§ Dr. StoateTo ask the Secretary of State for Health what guidance has been issued to the National Institute for Clinical Excellence to enable it to develop a clinical guideline on the investigation and management of heart failure. [1413]
§ Mr. HuttonThe development of a guideline for heart failure was referred to National Institute for Clinical Excellence in September 2000 with the following remit
Appropriate means of diagnosis (including consideration of possible role of new developments in diagnosis e.g. brain naturetic peptide).Optimum symptom control using established treatments but also including relatively new evidence around drugs such as spironolactone, angiotensin-II receptor antagonists (e.g. losartan), beta blockers (and if appropriate how and where to manage treatment with beta blockers).Appropriate make-up of medical team treating (evidence for multi-disciplinary approach).Evidence on exercise tolerance and the possible beneficial effects of exercise on quality of life (limited evidence available but traditional advice to rest may not be appropriate in all cases).Role of supportive care—the potential of the 'palliative care approach', when to consider supportive care (not just an end of life/terminal phase issue) and when the use of specialist palliative care services may be appropriate.The role of primary care and community services—may these have an effect on frequent acute re-admissions?Role of lifestyle advice.Role of surgical interventions to treat or relieve symptoms.