Endocarditis prevention: time for a review of NICE guidance
Summary: In 2023, the European Society of Cardiology (ESC) updated its infective endocarditis (IE) guidelines strongly endorsing antibiotic prophylaxis (AP) before invasive dental procedures (IDPs) for high-risk patients, elevating their recommendation to Class I. The American Heart Association (AHA...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-04-01
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| Series: | The Lancet Regional Health. Europe |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666776224000425 |
| _version_ | 1797271248641720320 |
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| author | Martin Thornhill Bernard Prendergast Mark Dayer Ash Frisby Larry M. Baddour |
| author_facet | Martin Thornhill Bernard Prendergast Mark Dayer Ash Frisby Larry M. Baddour |
| author_sort | Martin Thornhill |
| collection | DOAJ |
| description | Summary: In 2023, the European Society of Cardiology (ESC) updated its infective endocarditis (IE) guidelines strongly endorsing antibiotic prophylaxis (AP) before invasive dental procedures (IDPs) for high-risk patients, elevating their recommendation to Class I. The American Heart Association (AHA) is aligned with this view and reaffirmed the need for AP to prevent IE in those at high-risk in its 2021 guidelines. In contrast, the UK's National Institute for Health and Care Excellence (NICE) recommends against routine AP use. Despite considerable new evidence, NICE has not reviewed this recommendation since 2015. In this Personal View, we review the new evidence that has arisen since 2015. Our analysis establishes the association between IDPs and IE and shows that AP is both safe and effective in reducing the IE-risk following IDPs in those at high-risk. Data also show that AP is cost-effective and would result in significant cost savings and health benefits if re-introduced into the UK's National Health Service for high-risk patients. Given these insights, we argue it is time NICE reviewed its guidance so that high-risk patients in the UK receive the same protection against IE that is afforded to patients in the rest of the world. Funding: The authors received no specific funding for this work. |
| first_indexed | 2024-03-07T13:59:04Z |
| format | Article |
| id | doaj.art-5be8b3f95c2841aa9203c2a71e36302e |
| institution | Directory Open Access Journal |
| issn | 2666-7762 |
| language | English |
| last_indexed | 2024-03-07T13:59:04Z |
| publishDate | 2024-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Europe |
| spelling | doaj.art-5be8b3f95c2841aa9203c2a71e36302e2024-03-07T05:30:30ZengElsevierThe Lancet Regional Health. Europe2666-77622024-04-0139100876Endocarditis prevention: time for a review of NICE guidanceMartin Thornhill0Bernard Prendergast1Mark Dayer2Ash Frisby3Larry M. Baddour4Unit of Oral & Maxillofacial Medicine, Surgery and Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK; Corresponding author. Unit of Oral & Maxillofacial Medicine, Surgery and Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, S10 2TA, UK.Guy's and St Thomas' Hospital, London and Chair of Cardiology, Cleveland Clinic, London, UKSomerset NHS Foundation Trust, Somerset, UKPatient Advocate, London, UKDivision of Public Health, Infectious Diseases and Occupational Health, Departments of Medicine and Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USASummary: In 2023, the European Society of Cardiology (ESC) updated its infective endocarditis (IE) guidelines strongly endorsing antibiotic prophylaxis (AP) before invasive dental procedures (IDPs) for high-risk patients, elevating their recommendation to Class I. The American Heart Association (AHA) is aligned with this view and reaffirmed the need for AP to prevent IE in those at high-risk in its 2021 guidelines. In contrast, the UK's National Institute for Health and Care Excellence (NICE) recommends against routine AP use. Despite considerable new evidence, NICE has not reviewed this recommendation since 2015. In this Personal View, we review the new evidence that has arisen since 2015. Our analysis establishes the association between IDPs and IE and shows that AP is both safe and effective in reducing the IE-risk following IDPs in those at high-risk. Data also show that AP is cost-effective and would result in significant cost savings and health benefits if re-introduced into the UK's National Health Service for high-risk patients. Given these insights, we argue it is time NICE reviewed its guidance so that high-risk patients in the UK receive the same protection against IE that is afforded to patients in the rest of the world. Funding: The authors received no specific funding for this work.http://www.sciencedirect.com/science/article/pii/S2666776224000425Infective endocarditisAntibiotic prophylaxisInvasive dental proceduresGuidelinesNICE |
| spellingShingle | Martin Thornhill Bernard Prendergast Mark Dayer Ash Frisby Larry M. Baddour Endocarditis prevention: time for a review of NICE guidance The Lancet Regional Health. Europe Infective endocarditis Antibiotic prophylaxis Invasive dental procedures Guidelines NICE |
| title | Endocarditis prevention: time for a review of NICE guidance |
| title_full | Endocarditis prevention: time for a review of NICE guidance |
| title_fullStr | Endocarditis prevention: time for a review of NICE guidance |
| title_full_unstemmed | Endocarditis prevention: time for a review of NICE guidance |
| title_short | Endocarditis prevention: time for a review of NICE guidance |
| title_sort | endocarditis prevention time for a review of nice guidance |
| topic | Infective endocarditis Antibiotic prophylaxis Invasive dental procedures Guidelines NICE |
| url | http://www.sciencedirect.com/science/article/pii/S2666776224000425 |
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