The first official NHS guidance requiring doctors to advise patients to change their lifestyle was published yesterday.
People with chronic heart failure must be told to play their part in managing the disease by giving up smoking, exercising regularly and abstaining or cutting down on alcohol, according to recommendations for treating the condition thought toaffect 750,000 people.
The national institute for clinical excellence (Nice), whose remit is limited to England and Wales, went further than any government body so far in suggesting that patients had a responsibility to make lifestyle changes to help health professionals manage progressive diseases.
Its new guidelines, designed to sit alongside professional advice from the royal colleges and other health bodies, represented the heaviest moral pressure yet on patients to use the NHS responsibly.
The Labour party is currently consulting members on whether the government should bring in formal contracts between doctors and patients which would not be legally binding but express "mutual good intent" in making lifestyle changes. Such measures might become part of Labour's next election manifesto, but patients who did not change their unhealthy habits would still be treated.
Nice has already warned doctors treating patients taking anti-smoking treatments and drugs against obesity on the NHS that prescriptions for these will cease unless patients show commitment to changing their lifestyles.
But the guidance on heart failure is the first time such advice has been included in a complete treatment and management package for people suffering from a chronic condition.
Chronic heart failure is thought to be increasing by about 10% a year as the population ages. It kills about 6,000 people annually and is responsible for about one in 20 medical admissions to hospital. Many patients have to be readmitted within months.
The guidance covers diagnosis, treatments, monitoring, hospital discharge and support for patients, especially those suffering anxiety and depression or needing palliative care before death.
The guidance will be accompanied by leaflets on how patients can manage their conditions. Patients with heart failure will also be offered an annual flu vaccination and a one-off vaccination against pneumococcal disease.
The guidelines may increase drug bills - thought to be about £20m annually for this condition - but medication only accounts for about 16% of the cost to the NHS. Hospital costs account for about two-thirds of the bill from chronic heart failure. This should be reduced if the guidance is followed.
Anne-Toni Rogers, corporate affairs director for Nice, said official guidance would give patients responsibility for their treatment.
Roger Boyle, the NHS's national director for heart disease, said: "There is a great deal that can be done to manage the condition more effectively, with better outcome for patients and their families."
