GPs could soon be treating many heart failure patients with a completely new drug, under NICE draft plans for phasing out ACE inhibitors and angiotensin receptor blockers (ARBs).


NICE experts have provisionally given the green light for the new drug, a combination of sacubitril and the ARB valsartan, as an option in patients suffering from heart failure and impaired systolic function.


The plans, unveiled today, will see patients with New York Heart Association (NYHA) class II to III chronic heart failure, and a left ventricular ejection fraction of 35% or less, given the option to come off ACE inhibitors, or ARBs, and switch over to the new drug.


NICE says treatment should be started by a heart failure specialist with access to a multidisciplinary heart failure team, but dose titration and monitoring may be done in primary care by either a GP with a special interest in heart failure or a heart failure specialist nurse.


The drug was previously approved by the Medicines and Healthcare Products Regulatory Agency (MHRA) Early Access to Medicines Scheme (EAMS) in September, meaning it could be prescribed on the NHS to eligible patients with significant unmet medical need.


Last year GP experts stated that if approved, the drug could be a ‘game changer’ in the management of heart failure, as it has proven to be more effective than other established treatments.


In trials, the drug has been shown to significantly reduce cardiovascular deaths and heart failure hospitalisations when compared with ‘gold-standard’ treatment with enalapril.


NICE experts said the drug would be cost effective compared with the older drugs, at a cost per quality adjusted life year (QALY) gained of £29,500 to £30,100.


Dr Terry McCormack, a GPSI in cardiology in Whitby, North Yorkshire said he welcomed NICE’s decision ‘as the evidence is that this drug will improve the wellbeing of patients with heart failure’.


However he added that because hospitals in some areas do not report ejection fraction, this requirement before a treatment offer ‘may be controversial’.


Dr McCormack also said it was ‘irritating that they are insisting all patients are initiated by heart failure specialist consultants as this will require re-referral of patients previously assessed and now being managed by heart failure nurses who will be more than capable of identifying the correct patients’.

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