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National Institute for Health and Care Excellence (NICE) guidance on heart valve disease
  1. Benoy Nalin Shah
  1. Cardiology, University Hospital Southampton NHS Foundation Trust Cardiovascular and Thoracic Service, Southampton, UK
  1. Correspondence to Dr Benoy Nalin Shah, Cardiology, University Hospital Southampton NHS Foundation Trust Cardiovascular and Thoracic Service, Southampton, SO16 6YD, UK; benoy.shah{at}


The National Institute for Health and Care Excellence (NICE) guidelines are evidence-based recommendations for health and care in England. In late 2021, NICE published its first ever guidance on the investigation and management of adults with heart valve disease. This followed on from recent updates to the international societal practice guidelines on heart valve disease produced by the American College of Cardiology and American Heart Association (in 2020) and the European Society of Cardiology and European Association for Cardiothoracic Surgery (in 2021). The purpose of the NICE guidance has significant differences from societal guidelines, as NICE guidance is designed for implementation within the UK’s taxpayer-funded National Health Service and thus must account not just for clinical effectiveness of treatments but cost-effectiveness also. This explains some of the differences between recent recommendations from these bodies, most notably in the treatment of patients with symptomatic severe aortic stenosis, in which NICE clearly explains that cost implications influenced their final guidance (which differs from the recently published European and North American guidelines). The aims of this review article are to provide an overview of the scope and recommendations of the NICE guideline and to compare and contrast the guidelines, highlighting reasons for differences between the guidance from professional societies and NICE and discussing the relative strengths and weaknesses of the NICE guideline.

  • heart valve diseases
  • aortic valve stenosis

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  • Contributors BNS wrote the first draft, created the figures and tables (unless stated otherwise) and revised the manuscript as per peer-reviewer requests. BNS is the sole guarantor for the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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