Portable device for pacemaker and ICD patients
A new portable monitoring device (CardioMessenger Smart, Biotronik) has been launched in the USA. Roughly the size of a smartphone, the device keeps pacemaker, implantable cardioverter defibrillator, and insertable cardiac monitor patients connected to their physician remotely.
The device automatically transmits daily reports of cardiac activity via worldwide cellular networks to physicians without intervention from the patient. It also provides fully customisable alerts that can be programmed to the physician’s specifications. Studies have found that home monitoring can significantly reduce hospitalisation, stroke and mortality.
The manufacturers claim the device’s portability will help to ensure patient compliance, and that the consistent transmission of data will enable physicians to identify and prevent potential cardiac events.
One hour of activity could offset health risk of eight hours of sitting
A new study of over one million people finds that doing at least one hour of physical activity per day, such as brisk walking or cycling for pleasure, may eliminate the increased risk of death associated with sitting for eight hours a day.
The findings come from a new four-paper series published in The Lancet (available at http://www.thelancet.com/series/physical-activity-2016).
In the first paper in the series, researchers analysed data from 16 studies. The research team wanted to see how many hours of daily physical activity would be required to eliminate the association between prolonged sitting time and increased risk of death. They found people who sat for eight hours a day but were physically active had a much lower risk of death compared to people who sat for fewer hours a day, but were not physically active. Examples of physical activity were brisk walking at 5.6 km/h or cycling for pleasure at 16 km/h.
Other authors of papers in the series warn there has been too little progress in tackling the global pandemic of physical inactivity since the 2012 Olympics, with a quarter of adults worldwide still failing to meet current recommendations on physical activity. Physical inactivity costs the global economy US$ 67.5 billion.
ATMOSPHERE shows no benefit of aliskiren in heart failure
A subgroup analysis in heart failure patients with diabetes from ATMOSPHERE (the Aliskiren Trial to Minimize OutcomeS in Patients with HEart failure) has failed to show benefit and may signal the end of the road for aliskiren in heart failure. The findings were presented for the first time in a late-breaking trial session at Heart Failure 2016 and the 3rd World Congress on Acute Heart Failure, Florence, Italy.
Following the results of two separate trials – ALTITUDE (The Aliskiren Trial in Type 2 Diabetes Using Cardiorenal Endpoints) and ASTRONAUT (The Aliskiren Trial on Acute Heart Failure Outcomes) – the European Medicines Agency (EMA) requested the withdrawal of all patients with diabetes from ATMOSPHERE. ALTITUDE had been stopped after patients with diabetes and a high risk of cardiovascular events were found to have an excess risk of cardiovascular and renal events with aliskiren, while ASTRONAUT had found a tendency towards harm in patients with diabetes.
“This was a subgroup analysis with the inherent limitations of this type of study. It failed to show superiority or non-inferiority of aliskiren over the angiotensin-converting enzyme inhibitor enalapril in heart failure patients with diabetes,” said principal investigator Professor Lars Kober (Rigshospitalet, Copenhagen University Hospital, Denmark).
Exercise associated with longer life in patients with heart failure
Exercise is associated with a longer life in patients with heart failure, regardless of heart failure severity, age and gender, according to a recent analysis of more than 4,000 patients.
An international research group, ExTraMATCH II (Exercise Training Meta-Analysis of Trials in Heart Failure), identified 23 randomised trials of exercise that included at least 50 heart failure patients who were followed up for six months or longer. After asking the authors of all 23 studies for individual patient data, they received the information from 20 trials.
The investigators found that exercise was associated with an 18% lower risk of all-cause mortality and an 11% reduced risk of hospitalisation compared with no exercise. Lead author Professor Rod Taylor (Exeter Clinical Trials Unit, University of Exeter Medical School, Exeter) said: “This is about increasing one’s routine physical activity – for example walking for 20 to 30 minutes three times at week at an intensity that makes you feel a little bit breathless but not necessarily symptomatic”.
Twice as many stroke patients have correct diagnosis with thumb-ECG
In a recently completed project at Queen Alexandra Hospital in Portsmouth, twice as many stroke patients received the correct atrial fibrillation (AF) diagnosis with thumb-ECG (Zenicor) compared to current standard of care. The aim of the project was to develop and improve the diagnosis of AF for stroke patients in Portsmouth and to prevent recurrent strokes. The study was presented recently at the European Stroke Organisation Conference, Venice, Italy.
The thumb-ECG device has been used at Queen Alexandra Hospital in Portsmouth by 70 stroke patients over six months. The patients were investigated with thumb-ECG for three weeks in combination with continuous 24 hours Holter-ECG. With thumb-ECG, 14% of the patients were diagnosed with AF but only 7% were detected with the Holter ECG. The results are consistent with previous research from Sweden, where 7–11% of AF has been diagnosed with thumb-ECG and 1.5–4% with Holter-ECG.
