Innovative drug for common heart condition (England)
NICE is provisionally recommending novel heart failure drug sacubitril valsartan (Novartis) as an option for some people with heart failure.
This guidance recommends the drug for treating chronic heart failure with reduced ejection fraction[i] in people with New York Heart Association class II to III symptoms[ii] who are on a stable dose of ACE inhibitors (or angiotensin II receptor blockers for people who are intolerant of ACE inhibitors) and who have a left ventricular ejection fraction of 35% or less.
Heart failure affects about 900,000 people in the UK. It is a complex clinical syndrome of symptoms such as breathlessness, tiredness and fluid retention that suggest the heart is unable to pump enough oxygen and nutrients to meet the body’s needs.
The most common cause of heart failure in the UK is coronary artery disease, with many patients having had a heart attack in the past.
Heart failure is associated with significant ill-health and mortality. In 2012/13 over 30,000 people were admitted to hospital in England with heart failure with reduced left ventricular ejection fraction[iii].
Around 30-40% of patients diagnosed with heart failure die within a year but thereafter the mortality rate falls to less than 10% per year.
|I||No symptoms and no limitation in ordinary physical activity, e.g. shortness of breath when walking, climbing stairs etc|
|II||Mild symptoms (mild shortness of breath and/or angina) and slight limitation during ordinary activity.|
|III||Marked limitation in activity due to symptoms, even during less-than-ordinary activity, e.g. walking short distances (20–100 m).
Comfortable only at rest
|IV||Severe limitations. Experiences symptoms even while at rest. Mostly bedbound patients.|
iii. The National Heart Failure Audit April 2012-March 2013.