The evidence in stage IIIb patients was more limited, and while this group Chronic Heart Failure Treating Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 would also benefit from standard HFREF therapies, the evidence was not sufficient to support an offer recommendation. Instead, the committee agreed that standard HFREF drugs should be considered in this group. In CKD stage IV, the side effects of all of these medications is likely to be increased. While there is not a substantial evidence base in this population, the committee agreed that standard HFREF treatment recommendations should generally be applied, subject to the consideration of individual risk factors and liaison with renal specialists as appropriate. Trade-off between net clinical effects and costs No previously published economic evaluations were identified specifically for patients with heart failure and chronic kidney disease. Unit costs were not presented to the committee as all of the drugs reviewed are already recommended for all patients with HFREF and have been shown to be cost- effective treatments The committee discussed the cost of monitoring that is required in patients with both HFREF and CKD. The cost of monitoring would primarily involve blood tests to assess serum sodium, potassium, creatinine and eGFR and are therefore likely to be consist of a biochemistry blood test which is a small cost. The committee stressed that close monitoring is even more important in patients with CKD to help prevent hyperkalaemia and possible acute kidney injuries, and therefore the cost of monitoring could be offset by the savings by reducing the potential adverse effects of heart failure treatment on kidney function. 