Project lead Dr Ugnius Sukys (Queen Alexandra Hospital, Portsmouth) said: “We could repeat the results from the Swedish studies, and the investigation with Zenicor thumb-ECG even proved to be more effective in the Portsmouth population of stroke patients. We detected AF in a number of patients who would have been missed otherwise, and could therefore provide a better treatment for our stroke patients”.
Flu jab associated with fewer hospitalisations in heart failure…
The flu jab is associated with a reduced risk of hospitalisation in patients with heart failure, according to research presented recently at Heart Failure 2016 and the 3rd World Congress on Acute Heart Failure, Florence, Italy. The study in about 60,000 patients ends the controversy over flu vaccination in heart failure patients and provides more robust evidence for current recommendations, say the authors.
Primary care and hospital records of 4.9 million adults from the UK Department of Health’s Clinical Practice Research Datalink 1990–2013 were used to assess the impact of flu vaccination on the risk of cause-specific hospitalisation in heart failure patients. The risk of hospitalisation for cardiovascular disease, respiratory disease, and all causes was compared between a year in which a patient was vaccinated and an adjacent year when they were not, excluding the peri-vaccination period to minimise the risk of confounding.
Flu vaccination was associated with a 30% lower risk of hospitalisation for cardiovascular diseases, 16% lower risk of hospitalisation due to respiratory infections, and 4% lower risk of all-cause hospitalisation in the period 31 to 300 days after vaccination, compared with the corresponding period in an adjacent vaccination-free year.
Professor Kazem Rahimi (The George Institute for Global Health, University of Oxford) said while we cannot entirely rule out the possibility of residual confounding, “the findings do provide further evidence that there are likely worthwhile benefits and on that basis more efforts are needed to ensure that heart failure patients receive an annual flu jab”.
…and linked to lower dementia risk
Flu vaccination is associated with a lower risk of dementia in patients with heart failure, according to a recent study of more than 20,000 patients.
Authors led by Dr Ju-Chi Liu, (Taipei Medical University, New Taipei City, Taiwan) investigated whether heart failure patients who had received the flu vaccine had a lower risk of dementia. The study included all patients over 60 years of age who visited healthcare facilities in Taiwan with a diagnosis of heart failure during 2000–2012. Those who had dementia prior to being diagnosed with heart failure were excluded from the study. Patients were recruited from the National Health Insurance Research Dataset, which holds information on 98% of Taiwan residents.
When they examined the association by age, the researchers found that vaccinated heart failure patients had a 44% lower risk of dementia if they were over 70 years old and a 26% lower risk if they were between 60 and 69 years old. Vaccinated male heart failure patients had a 40% lower risk of dementia while vaccinated female heart failure patients had a 31% lower dementia risk.
Heart failure hospital visits rise 36% in decade
The number of heart failure hospital visits has increased by more than a third in the last 10 years as more people are diagnosed with the condition, according to latest statistics from the British Heart Foundation (BHF). Figures show the number of hospital visits by heart failure patients increased by 36% from 107,000 to 146,000 between 2004–2005 and 2014– 2015.
The BHF warns that more research is urgently needed to reduce the number of people with heart failure and improve treatments to halt the alarming increase in hospital visits. It says this rapidly rising trend in hospital visits is down to the ageing population and improving myocardial infarction (MI) survival rates.
Male GPs more likely to consider heart disease a “man’s issue”
Male GPs are more likely to consider heart disease a “man’s issue” and neglect to assess cardiovascular risk in female patients, reports a study of 52 GPs and more than 2,200 patients.
The study (Eur J Prevent Cardiol doi: 10.1177/2047487316648476) included 52 GPs and 2,262 patients who completed a questionnaire about their personal characteristics. For GPs this included age, gender, and office hours, while for patients there were questions about educational level and medical insurance. Medical files were used to obtain data on patients’ gender, age, history of diabetes, and standard cardiovascular risk factors.
The investigators found that information on smoking, blood glucose and cholesterol were reported less often in the files of female patients. Because of insufficient information in the medical files, both cardiovascular risk scales could be assessed less frequently in female than in male patients (36% less often for the French scale and 37% less often for the SCORE scale).
Lead author Dr Raphaëlle Delpech (Paris XI University and INSERM U1018, Paris, France) said: “I think most GPs will be surprised by our findings, and I hope this will help them ensure they assess cardiovascular risk equally in their male and female patients”.
Action required to minimise heart failure in breast cancer survivors
Despite the known toxic effects of chemotherapy on the heart, the majority of women undergoing breast cancer treatment are not getting the recommended follow-up heart scans, according to research presented at the British Cardiovascular Society (BCS) Conference in Manchester recently (abstract available at http://www.bcs.com/abstracts3/marker_view.asp?AbstractID=1913).
