Heart valve disease presenting in adults: investigation and management

Resource impact summary report

The NICE guideline on heart valve disease covers investigating and managing heart valve disease presenting in adults. It aims to improve diagnosis and raise awareness of the indications for intervention. The guideline updates, expands and replaces the recommendations on valve surgery and percutaneous intervention in the NICE guideline acute heart failure.

The guideline is not anticipated to have a significant impact on resource because:

• The recommendations are broadly reflective of current practice.
• The recommendations on transcatheter mitral valve repair for primary mitral regurgitation represent a change in clinical practice, however NHS England has recently commissioned this intervention and it is not expected that the use of the intervention will be increased any further as a result of this guideline.

The guideline is currently recommending transcatheter aortic valve implantation (TAVI) as a second line intervention, only for a subset of patients who are at high risk and for whom surgery is unsuitable. Although TAVI was shown to be clinically effective for all population groups, and has interventional procedures guidance for standard arrangements, it was not considered cost effective and therefore is only currently recommended for high-risk patients. This is in line with current NHSE specialised commissioning policy.

Based on the current recommendations we do not expect this guideline to have a significant impact on resources.

Cardiology services are commissioned by NHS England and integrated care systems/clinical commissioning groups. Providers are NHS hospital trusts.

Additional Information

NHS England Specialised Commissioning are currently working with their commissioning partner NHS Supply chain in the development of a procurement strategy to explore cost effective solutions with suppliers within this area. If a cost effective solution is found then NICE will update the recommendations in this guideline.

NHS England and Improvement are keen to reduce barriers to access interventions that will support timely recovery from the effects of COVID-19 on cardiac surgery waiting times.

NHS England and Improvement will develop a commissioning position on TAVI that aligns with the NICE guidance once a cost-effective solution has been finalised.

Further information is available in the implementation statement.