ISBN: 978-1-4731-3093-7 6.2 Pharmacological treatment A review of new evidence published after 2010 was carried out in order to determine whether any changes to current recommendations where likely to be required. The decision on which drugs to include in the update of the guideline was made following consultation of the scope. Drugs reviewed in the update included: Mineralocorticoid receptor antagonists Beta-blockers in people with with CHF and atrial fibrillation Treating heart failure in people with chronic kidney disease Iron supplementation As a consequence of updating the mineralocorticoid evidence, and the need to incorporate new NICE technology appraisal guidance for sacubitril valsartan and ivabradine within the treatment pathway, the initiation and sequencing of pharmacological therapies was considered and revised by the guideline committee. The following agents were not considered in the update. For more information: Refer to Appendix R, the 2010 Guideline: Angiotensin converting enzyme inhibitors (ACEI) Beta-blockers Hydralazine and nitrate combination Angiotensin-II receptor antagonists Refer to Appendix R, the 2003 Guideline Amiodarone Anticoagulants Inotropic agents Calcium channel blockers Diuretics Digoxin Chronic Heart Failure Beta-blockers in heart failure and concomitant atrial fibrillation NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 6.2.2 Beta-blockers in people with heart failure and atrial fibrillation Since the early 1990s, there have been several randomised controlled trials which clearly demonstrated that beta-blockers can significantly reduce the morbidity and mortality of patients with HFREF. Beta-blockers have been recommended in NICE heart failure guidance since 2003.The prescription of beta-blockers in heart failure has become more common as recorded in successive large observational studies such as those from the UK National Heart Failure audit. This development has been associated with a progressive decline in the reported mortality of patients with HFREF over the past 10 years or so. 