Clinical articles

Many heart failure patients are eligible to receive financial support (Disability Living Allowance or Attendance Allowance) because of their impaired mobility. Those with a very limited prognosis can gain rapid access to these benefits by claiming under “special rules” with the support of a report (DS 1500) from their doctor.

Little is currently known of the effect of switching statin therapy on cardiovascular outcomes. Using The Health Improvement Network database, patients who had received atorvastatin for ≥ six months were identified. They were classified as ‘switch’ if they were subsequently switched to simvastatin, and were matched to up to four ‘control’ patients who remained on atorastatin. Time to death or first major cardiovascular event was compared, controlling for the matching co-variates, prior statin exposure and baseline cholesterol concentration.

Implementation of a new specialty training Curriculum in Cardiology from August 2007 will bring significant changes to specialist training in cardiology. The format, delivery and evaluation will differ, and these changes are relevant to both existing and newly appointed trainees. This article aims to summarise the changes and incorporates presentations by the Cardiology Specialist Advisory Committee at the British Cardiovascular Society conference in June 2007.

Several imaging modalities are available for the optimal management of patients with cardiovascular disease. When assessing any imaging technique, the radiation dose must be considered along with the value of the imaging technique. In this article, we summarise the radiation doses associated with cardiovascular imaging techniques, such as heart catheterisation, nuclear medicine and multi-slice computed tomography. The effective dose of the dual isotope scan, an image modality frequently used in cardiac patients, is higher (~25 mSv) than cardiac computed tomography (~10 mSv) or diagnostic heart catheterisation (~5 mSv). The physician should weigh carefully which test to recommend in each patient.

This case describes the unfortunate consequence of hepatic abscess, initially discovered following abnormal liver function tests.

The aims of treatment in chronic heart failure are to reduce symptoms, improve function and prolong life. Currently there is no patient-centred health-related quality of life measure in chronic heart failure. The aim of this study was to explore health-related quality of life from the perspective of patients with chronic heart failure and to identify themes for inclusion in a patient-generated instrument. 

Semi-structured interviewing of patients with an objective diagnosis of chronic heart failure was undertaken. Analysis of the transcripts identified seven themes on health-related quality of life. These were: changes in physical ability, emotional state, self-awareness and self-perception, changes in relationships, symptoms, maintaining social/lifestyle status and cognitive aspects. 

Findings from this study will contribute to the development of a patient-led health-related quality of life measure for use in everyday practical care in a chronic heart failure population.

Atherothrombosis is a leading cause of global mortality. It represents a significant public health issue in the UK and, as such, the UK Government has made it a healthcare priority. The global REduction of Atherothrombosis for Continued Health (REACH) Registry aims to evaluate the long-term risk of atherothrombotic events in an at-risk population, to assess the importance of cross-risk and to define predictors of atherothrombotic events. REACH has recruited over 68,000 people in over 5,000 centres in 44 countries, of which 618 were from the UK.

Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease and in February 2006 was added to the Quality and Outcomes Framework (QOF) for primary care in the UK. The QOF indicators apply to all patients with stage 3–5 CKD and include the production of a register of such patients, appropriate monitoring and treatment of hypertension and the prescription of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs).

Over the last few years, there has been a gradual increase in the use of intensive statin therapy, ostensibly atorvastatin 80 mg for high-risk individuals, such as those who suffered a myocardial infarction or underwent revascularisation. First-World economies, such as the UK, with a significant state contribution healthcare funding, had mounting anxiety because of the expanding indications and therefore cost of intensive statin therapy. The perceived relative expense of this strategy provoked a swift, often unilateral, withdrawal of such regimens by commissioners.

Stent thrombosis (ST) is an uncommon but serious complication of percutaneous coronary intervention (PCI), and is associated with the discontinuation of antiplatlet therapy. In a retrospective study of ST cases during a two-year period of the Wessex Regional Cardiac Unit, 3,004 (1,661 emergency and 1,343 elective) patients underwent PCI between November 2003 and October 2005. There were 25 episodes of ST occurring in 22 patients (overall incidence of ST is 0.83%). There were two (8%) cases of acute ST, eight (32%) of sub-acute ST and 15 (60%) of late or very late ST (five cases between six and 12 months and one case more than one year post-procedure). In the late and very late ST group only one patient was taking dual antiplatelet therapy.