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Editorial articles

Management of refractory angina: the importance of winning over both hearts and minds

June 2016 Br J Cardiol 2016;23:45–6 doi:10.5837/bjc.2016.018

Management of refractory angina: the importance of winning over both hearts and minds

Christine Wright, Ranil de Silva

Abstract

Refractory angina (RA) is an increasingly common, chronic, debilitating condition, which severely reduces quality of life. It can severely impact on physical, social and psychological wellbeing. RA should be considered in patients with known coronary artery disease, who continue to experience frequent angina-like symptoms, despite surgical or percutaneous revascularisation and optimal medical therapy. Objective evidence of reversible ischaemia should also be demonstrated. Treatment is challenging and often not delivered adequately. Management should ideally be provided by a specialist multi-disciplinary team, but national provision of such services is extremely limited. As a result, patients with RA commonly enter a downward spiral of long-term local review, cycling between the outpatient department and Accident and Emergency (A&E). Consequently, a disproportionately high proportion of healthcare resource is consumed in the management of these patients due to high attendance rates in primary and secondary care, unscheduled hospitalisation, prolonged hospital stays, investigations and polypharmacy. This may be improved by the implementation of more appropriate models of care delivery.

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April 2016 Br J Cardiol 2016;23:49–50 doi:10.5837/bjc.2016.014 Online First

Growing need for trainees in adult congenital heart disease in the UK

Kate English, Aisling Carroll, S M Afzal Sohaib, Michael Stewart, Russell Smith, J Ian Wilson

Abstract

Deaths from congenital heart disease in childhood have fallen 83% in the last 25 years.1 This dramatic change has led to a significant increase in the numbers of adults with congenital heart disease (ACHD) requiring care, and prevalence is not expected to plateau until 2050.2 Even patients with extremely complex pathophysiology are now expected to survive well into adult life, and will have significantly higher rates of utilisation of all hospital services than the general population.3,4 

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Does hand-held cardiac ultrasound herald the end of the stethoscope?

February 2016 Br J Cardiol 2016;23:(1) doi:10.5837/bjc.2016.001 Online First

Does hand-held cardiac ultrasound herald the end of the stethoscope?

Peter Currie

Abstract

I first started using the V scan myself over four years ago, and I have found this hand-held mobile device extremely useful for providing rapid and important diagnostic information at the bedside. The quality of the images of the V scan are usually of sufficiently high quality to make a useful clinical assessment. It is usually possible to make a fair assessment of systolic function of the left ventricle. I have also found that the identification of a dilated right heart has often been very useful for diagnosing massive pulmonary emboli – quite frequently when this diagnosis would not otherwise have been suspected. Valve lesions of significance are invariably pretty obvious and the images are usually adequate to identify vegetations as well. Pericardial effusion is readily detected.

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Impact of latest NICE guidelines on CRT and ICD implant rates

December 2015 Br J Cardiol 2015;22:134–5 doi:10.5837/bjc.2015.039

Impact of latest NICE guidelines on CRT and ICD implant rates

Andrew J Turley

Abstract

Cardiac implantable electronic devices (CIEDs) have an unquestionable evidence base in patients with reduced left ventricular ejection fraction (LVEF), already on optimal medical therapy. Implantable cardioverter defibrillators (ICDs) effectively treat ventricular arrhythmias, which account for up to 50% of mortality in patients with reduced LVEF.1 Likewise in appropriately selected patients, cardiac resynchronisation therapy (CRT) reduces hospitalisation rates, improves symptoms and prolongs life-expectancy.2

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Surgeon-specific mortality data are misleading and harmful

December 2015 Br J Cardiol 2015;22:132–3 doi:10.5837/bjc.2015.038

Surgeon-specific mortality data are misleading and harmful

Ravi De Silva

Abstract

The Government is soon to publicly disclose a league table for cardiac surgical units within National Health Service (NHS) England. While this information may be useful and raise questions as to why one unit may be better or worse than another, we are also to be made aware of surgeons who are performing significantly better or worse than expected in terms of risk-adjusted mortality. But are patient deaths following surgery caused exclusively by the surgeon, as surgeon-specific mortality data (SSMD) would imply? And is the surgeon with the lowest operative mortality the best doctor? In my opinion the answer to both these questions is a resounding no.

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‘The age of no retirement’: implications for the health of the nation

October 2015 Br J Cardiol 2015;22:130–1 doi:10.5837/bjc.2015.032 Online First

‘The age of no retirement’: implications for the health of the nation

Jonathan Collie

Abstract

Life-expectancy is now approaching 90 years, and it won’t stop there. Healthy life-expectancy is also extending, so that the average 60 year old can expect a further 11 years of healthy life. Currently, 35% of the UK population is over 50 years, and growing – and on the whole they are healthier, more skilled, better educated and more dynamic than ever before.

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Statins and myalgia: fact or fiction?

October 2015 Br J Cardiol 2015;22:127–9 doi:10.5837/bjc.2015.033 Online First

Statins and myalgia: fact or fiction?

Peter Sever

Abstract

Contemporary guidelines have lowered the threshold for statin use in primary prevention (7.5% risk of a cardiovascular event over 10 years in the USA,1 10% risk according to National Institute for Health and Care Excellence [NICE] guidelines in the UK).2 Applying these thresholds, the majority of men over 50 years and more than half of women over 60 years will qualify for statin use. Countering the more widespread uptake of statin use in primary prevention advocated by these guidelines are claims, popularised by the lay press and uncritically published in some medical journals,3,4 that statin use is accompanied by an unacceptable incidence of side effects that adversely compromise lifestyle and which challenge whether the small absolute benefits in some lower risk groups are worth the intolerance of the statin.

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August 2015 Br J Cardiol 2015;22:87 doi:10.5837/bjc.2015.028

Initiating oral anticoagulation in hospitalised AF patients: it’s time to talk

Matthew Fay

Abstract

When the National Institute for Health and Care Excellence (NICE) clinical guideline 180 on atrial fibrillation (AF) was published in June 2014, out if its many recommendations, two points seemed paramount. First, it is the patient, and not the clinician, who should make the decision as regards the nature of the treatment they are to receive, whether this be for stroke prevention or for symptom management, and that all those with AF should be offered stroke preventive therapy, with the exception of those without risk factors (CHA2DS2-VASc 0 or 1 in females).

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The new NICE AF guideline and NOACs: safety first or safety last?

June 2015 Br J Cardiol 2015;22:50–2 doi:10.5837/bjc.2015.018

The new NICE AF guideline and NOACs: safety first or safety last?

Adrian J B Brady, Derek T Connelly, Andrew Docherty

Abstract

A non-fatal myocardial infarction (MI) is an inconvenience; a non-fatal stroke is a catastrophe. While this is a simplification, it draws attention to the fact that most patients with a non-ST-segment elevation MI (NSTEMI) do quite well. Conversely, most patients who suffer a non-fatal stroke suffer a massive change to their lives and their families’ lives, and experience a devastating change in their quality of life.

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The new NICE AF guideline and NOACs: a response

June 2015 Br J Cardiol 2015;22:53–5 doi:10.5837/bjc.2015.019

The new NICE AF guideline and NOACs: a response

Campbell Cowan, Matthew Fay, Neal Maskrey

Abstract

We share Professor Brady et al.’s opinion1 that stroke prevention is the single greatest priority in the management of patients with atrial fibrillation (AF). It is reasonable to say that highlighting the inappropriately low levels of anticoagulant uptake as a major public health issue and seeking to improve anticoagulant uptake nationwide was uppermost in the minds of the Guideline Development Group (GDG) members.

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