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The prevalence of anaemia in heart failure (HF) is becoming better recognised, yet little is known about its natural history in a HF population. We examined the records of 200 consecutive patients who were admitted to our service with New York Heart Association (NYHA) class IV HF, survived and were followed for six months following discharge. Complete records were available on 120 patients. Anaemia was defined as a haemoglobin concentration of < 13 g/dL in males and < 12 g/dL in females. Forty-one patients (34%) were found to have anaemia of unknown cause on admission. At follow-up (mean time 6.1+0.3 months), 28 patients were persistently anaemic. The haemoglobin concentration in the remaining 13 had returned to normal. A further group of 11 patients had become anaemic during the six-month follow-up period. All patients had been treated with maximally tolerated medical therapy. Anaemia was found to be equally prevalent in patients with preserved systolic function HF. Factors found to be independently associated with lower haemoglobin at follow-up were female sex, a history of gastrointestinal disease, inflammatory disease and a low glomerular filtration rate (GFR). Haemoglobin concentration at follow-up was found, on univariate analysis, to be associated with an increased risk of a HF-related admission during the follow-up period and increased severity of HF symptoms. On multivariate analysis, haemoglobin concentration at follow-up was found to be an independent predictor of NYHA class III–IV symptoms. In conclusion, anaemia is prevalent in a population admitted with class IV failure. While the haemoglobin concentration had normalised in a significant number of patients during follow-up, the presence of anaemia six months after discharge was associated with having a HF-related readmission and independently associated with moderate-to-severe HF symptoms....

This is the final article in a series examining how the Coronary Heart Disease Collaborative (CHDC) supports clinical teams to improve services for coronary heart disease. The focus in this issue is on secondary prevention services....

We continue our series on the work of the Coronary Heart Disease Collaborative (CHDC), which is part of the NHS Modernisation Agency. In this issue the CHDC looks at how its teams are helping improve services for patients undergoing cardiac surgery....

Percutaneous aortic valve replacement, a new technique developed to overcome the problem of restenosis of the native valve in patients treated with balloon aortic valvuloplasty. It describes the first four cases which have been undertaken using this new technique that show the potential for its development for more widespread use in the future. ...

Patients with suspected angina pectoris pose a major challenge to all levels of cardiology services. Their pathway through their NHS care can involve many stages over many years – figure 1 shows this hypothetical journey. ...

Cardiac rehabilitation received full support in the National Service Framework (NSF) for Coronary Heart Disease (CHD). ...

Better care without delay: heart failure Coronary Heart Disease Collaborative Heart failure is a subject that is equally challenging to primary and secondary care physicians but in different ways. These challenges, however, are different faces of the same problem but their presentation can lead to confusion and anxiety among some doctors treating heart failure patients. We continue our series on the Coronary Heart Disease Collaborative (CHDC) and turn our focus in this issue to its work in helping clinical teams improve heart failure services across the country....

Exploring how the CHD Collaborative is helping clinical teams across the country achieve clear improvements in services for patients with coronary heart disease. Each article will focus on one of the Collaborative’s six project areas (seen in the heart right). Here, national clinical leads and other Collaborative staff, who have a particular interest in the acute myocardial infarction pathway, report on some of the work that has been done so far....

Revascularisation and the diabetic patient: the potential role of drug-eluting stents David Barrow David Barrow, a medical journalist with a special interest in interventional cardiology, discusses the potential benefit of drug-eluting stents in relationship to the revascularisation of the diabetic patient. It has been estimated that 13% to 25% of the patients undergoing coronary revas-cularisation procedures have diabetes and the diabetic patient continues to face higher mortality rates than non-diabetic patients after revascularisation. There is much debate on the preferred method of revascularisation in the diabetic patient: percutaneous transluminal intervention (PCI) or coronary artery bypass graft surgery (CABG)....

Waiting for a bypass: a comment from primary care Peter Stott The length of time that patients spend on the waiting list for coronary artery bypass surgery (CABG) is a matter of concern. In one study of 1,049 patients in the South East of the UK, the mean time to specialist consultation was 36 days (SD 43); the time waiting for coronary angiography was 85 days (SD 89); and the mean time on the surgical waiting list for CABG was 133 days (SD 134) – a mean time of 279 days (SD 209; range 1–1,579 days) from GP referral1 to CABG....