The
Cardiomyopathy
Association

CMA member Richard Mindham, who has dilated cardiomyopathy, was a patient representative on the guideline development group

New guidelines for improving the diagnosis, treatment and care of patients with chronic heart failure, including dilated cardiomyopathy, were announced today by NICE (the National Institute for Health and Clinical Excellence).

The guidelines, welcomed by the CMA, provide the most comprehensive and up-to-date set of recommendations yet on the diagnosis, treatment, rehabilitation and monitoring of people with this condition, says NICE.

Chief executive of the CMA Robert Hall said: ‘The original 2003 guidelines were a major step forward in treating heart failure conditions. The updated version encompasses many developments that have occurred in the intervening years.  And it is good to see the need for patient education and rehabilitation stated so clearly alongside the diagnostic and treatment recommendations.”

The guidelines set out best practice for the care of people who have, or who are suspected of having, heart failure.  They define the symptoms, signs and investigations that are most effective in confirming a diagnosis and influencing best treatments.

Among those sitting on NICE’s guideline development group was patient representative and CMA member Richard Mindham (pictured right), who has dilated cardiomyopathy.

Richard said: “There have been many significant advances in the diagnosis and treatment of heart failure since the original heart failure guidelines were published. This update gives a streamlined treatment pathway for many heart failure patients and will improve their length and quality of life.  And although improved diagnoses will initially be more demanding on the health service, it will lead to more timely treatment known to be effective at reducing hospital admissions and patient mortality.”

Robert added: "We are grateful to the NICE project team and particularly to Richard who has worked so diligently on this project to help cardiomyopathy patients on behalf of the CMA."

Heart failure affects about 900,000 people in the UK, with almost the same number again who have damaged hearts but as yet no symptoms.  These numbers are increasing as survival rates improve for those with coronary artery disease and the population ages.

The statistics quoted include heart failure caused by many conditions, not only cardiomyopathy. The most common cause is secondary to coronary artery disease.

The new recommendations in the guideline include:

♥ Refer patients with suspected heart failure and previous heart attack urgently for echocardiography and specialist assessment within two weeks

♥ Refer patients with suspected heart failure and very high levels of serum natriuretic peptides (a hormone secreted largely by the left ventricle in response to strain) for urgent echocardiography and specialist assessment within two weeks. Patients with suspected heart failure and raised levels of serum natriuretic peptides should be referred for echocardiography and specialist assessment within six weeks.

♥ Offer both angiotensin-converting enzyme (ACE) inhibitors and beta-blockers licensed for heart failure to all patients with heart failure due to left ventricular systolic dysfunction. Use clinical judgement when deciding which drug to start first.

♥ Consider adding one of the following if a patient remains symptomatic despite optimal therapy with an ACE inhibitor and a beta-blocker: