Servier Laboratories’ heart-rate-lowing drug Procoralan (ivabradine) has been recommended as a treatment option for people with chronic heart failure in final guidance.

The treatment is recommended in patients with systolic dysfunction, who are in sinus rhythm and whose heart rate is 75 beats per minute or more and who have a have a left ventricular ejection fraction of 35% or less.

Professor Carole Longson, NICE Health Technology Evaluation Centre Director, said “Procoralan has been shown to have a beneficial effect in reducing mortality and improving quality of life in people with some types of chronic heart failure.”

Heart failure affects approximately 900,000 people in the UK. The most common cause of heart failure is coronary heart disease.

The guidance also states that Procoralan should be taken in combination with standard therapy or when beta-blockers are contraindicated or not tolerated. Additionally, it must only be used after a stabilisation period of 4 weeks on optimised standard therapy.

“The Committee was mindful that there is robust evidence for the effectiveness of ACE inhibitors, beta-blockers and aldosterone antagonists that are used routinely in managing heart failure,” said Professor Longson.

“They concluded, therefore, that Procoralan could be considered a cost-effective use of NHS resources for treating chronic heart failure after optimal treatment with these drugs has been achieved and when patients are still symptomatic after receiving optimised initial therapies, or when beta-blockers are contraindicated or not tolerated by the patients.”

NICE has confirmed its recommendation of Servier Laboratories’ Procoralan (ivabradine) for the treatment of chronic heart failure in final draft guidance.

The guidance states Procoralan should be taken in combination with standard therapy options or when beta-blockers are contraindicated or not tolerated – after a four week stabilisation period of standard therapy.

Professor Carole Longson, NICE Health Technology Evaluation Centre Director, said the treatment “has been shown to have a beneficial effect in reducing mortality and improving quality of life in people with some types of chronic heart failure.”

Heart failure affects around 900,000 people in the UK. The most common cause of heart failure is coronary artery disease. The aim of treatment is to improve life expectancy and quality of life and to avoid patients being admitted to hospital.

“The Committee was mindful that there is robust evidence for the effectiveness of ACE inhibitors, beta-blockers and aldosterone antagonists that are used routinely in managing heart failure,” Professor Longson said.

“They concluded, therefore, that ivabradine could be considered a cost-effective use of NHS resources for treating chronic heart failure after optimal treatment with these drugs has been achieved and when patients are still symptomatic after receiving optimised initial therapies, or when beta-blockers are contraindicated or not tolerated by the patients.”

The recommendation means Procoralan can be supplied as an option for patients with systolic dysfunction, who are in sinus rhythm, whose heart rate is 75 beats per minute or more and who have a left ventricular ejection fraction of 35% or less.

Servier’s Procoralan (ivabradine) has been recommended by NICE in draft guidance as a treatment option for people with chronic heart failure.

The treatment has been recommended in combination with standard therapy or when beta-blocker therapy is contraindicated or not tolerated, after impressing in clinical trials.

Professor Carole Longson, NICE Health Technology Evaluation Centre Director, said Procoralan has demonstrated a “beneficial effect in reducing mortality and improving quality of life”.

The draft guidance also recommends that standard therapies used routinely for managing the condition should be optimised before treatment begins with Procoralan and after a stabilisation period of four weeks.

“The (Appraisal) Committee was mindful that there is robust evidence for the effectiveness of ACE inhibitors, beta-blockers and aldosterone antagonists that are used routinely in managing heart failure,” said Professor Longson. “They concluded that ivabradine should be initiated only after optimal treatment with these drugs has been achieved when patients are still symptomatic after receiving optimised initial therapies, or when beta-blockers are contraindicated as specified in the marketing authorisation or not tolerated by the patients.”

It is estimated that chronic heart failure affects about 900,000 people in the UK – a figure that continues to rise due to an ageing population and improved prognosis.

Pfizer’s drug Inspra (eplerenone) has been licensed in the UK for treatment of patients with chronic heart failure (CHF).

The new indication follows evidence that Inspra can reduce the risk of death or hospitalisation from heart failure in the relevant patient group by 37%.

The drug, already licensed for treatment of heart failure after recent myocardial infarction, can now be used to improve CHF patients’ health at an earlier stage.

The addition of Inspra to standard therapy has been shown to offer an incremental cost of £3,534 per QALY gained – well below the £20,000 threshold accepted as good value by NICE.

CHF affects over 875,000 people in the UK, and one in three patients die within a year of diagnosis while the rest suffer frequent hospitalisations lasting an average of 11 days.

Inspra, a selective aldosterone antagonist and mineralocorticoid receptor antagonist, is now approved for use with standard therapy in adult patients with CHF and left ventricular systolic dysfunction (LVEF) up to 30%.

It was already indicated to treat patients with heart failure and LVEF up to 40% after recent myocardial infarction, alongside standard therapy.

The EMPHASIS-HF trial showed that adding Inspra to the patient’s regime reduced the risk of death from cardiovascular causes or a first hospitalisation for heart failure by 37%.

Professor Martin Cowie, Consultant Cardiologist at the Royal Brompton Hospital, London, commented: “Patients with chronic heart failure have a shorter life expectancy than patients with the most common types of cancer and can require frequent admission to hospital. These admissions account for the majority of the costs associated with treating CHF.

“New strategies that have the potential to reduce these costs, as well as extending patients’ lives, are particularly welcome during these times of increased financial pressure.”

Telehealth Solutions has launched a new managed telehealth service in the UK that has the potential to transform the treatment of serious long-term conditions.

The new service combines a customised home monitoring system and a specialist nurse triage service for patients with chronic obstructive pulmonary disease (COPD), diabetes or chronic heart failure.

As well as improving patient care through more regular monitoring and timely intervention, managed telehealth is expected to reduce hospital admissions and administrative workload for clinicians.

COPD affects 900,000 COPD people in the UK, with hospital admissions for these patients costing the NHS an estimated £35 million per year.

The ‘end-to-end’ managed telehealth service directly involves patients in their own treatment, while enabling clinicians to personalise the collection of data for each patient, detecting warning signs and making early interventions.

The Telehealth Solutions home monitoring system incorporates a range of vital sign collection devices: weight scales, peak flow meter, thermometer, pulse oximeter, blood pressure meter, ECG, blood glucose meter and INR tester.

John Dyson, Chief Executive of Telehealth Solutions, said: “The Telehealth Solutions ‘end-to-end’ service is a tailored, comprehensive patient care model, ensuring full collaboration and dialogue between patient and healthcare professional from the outset.

“It is a significant step forward for patients with these long-term conditions as they can now take more control over their treatment plan and actively participate in consultations.”

The DH will shortly publish the outcome of the NHS Whole Systems Demonstrator programme, which has trialled telehealth systems with 6,000 patients over three sites in England.

Based in Watford, Telehealth Solutions has achieved success with its GP practice-based Surgery Pod for monitoring patients with long-term conditions.