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Br J Cardiol 2017;24:61 Leave a comment
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Air pollution linked to heart problems

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For UK healthcare professionals only

Nanoparticles, inhaled from sources such as vehicle exhausts, have been shown to cross from the lungs into the blood stream. They can then accumulate in areas susceptible to heart problems, according to research part-funded by the British Heart Foundation. 

Previous studies have identified a correlation but not a causal link between nanoparticles and strokes or cardiovascular disease. It is not currently possible to measure environmental nanoparticles in the blood. So, researchers from the University of Edinburgh, and the National Institute for Public Health and the Environment in the Netherlands, used a variety of specialist techniques to track the fate of gold nanoparticles breathed in by volunteers.

They were able to show that nanoparticles can migrate from the lungs into the bloodstream within 24 hours after exposure and were still detectable in the blood three months later. By looking at surgically removed plaques from people at high risk of stroke, they were also able to find that nanoparticles accumulated in the fatty plaques.

Professor Jeremy Pearson (Associate Medical Director at the British Heart Foundation) said: “These results emphasise that we must do more to stop people dying needlessly from heart disease caused by air pollution.”

Alarm over low UK implant rates of complex devices  

50% of hospitals do not meet the minimum criteria to implant complex cardiac rhythm devices, according to the latest National Cardiac Rhythm Management Audit data (1st April 2015 to 31 March 2016) released recently.  This shows significant variation across the UK in the rates of pacemaker and defibrillator implants, and that the UK lags far behind many of its Western European counterparts.

Trudie Lobban (CEO and Founder, Arrhythmia Alliance) is calling for more to be done to ensure every arrhythmia patient receives equitable treatment, wherever they may live in the UK, and will be raising her concerns to the newly formed All-Party Parliamentary Group on Arrhythmias.

She added, “Access to available treatments vary significantly from one area to another which is totally unacceptable. Sudden cardiac death is the number one killer in the UK, yet despite this we still see low implant of life-saving devices such as ICDs and pacemakers. We must now use this data to improve and increase access to care to save more lives and to improve the quality of life for all arrhythmia patients.”

The UK is one of the top countries in Europe performing cardiac resynchronisation therapy but a significant number of UK hospitals continue to perform small numbers of pacemaker and defibrillator implants.

‘Let’s talk about anticoagulation’ video

Anticoagulation UK have created a video to help patients and healthcare professionals, providing an overview of the range of associated conditions, current treatments and the importance of engaging the patient in the decision-making process.

The video was developed with newly-diagnosed patients requiring anticoagulation, existing patients who are considering new treatments and is intended to assist healthcare professionals by complementing verbal and written information provided during the consultation process.

The video  ‘Let’s talk about Anticoagulation’ can be seen here: http://tinyurl.com/hfw56t7 or on YouTube

Cardiology innovations in health tech awards

Two pioneering examples of cardiological health tech were recently shortlisted as finalists for the AXA PPP Health Tech and You 2017 awards, held at the London Design Museum. 

Kardia Mobile (AliveCor®) is a heart rhythm monitor, smaller than a credit card, that can be attached to a smartphone. It alerts users if medical attention is needed when it detects an irregularity. The device allows patients to take a quick measurement whenever they notice a problem, and store data in the cloud for later analysis. Kardia Mobile was shortlisted in The Trending Award category.

TickerFit (www.tickerfit.com) is a smartphone app that allows health professionals to support patients’ self-management of their heart health. It provides patients with programmes to learn about their condition and what they can do to recover. Other features include the ability to track metrics such as activity, appointment reminders and allowing feedback on outcomes.

TickerFit allows slow and steady feeding of healthcare advice to patients and early cohort tests indicate this can help reduce the incidence of readmissions. TickerFit was shortlisted in The Health & Care Professional’s Choice award.

Heart failure as ‘malignant’ as some common cancers

A new analysis finds that men and women with a diagnosis of heart failure continue to have worse survival rates than patients with certain common cancers, despite advances in care. 

The study included 56,658 adults in Scotland who were receiving care in a primary care setting, with a total of 147,938 person-years of follow-up. In men, heart failure was linked with worse survival than prostate cancer and bladder cancer, but better survival than lung cancer and colorectal cancer. In women, heart failure was linked with worse survival than breast cancer and colorectal cancer, but better survival than lung cancer and ovarian cancer.

