This website is intended for UK healthcare professionals only Log in | Register

Editorial articles

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).

| Full text
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.

| Full text
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.

| Full text
NICE guidelines for acute heart failure: long on pills, short on pumps

April 2015 Br J Cardiol 2015;22:(2) doi:10.5837/bjc.2015.014 Online First

NICE guidelines for acute heart failure: long on pills, short on pumps

Stephen Westaby

Abstract

The heart beats 120,000 times a day pumping 7,000 litres. Ischaemia or inflammation decimate this workload causing end organ dysfunction. New National Institute for Health and Care Excellence (NICE) guidelines for acute heart failure (AHF) acknowledge very high early mortality. Of 67,000 acute admissions, 11% die in hospital, 50% are readmitted and 33% are dead within 12 months.1,2 When cardiogenic shock ensues, prognosis is poor.3-5 Most patients are elderly but several thousand deaths occur in those under 65 years. Many are salvageable using advanced resuscitation techniques. When the prospectively randomised-controlled trial (RCT) IABP-SHOCK II trial (Intra-Aortic Balloon Pump in Cardiogenic Shock II) revealed the intra-aortic balloon pump (IABP) as ineffective, a New England Journal of Medicine (2012) editorial stated “we must move forward understanding that a condition with 40% mortality at 30 days remains unacceptable”.3,4 So do the guidelines help with this? 

| Full text
Synthetic and natural cannabinoids: the cardiovascular risk

March 2015 Br J Cardiol 2015;22:7–9 doi:10.5837/bjc.2015.006

Synthetic and natural cannabinoids: the cardiovascular risk

Ethan B Russo

Abstract

Cannabis has been employed medicinally and recreationally for thousands of years,1,2 but it was not until the 1960s that the structure and pharmacology of its primary phytocannabinoid components, cannabidiol (CBD)3 and tetrahydrocannabinol (THC)4 were identified, and another generation before the nature and function of the endocannabinoid system (ECS) were elucidated (see reference 5 for a comprehensive review). The ECS consists of endogenous cannabinoids, anandamide (AEA) and 2-arachidonoylglycerol (2-AG), their biosynthetic and catabolic enzymes, and their receptors: CB1, which is psychoactive, analgesic, neuromodulatory and the most abundant G-protein coupled receptor in the brain, and CB2, which is non-psychoactive, immunomodulatory and anti-inflammatory. The ECS may be thought of as a grand homeostatic regulator of chordate physiological functions, whose roles have been summarised as: “relax, eat, sleep, forget and protect”.6 Those actions closely describe the effects of THC and AEA, which are both weak partial agonists at CB1 and CB2. 

| Full text
Breaking the deadlock

March 2015 Br J Cardiol 2015;22:10–11 doi:10.5837/bjc.2015.007

Breaking the deadlock

Miriam J Johnson

Abstract

We know that people with advanced heart failure have unmet supportive and palliative care needs, and the burden of these concerns is comparable with people with cancer.1–2 Palliative care services in the UK and elsewhere have grown up around oncology services. Randomised controlled trials (RCTs) have confirmed that early integration of palliative care, alongside cancer treatment, improves patient outcomes.3–7 In contrast, experience of and the evidence base for integration of palliative care alongside heart failure treatment has been slow to develop. However, this is changing. A pilot RCT comparing the addition of a palliative care intervention to usual care for people with advanced heart failure has reported benefit in health-related quality of life, symptom control and health service utilisation (reduced hospital admission)8 and several phase three RCTs are ongoing. 

| Full text
Hypoglycaemia: patient inconvenience or serious cardiovascular risk? 

December 2014 Br J Cardiol 2014;21:128–30 doi:10.5837/bjc.2014.031

Hypoglycaemia: patient inconvenience or serious cardiovascular risk? 

Vidya Srinivas, Kashif Kazmi, Ketan Dhatariya

Abstract

Hypoglycaemia is defined as a lower than normal level of blood glucose, and in patients on glucose-lowering therapy, defined as glucose levels less than 4 mmol/L. In the UK, it is usually classified as ‘mild’, if the episode is self-treated, or ‘severe’, if the individual requires third-party assistance. However, the American Diabetes Association definition of hypoglycaemia is different.1 They classify hypoglycaemia into five categories. These are shown in table 1

| Full text
Support for prescribers to help improve patient adherence to medication

October 2014 Br J Cardiol 2014;21:131–2 doi:10.5837/bjc.2014.032 Online First

Support for prescribers to help improve patient adherence to medication

Linda van der Heiden, Joyca Lacroix, Saskia van Dantzig, Aart van Halteren

Abstract

Non-adherence to medication for chronic conditions, whether this involves tablets, inhalers, injections or other drug delivery systems, is a serious healthcare problem resulting in poor clinical outcomes and high costs. Here, we review the extent of the problem and the development of a novel evidence-based digital tool to support healthcare professionals (HCPs) in assessing and potentially improving the adherence of chronic patients. 

HCPs are increasingly focusing on developing interventions to address this problem. However, the development of effective adherence interventions is challenging; it involves finding the individual root causes of non-adherence, with the added difficulty of introducing and maintaining behavioural change, and offering tailored solutions that address the specific needs of a particular patient.

| Full text

September 2014 Br J Cardiol 2014;21:96–7 doi:10.5837/bjc.2014.026

TAVI – assessing the need for circulatory support

Christopher J Allen, Alison M Duncan, Neil E Moat, Alistair C Lindsay

Abstract

Transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) has expanded exponentially since it was first described 12 years ago, with around 100,000 procedures performed worldwide.1,2 Randomised controlled trials have established TAVI as the treatment of choice for severe AS in patients of prohibitive surgical risk and as a viable alternative to surgical aortic valve replacement (SAVR) in high-risk candidates.3–5 The feasibility and safety of TAVI is further supported by a large body of ‘real-world’ data from multi-centre registries with 93% 30-day and 79% one-year survival in the UK.6 Moreover, with growing operator experience and evolving valve technology, TAVI continues to expand beyond those populations originally studied, to include those with severe left ventricular dysfunction and those with failing surgical homografts (so called ‘valve-in-valve’ TAVI), for example.7,8

| Full text
New opportunities for cholesterol lowering: focus on PCSK9 inhibitors

July 2014 Br J Cardiol 2014;21:91–3 doi:10.5837/bjc.2014.021

New opportunities for cholesterol lowering: focus on PCSK9 inhibitors

Peter Sever, Judy Mackay

Abstract

Lowering serum cholesterol with statins has consistently shown benefits on cardiovascular outcomes. A 1 mmol/L reduction in low-density lipoprotein (LDL)-cholesterol is associated with approximately one-third fewer coronary events and one-fifth fewer ischaemic strokes.1 However, despite these impressive results, there remains a substantial residual risk of cardiovascular (CV) events despite optimal statin therapy.2 From pooled analyses of randomised-controlled trials of statins, there is a clear relationship between the achieved level of LDL-cholesterol and the number of coronary heart disease (CHD) events. This observation applies to both primary and secondary prevention trials.3 

| Full text
Close

You are not logged in

You need to be a member to print this page.
Find out more about our membership benefits

Register Now Already a member? Login now
Close

You are not logged in

You need to be a member to download PDF's.
Find out more about our membership benefits

Register Now Already a member? Login now