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October 2017 Br J Cardiol 2017;24:(4) doi: 10.5837/bjc.2017.026 Online First

How hard do we look for atrial fibrillation?

Ioannis Merinopoulos, Sajid Alam, David Bloore

Abstract

Atrial fibrillation (AF) is one of the most common arrhythmias, affecting approximately 2% of the general population. Identifying AF after an ischaemic stroke is particularly important as it changes the recommended antithrombotic therapy from antiplatelets to anticoagulation. Currently, there is no clear consensus with regards to the duration of rhythm monitoring post-stroke. In our study, we aim to review some of the pivotal studies regarding rhythm monitoring after an ischaemic stroke and identify the percentage of patients who get referred for prolonged rhythm monitoring after a stroke by providing real-world data from the Ipswich hospital. To our surprise, we did not identify any patients who got referred for prolonged rhythm monitoring (ILR) and the proportion of patients who did not have a 24-hour tape was unexpectedly high. In addition, there was a clear tendency for patients with lacunar strokes not to get investigated with 24-hour tape.

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October 2017 Br J Cardiol 2017;24:(4) doi: 10.5837/bjc.2017.027 Online First

The PACI survey: Patient adherence to cardioprotective lifestyle interventions in myocardial infarction patients treated with primary percutaneous coronary intervention

Justin L Mifsud

Abstract

Despite documented evidence of benefits of lifestyle cardioprotective interventions in reducing recurrent coronary heart disease (CHD) events, many patients still fail to adhere to proposed lifestyle interventions. To determine the percentage adherence rate and to identify the perceived barriers influencing adherence rate to cardioprotective lifestyle interventions among patients treated with primary percutaneous coronary intervention (PPCI) a cross-sectional survey was designed.

A total of 193 consecutive patients, with a clinical diagnosis of CHD who had a PPCI, were identified retrospectively between 2008 and 2013, and were subsequently telephone surveyed. Data were analysed using chi-square tests and Fisher’s exact tests. At survey, 21.8% of patients smoked cigarettes, 30.6% were adhering to physical activities as per guidelines, 36.3% were consuming five portions of fruits and vegetables per day, and 9.8% were consuming three portions of oily fish per week. Negative stress, low mood, advanced age, poor health, lack of enjoyment from physical activities, low expectations from physical activity benefits, obesity and diabetes, were associated with non-adherence to physical activities as per guidelines.

In conclusion, risk factor targets for secondary prevention were not reached by a large proportion of patients. Several barriers exist among these individuals. Thus, there is still considerable potential for cardiac rehabilitation clinicians to improve standards of preventive cardiology by clearly identifying barriers and ways to overcome them. 

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October 2017 Br J Cardiol 2017;24:(4) doi: 10.5837/bjc.2017.028 Online First

Current diagnostic yield of invasive coronary angiography at a district general hospital

Ali Rauf, Sarah Denny, Floyd Pierres, Alice Jackson, Nikolaos Papamichail, Antonis Pavlidis, Khaled Alfakih

Abstract

Invasive coronary angiography (ICA) is an important diagnostic test in the diagnosis of coronary artery disease (CAD). However, it is associated with a small risk and is a relatively expensive procedure. National Institute for Health and Care Excellence (NICE) 2010 guidelines on stable chest pain recommended that patients with stable chest pain and high probability of CAD should be investigated with ICA.

We audited our own practice at a district general hospital (DGH), with a single catheter lab, to assess the yield of significant CAD at ICA in patients presenting with stable chest pain and acute coronary syndromes (ACS). There were 457 patients who were referrals for ICA with stable chest pain and 250 were inpatients undergoing ICA for ACS. The incidence of severe CAD in the whole cohort was 41%, with a further 20% found to have moderate CAD. The prevalence was higher in the ACS subgroup with 55% of patients having severe CAD compared with 33% in the stable chest pain sub-group. Of the patients having ICA for stable chest pain, 72% were direct referrals, with 30% found to have severe CAD. Our data show that overall detection rate of severe CAD in patients presenting with stable chest pain, at ICA, is relatively low.

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August 2017 Br J Cardiol 2017;24:87–8 doi: 10.5837/bjc.2017.021

Self-monitoring blood pressure in pregnancy: is this the way forward?

Josephine Walshaw, Richard J McManus

Abstract

Hypertension is a significant problem, both in the general population and among pregnant women, with around one in 10 women experiencing a form of hypertensive disorder during pregnancy.1 It is the third most common direct cause of maternal mortality worldwide, after haemorrhage and infection,2 and is also associated with adverse affects to the baby, including intrauterine growth retardation, premature delivery and respiratory distress syndrome.3

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August 2017 Br J Cardiol 2017;24:90–2 doi: 10.5837/bjc.2017.022

Are NOACs safe in catheter ablation of atrial fibrillation?

Adam J Graham, Richard J Schilling

Abstract

Atrial fibrillation (AF) is known to increase stroke risk and can be stratified clinically by the CHA2DS2-VASc scoring system, which then informs recommendations for long-term anticoagulation. Susceptibility to thromboembolism is also increased around the time of catheter ablation of AF. Mechanistically, this is accounted for by endothelial injury, hypercoagulability due to contact of blood with foreign surfaces and altered blood flow after conversion to normal sinus rhythm (figure 1).1 The risk of stroke persists post-ablation, even in patients with low CHA2DS2-VASc scores, as the atria may remain stunned for several weeks post-ablation, and the endothelium takes time to heal. This phenomenon forms the rationale for guidelines currently recommending anticoagulation for two to three months post-ablation.2 

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