NICE has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Implantation of a left ventricular assist device for destination therapy in people ineligible for heart transplantation, in March 2015.
Heart failure is a complex clinical syndrome of symptoms that occurs when the efficiency of the heart as a pump is impaired. It leads to reduced blood flow to the body tissues and increased filling pressure in the heart, which causes congestion and oedema in the lungs (causing breathlessness) or the body (causing swelling of the legs). Other symptoms include reduced exercise tolerance, fatigue and malaise.
Medical treatment of heart failure involves drugs such as diuretics and inotropic agents. Invasive therapies include electrophysiological interventions such as pacemakers and implantable cardioverter defibrillators, revascularisation by percutaneous coronary angioplasty and stenting or coronary artery bypass grafting, valve replacement or repair, and temporary use of intra-aortic balloon pumps. In chronic heart failure, conventional treatment strategies may no longer work resulting in the need for heart transplantation. Ventricular assist devices can be used to provide temporary circulatory support while a patient awaits heart transplantation (bridge-to-transplantation).
The OPCS-4 code for a left ventricular assist device for destination therapy:
K54.1 Open implantation of ventricular assist device
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.