“Mortality rates for patients with heart failure remain significant and a major public health problem. Heart failure remains as malignant as many of the common cancers,” said Dr Mamas Mamas, lead author of the Eur J Heart Fail study (doi:10.1002/ejhf.822).

New personalised cardiovascular workouts tool

A new tool developed by the European Association of Preventative Cardiology gives clinicians the ability to tailor exercise programmes for patients. EXPERT (Exercise Prescription in Everyday Practice and Rehabilitation Training) generates exercise prescriptions for patients with different combinations of cardiovascular risk factors or diseases. It was designed by specialists from 11 European countries alongside computer scientists from Hasselt University.

Professor Dominique Hansen (Associate Professor in Exercise Physiology and Rehabilitation of Internal Diseases, Hasselt University, Diepenbeek, Belgium) explains: “… surveys have shown that many clinicians experience great difficulties in prescribing specific exercise programmes for patients with multiple cardiovascular diseases and risk factors”.

EXPERT can be installed on a laptop or personal computer (PC). During a consultation, the clinician inputs the patient’s characteristics and cardiovascular risk factors, cardiovascular diseases and other chronic conditions, medications, adverse events during exercise testing, and physical fitness (from a cardiopulmonary exercise test).

The tool automatically designs a personalised exercise programme for the patient. It includes the ideal exercise type, intensity, frequency, and duration of each session. Safety precautions are also given for patients with certain conditions. The advice can be printed out and given to the patient to carry out at home, and reviewed by the clinician in a few months.

‘Connshing syndrome’ – a new cause of hypertension

Research led by scientists at the University of Birmingham has revealed a new cause of hypertension, which could lead to major changes in managing the disease.

Studies estimate that one in four adults suffer from hypertension but most have no identifiable cause for the condition. In up to 10% of hypertensive patients, the overproduction of the adrenal hormone aldosterone (primary aldosteronism or Conn syndrome) is the cause of disease.

Professor Wiebke Arlt (Director of the Institute of Metabolism and Systems Research, University of Birmingham) said: “Our findings show that the adrenal glands of many patients with Conn syndrome also produce too much cortisol, which finally explains puzzling results of previous studies in Conn patients.

“These previous studies had found increased rates of type 2 diabetes, osteoporosis and depression in Conn patients – problems typically caused by overproduction of cortisol, or, Cushing syndrome, and not by too much aldosterone.”

The researchers have decided to name – the combined overproduction of aldosterone and cortisol – as Connshing syndrome. At present, many Conn syndrome patients are treated with drugs that are directed against the adverse effects of aldosterone. However, this leaves the cortisol excess untreated.

Greater benefits from extended weight loss programmes

Offering a year-long programme of weight loss classes could prevent an additional 1,786 cases of disease (hypertension, diabetes, heart disease) for every 100,000 people compared to a 12-week programme.

Extending NHS weight loss programmes from one session per week for 12 weeks to one session per week for a year helped people who are overweight to lose more weight and keep it off for longer, according to a study published in The Lancet (doi: 10.1016/S0140-6736(17)30647-5), and led by researchers from the Universities of Cambridge, Liverpool and Oxford.

Although upfront costs for the longer programme are higher, the study estimates that offering more sessions would be cost-effective to the NHS in the long-term because it would help to prevent more people from developing diseases as a result of their weight.

The trial involved 1,267 participants with a BMI of 28 or above and provides important data that offering support to lose weight – and referring people to a community weight loss group – is more successful than a self-help approach, and that providing classes for longer helps people keep weight off for longer.

Single injection can repair damaged hearts

Patients who experience large heart attacks can see improved remodelling of damaged tissue when injected with a low-dose insulin-like growth factor. 

Two different low-dose preparations of insulin-like growth factor or placebo were tested in a randomised, double-blind clinical trial, RESUS-AMI, in 47 patients. It showed that those who received the higher dose had improved remodelling of their heart muscle in the two-month follow-up after their heart attack, which correlated with other measures of improved heart performance. 

The study carried out by Professor Noel Caplice (Chair of Cardiovascular Sciences at University College Cork, Ireland) and colleagues at Cork University Hospital.

If larger future trials prove a success, the growth factor could be used more widely to benefit patients in terms of quality adjusted life years, and reduce the impact on health services. 

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