Researchers analysed medical records from the CHEMOCARE database focusing on the 1,229 breast cancer patients who were treated with either anthracyclines alone or combined with the monoclonal antibody trastuzumab at Ninewells Hospital, Dundee between January 2003 and December 2014.
Despite clear guidelines that women receiving these treatments should have their heart function monitored, only 625 (51%) of the women underwent an echocardiogram before starting chemotherapy. Of these, only 238 (38% of those screened) had follow-up scans during the course of their treatment, as recommended by the guidelines. Although the researchers expect their findings to be representative of cancer treatment across Scotland and the wider UK, broader analysis is needed to confirm this.
Three-year telehealth study builds case for supported self-care
The results from a large, self-care programme in Liverpool among 1,808 people living with long-term conditions (LTCs), including diabetes, heart failure and chronic obstructive pulmonary disease has highlighted clear benefits among study participants.
Reductions in emergency admissions and secondary care costs ranging from 22% to 32% for patients with above average risk (25% or more) were seen and patient-reported outcomes suggested that 90% felt more in control of their condition, had gained confidence, and/or felt better able to cope.
The study sought to improve patient independence and emotional well-being using innovative telemonitoring equipment alongside the support of a clinical hub and structured programme of case management, monitoring, education and coaching for populations living with varying levels of LTCs.
The programme results have been published by Royal Philips, working in partnership with the NHS Liverpool Clinical Commissioning Group (CCG) in Evidence for Supported Self Care.
“The results from this telehealth program are really game changing,” said Dr Simon Bowers (Digital Care and Innovation Clinical Director, NHS Liverpool Clinical Commissioning Group). “This is good for the NHS, but more importantly it’s good for the individual patients, who are being empowered to take control of their health and having the opportunity of a better quality of life as a result.”
Virtual reality and treadmill training could help prevent falls in elderly
Combining virtual reality and treadmill training helps prevent falls in older adults better than treadmill training alone, according to a new randomised controlled trial published in The Lancet (doi: 10.1016/S0140-6736(16)31325-3). The authors from the Tel Aviv Medical Centre, Israel, say that the intervention, which combines the physical and cognitive aspects of walking, could potentially be used in gyms, rehabilitation centres or nursing homes to improve safe walking and prevent falls in older adults or people with disorders which affect movement such as Parkinson’s disease.
Data were analysed from 282 participants from five clinical sites in Belgium, Israel, Italy, the Netherlands, and the UK (University of Newcastle) between 2013 and 2015. Participants were assigned to treadmill training with virtual reality (146), or treadmill training alone (136). The virtual reality component consisted of a camera that captured the movement of participants’ feet and projected it onto a screen in front of the treadmill, so that participants could ‘see’ their feet walking on the screen in real time.
The game-like simulation was designed to reduce the risk of falls in older adults by including real life challenges such as avoiding and stepping over obstacles like puddles or hurdles, and navigating pathways. On average, participants in each group took part in 16 training sessions over six weeks, with each session lasting about 45 minutes.
During the six months after training, the incidence rate of falls decreased in both groups, but the decrease was only statistically significant in the treadmill plus virtual reality group (11.9 to 6.0 falls in the virtual reality group – a 42% reduction; compared to a decrease from 10.7 to 8.3 in the treadmill only group).
NICE draft guidance recommends ticagrelor
The National Institute for Health and Care Excellence (NICE) has published draft guidance recommending anti-clotting drug ticagrelor 60 mg (Brilique®, AstraZeneca) with aspirin for people who have had a myocardial infarction (MI).
A higher dose of ticagrelor is already recommended for 12 months post- MI. Now new draft guidance is recommending it is continued in these people at a lower dose for a further three years to reduce their risk of a further MI or stroke.
This draft guidance looks at the use of ticagrelor at a lower dose beyond the initial 12-month period as a continuation of their previous ticagrelor treatment. It recommends ticagrelor 60 mg, which costs about £1 per tablet, with aspirin, taken twice a day for up to three years for people who have had an MI at least 12 months ago and who remain at high risk of having a further MI or stroke. The draft guidance states there should no interruption between treating at the higher 90 mg dose and the lower 60 mg dose.
SMC recommends alirocumab in patients at high-risk for MI and stroke
The Scottish Medicines Consortium (SMC) has recommended alirocumab (Praluent ®, Sanofi) as a treatment option for people who are at high risk of a myocardial infarction (MI) or stroke and who have raised levels of low-density lipoprotein (LDL) cholesterol and are unable to reach target levels despite modifying their diet and taking the maximum tolerated dose of a statin and/or other lipid-lowering therapies.
