Tag Archives: chronic heart failure

Systems of heart failure delivery Best practice tariff There is now a ‘best practice tariff’ (BPT) programme for heart failure (and for many other conditions). Professor Iain Squire (University of Leicester) reviewed the implications of this and discussed National Institute for Health and Care Excellence (NICE) quality standards for chronic heart failure (CHF). The first year of the BPT (April 2015–March 2016) was voluntary but it has been compulsory since the beginning of the 2016–2017 financial year. For the financial year 2016–2017, the tariff is worth a 5% uplift in the amount a trust is paid for each and every admission. It is

The Sheffield audit of heart failure discharge advice given to GPs by Kanaan, Bashforth and  Al-Mohammed (see pages 113–16) illustrates perfectly the imperfections of implementing research findings and guidelines into every day clinical practice. The paper rightly points out the selective nature of the entry criteria of patients to RALES (Randomised Aldactone Evaulation Study).1 Most research trial patients are more scrupulously managed and monitored than in real world circumstances. The traditional way of organising discharge summaries usually defaults to the least experienced junior staff. The perception is often that a career in account

In the USA, in 2008 the total inflation-adjusted cost of heart failure admissions was US$10.7 billion, compared with US$6.9 billion in 1997.2 So heart failure admissions are expensive and there is considerable interest in how we might reduce admissions, thereby reducing costs and leading to an improved quality of life (QoL) for patients with heart failure.3  One solution might be the Observation Unit (OU) proposed by Collins et al.4 as an alternative to hospital admission for patients needing a brief period (under 24 hours) of intravenous diuretic therapy. Observation, by definition, is the use of appropriate monitoring, diagnostic testing,

A new treatment for acute heart failure? The recently published RELAX-AHF (Efficacy and Safety of Relaxin for the Treatment of Acute Heart Failure) study was a prospective, randomised, double-blind, placebo-controlled trial carried out in a targeted population of patients with acute HF.1 Relaxin is a physiological hormone that regulates maternal adaptations to pregnancy, increasing cardiac output, renal blood flow, and arterial compliance, alongside decreased peripheral vascular resistance.2,3 Serelaxin is a recombinant human relaxin-2 shown to have beneficial effects on symptoms and outcomes in early studies.4 The primary end points in thi

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NICE updates A new ‘Evidence Update’ has been produced by the National Institute for Health and Clinical Excellence (NICE), which summarises selected new evidence relevant to the NICE guideline on the management of chronic heart failure (CHF) in adults in primary and secondary care (clinical guideline 108).NICE says “Whilst Evidence Updates do not replace current accredited guidance, they do highlight new evidence that might generate a future changes in practice.”  It says it will welcome feedback from societies and individuals in developing this service. The update is available from www.evidence.nhs.uk/evidence-update-2. New guides

Anaemia in chronic heart failure: what constitutes optimal investigation and treatment? Dear Sirs, We read with interest the recent supplement on anaemia in heart failure patients.1 Since the publication by Bolger et al.2 on the benefits of intravenous iron therapy in chronic heart failure (CHF), we have been screening for anaemia and iron deficiency in this cohort. We actively treat these patients based on the criteria of a haemoglobin level less than 12 g/dL, already on optimal conventional heart failure therapy, New York Heart Association (NYHA) class II symptoms or worse, and a ferritin of less than 100 μg/L. We were previously using an

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Correction of anaemia is, therefore, an appealing strategy. Whilst erythropoietin levels may be elevated in CHF, they are often lower than expected when considering the haemoglobin concentration, indicating a relative deficiency. Similarly, iron metabolism is frequently disturbed, with many patients experiencing either an absolute or functional deficiency. Chronic iron deficiency may contribute to breathlessness and reduced exercise capacity, the hallmarks of symptomatic CHF. This supplement aims to increase awareness of anaemia in CHF and also to provide an overview of recent studies of erythropoiesis-stimulating agents (ESAs) and of intrav

Prevalence In published reports of patients with heart failure, the prevalence of anaemia varies markedly, reflecting the very varied characteristics of the studied populations. In reports based upon clinical trials, the reported prevalence ranges from 10–25% (figure 1), while in cohorts of patients in observational or registry-based studies, it appears to be higher, from 15–50% (figure 2). This variation is unsurprising given the relatively selected nature of patients recruited to clinical trials in CHF. A reasonable overall estimate can be gleaned from a large systematic review of 34 studies, including more than 150,000 patients, in wh