Treating Heart Failure Chronic Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: Abbreviations: ACEi = Angiotensin-converting enzyme inhibitor; BB = Beta-blockers; CHF = chronic heart failure; ICER: incremental cost-effectiveness ratio; LYG =life year Gained; NYHA = New York Heart Association Classification; QALY: quality-adjusted life years; RALES = Randomised Aldactone Evaluation Study; RCT: randomised controlled trial. (a) UK NHS perspective, however HRQoL is not reported directly from patients the trial analysis is based upon. (b) The analysis is based on estimates of relative treatment effect and resource use from a single study, so does not reflect all available evidence in this area. There is cross-over between the trial arms. Utility values are not reported directly from patients of the EMPHASIS-HF trial. Potential bias due to the sponsor of the study. (c) Analysis developed from an Irish perspective, a healthcare system reasonably comparable to the UK NHS; Population assessed limits the generalisation of results. There is also some uncertainty regarding the applicability of resource use and costs from the Irish NHS in 2003 to current NHS setting. (d) Outcomes were not reported as QALYs; Incremental cost and incremental effect were not reported. (e) Using the utility score proposed by Mant 2009212 of 0.65 for patients with heart failure, we estimated the threshold in cost per LYG equivalent to the 20,000 per QALY gained, proposed by NICE, to be 13,000 per LYG. Chronic Heart Failure Treating Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 6.2.4.5 Evidence statements Clinical Four studies (reported in 13 publications), comparing MRAs with placebo in people with heart failure with reduced ejection fraction on current standard first line treatment, were identified for inclusion within the review. 