The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on implanting a baroreceptor stimulation device for resistant hypertension in October 2015..
Hypertension is usually asymptomatic, but it is a common and preventable cause of premature morbidity and death. It is a major, but modifiable, risk factor for cardiovascular disease (including stroke and myocardial infarction) and chronic kidney disease. The cause of primary hypertension, which is the most common form, is not fully understood. However, it is likely to involve multiple factors including an increase in sodium retention and a reduction in renal blood flow mediated by the sympathetic nervous system. Secondary hypertension, which is less common, is caused by conditions affecting the kidneys, arteries, heart or endocrine system.
The NICE guideline on hypertension defines resistant hypertension as blood pressure that remains higher than 140/90 mmHg after treatment with the optimal or best tolerated doses of an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin-II receptor blocker (ARB) plus a calcium-channel blocker (CCB) plus a diuretic. First-line treatment of hypertension includes lifestyle changes, such as diet and exercise. Antihypertensive medications are used if high blood pressure persists. Implanting a baroreceptor stimulation device may be considered if hypertension fails to respond adequately to these measures.
The OPCS-4 codes for Baroreflex Activation are:
L30.5 Operations on carotid body
Y02.1 Implantation of prosthesis into organ NOC
The Clinical Classifications Service has advised NICE that currently these are the most suitable OPCS-4 codes to describe this procedure. The OPCS-4 classification is designed to categorise procedures for analysis and it is not always possible to identify a procedure uniquely.
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, and specifically any special arrangements relating to the introduction of new interventional procedures. 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.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
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. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
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.