MI or death
patients with NSTEMI who are at high risk of subsequent MI or death.
Patients who are at high risk and for whom percutaneous coronary intervention (PCI) is recommended but delayed beyond the initial medical management phase receive a GP IIb/IIIa inhibitor (abciximab) as an adjunct to PCI.
A GP IIb/IIIa inhibitor (abciximab) is considered as an adjunct to PCI for all patients with diabetes who are undergoing elective PCI or for those patients undergoing complex procedures.
A GP IIb/IIIa inhibitor is not used for patients who are undergoing procedurally uncomplicated, elective single-vessel PCI, unless unexpected immediate complications occur.
Local clinical audits on the care of patients with ACS also could include criteria on other aspects of care referred to in the National Service Framework for Coronary Heart Disease.