In particular, clinicians should address any misconception that so long as a patient pulls through the surgery, their heart failure will necessarily be fixed , as some patients will have an excellent symptomatic response and others far less. It should be emphasised that where benefit accrues from CABG this only occurs after more than 5 years, and that to date it is difficult to identify which individuals will do well. The committee noted that in the UK, PCI is used more commonly than CABG for revascularisation, due to a lower rate of complications and shorter recovery period. However, the committee recognised that in heart failure, there is no RCT evidence on the effectiveness of PCI. A UK study of PCI in patients with HFREF (EF < 30%), extensive coronary disease and viable myocardium (in 30% of dysfunction segments) is currently underway c See TA314 Implantable cardioverter defibrillators and cardiac resynchronisation therapy for arrhythmias and heart failure Chronic Heart Failure Treating Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Recommendations Do not routinely offer coronary revascularisation to people who have heart failure with reduced ejection fraction and coronary artery disease. [2018] ). When considering the totality of the evidence for revascularisation, the committee decided that neither CABG nor PCI should be routinely offered to patients with HFREF. This was based on the absence of RCT level evidence supporting the use of PCI in HFREF, and the concerns regarding the applicability of the evidence on CABG in HFREF. Trade-off between net clinical effects and costs No previously published economic evaluations were identified assessing the cost-effectiveness of coronary revascularisation in a heart failure population; therefore the unit costs of CABG and PCI were presented to the committee for consideration of cost effectiveness alongside the clinical evidence. 