3 Current practice
There is a NICE care pathway, clinical guideline and quality standard for the management of chronic heart failure in adults. NICE has also developed several pieces of technology appraisal[2] and interventional procedure guidance[3] related to managing chronic heart failure. The European Society of Cardiology has also published a guideline on heart failure.
The NICE guideline on chronic heart failure in adults recommends both ACE inhibitors/ARBs and beta-blockers licensed for heart failure as first-line pharmacological treatments for heart failure with left ventricular systolic dysfunction. Clinical experts (involved in development of this resource and the guidance) detailed that clinical practice is broadly in line with the NICE guideline in terms of first-line treatment (that is, ACE inhibitors or ARBs are taken concomitantly with a beta blocker), with the addition of an aldosterone antagonist.
According to the technology appraisal guidance, sacubitril valsartan would be prescribed after this initial pharmacological management stage in the care pathway.
[2] Implantable cardioverter defibrillators and cardiac resynchronisation therapy for arrhythmias and heart failure (2014) NICE technology appraisal guidance 314 and ivabradine for treating chronic heart failure (2012) NICE technology appraisal guidance 267.
[3] Insertion and use of implantable pulmonary artery pressure monitors in chronic heart failure (2013) NICE interventional procedure guidance 463 and partial left ventriculectomy (the Batista procedure) (2004) NICE interventional procedure guidance 41.