Tag Archives: heart failure

Introduction Dr Tobias MacCarthy In 1736, Benjamin Franklin declared that ‘an ounce of prevention is worth a pound of cure’. With an ever-growing incidence of obesity, diabetes and cardiovascular disease, compounded by overwhelmed health services, this principle remains central to healthcare policies today. Diabetes has long been known to be associated with cardiovascular disease, principally heart failure, and the two are interlinked through mechanisms including increased oxidative stress, which leads to myocardial inflammation and fibrosis. There is now increasing focus on the concept of the ‘metabolic syndrome’ as an umbrella term

Introduction Chronic right ventricular (RV) pacing is associated with deterioration in cardiac function, increased mortality and heart failure hospitalisation.1 The UK PACE (United Kingdom Pacing and Cardiovascular Events) trial reported an overall annual incidence of clinical heart failure (HF) of approximately 3% in patients implanted with either a single-chamber or dual-chamber pacemaker over a three-year follow-up duration.2 A broader-paced QRS duration at baseline and the presence of coronary artery disease (CAD) are independently associated with new-onset HF in patients requiring permanent RV pacing for high-degree atrioventricular (AV)

Introduction Heart failure (HF) is a clinical syndrome due to a structural or functional abnormality of the heart that results in elevated intracardiac pressure or inadequate cardiac output at rest or during exercise.1 It affects around 900,000 people in the UK and poses a significant burden on the National Health Service (NHS), accounting for one million bed days per year.2 HF reduces life-expectancy with a one-year survival rate of 75.9% post-diagnosis and a 10-year survival of 24.5%.3 Patients living with HF also suffer from disability and reduced quality of life.4 With an ageing population, greater survival from myocardial infarctions (MI

Introduction Heart failure with reduced ejection fraction (HFrEF) affects 3.5–7.0% of patients aged 65–75 years, and up to 11% of those >80 years. Heart failure with preserved ejection fraction (HFpEF) accounts for at least half of heart failure diagnoses. The current overall prevalence of HFpEF (also known as HF with normal ejection fraction – HFnEF) and HFrEF is estimated to be 4.9% and 3.3%, respectively. Prevalence is expected to rise with an ageing population. There are multiple interventions proven to prolong life in patients with HFrEF.1 General practitioners (GPs) in the UK are financially incentivised by the Quality Outcome

Heart failure – best of times The conference was opened by Professor Theresa McDonagh, who showcased both triumphs and ongoing challenges in heart failure. She began by highlighting the key ingredients needed for good heart failure management – starting with the invaluable contribution of heart failure nurses to patient care, bolstered by the British Heart Foundation (BHF), and ambitious targets for training specialist heart failure consultants, aiming for 25% representation in tertiary centres and a third in district general hospitals. The role of B-type naturietic peptide (BNP) in heart failure management was underscored as pivotal, al

Introduction Following its discovery and introduction for clinical use in Birmingham, UK almost 250 years ago, digoxin has been used for the treatment of heart failure (HF). Indeed, until the advent of diuretics in the 1950s, it was the only available drug for this condition.1 Digoxin is an unusual drug in many respects. Derived from the foxglove plant, it increases intracellular Ca2+, and as an oral inotrope, is the only drug for chronic use in HF that addresses the primary problem, namely reduced cardiac pumping capacity (figure 1). All the other commonly used drugs for HF act indirectly to either inhibit the adverse neurohormonal response

Many randomised-controlled clinical trials (RCTs), such as DAPA-HF, DELIVER, EMPEROR-Preserved, EMPEROR-Reduced and CREDENCE trials have been conducted, using the different SGLT2 inhibitors, and have reported increased positive outcomes in the HF population.1–6 The mechanism(s) behind the cardiovascular protective effects by SGLT2 inhibitors remains unclear. Pleiotropic effects have been suggested; other plausible mechanisms include improved glycaemic control, reduced albuminuria, reduced blood pressure and amelioration of fluid overload.7 However, the increased use of this class of medications should be undertaken with awareness of the pot

Introduction The European Society of Cardiology (ESC) heart failure guideline has undergone major updates every few years, with recent publications being in 2016 and 2021, respectively.1,2 Advances within heart failure care continue at pace, with presentation and publication of key randomised-controlled trials (RCTs) and meta-analyses being seen at the major cardiology scientific congresses. Given the likely impact of several trials on heart failure management and patient outcomes, the decision was made to publish a focused update in 2023 incorporating the most recent data.3 After robust review by the ESC guideline task force, only trials th

Figure 1A. Volume domain representation of data sets referring to acute myocardial infarction patients. End-systolic volume (ESV) is plotted against end-diastolic volume (EDV). The dark blue line indicates a trajectory with a constant value for ejection fraction (EF), in this case 45%. Four patients satisfy this condition, but can be distinguished by considering the distance from the origin to each individual point. This distance is termed the companion to EF, and denoted as EFC. An example (pink-arrowed bar) is shown for the patient with the smallest ventricle having EF=45%. Four patients (marked by the coloured dotted lines referring to th

Dr Rosalynn C Austin Burden of treatment is a concept that describes the balance between an individual’s capacity (their abilities and available resources) and the workload (tasks assigned by healthcare professionals) related to treating their illness.5 When workload exceeds capacity, engagement with self-care, quality of life and clinical outcomes worsen.6–9 Research in people with HF has shown a relationship between symptom severity and the difficulty reported with workload associated with their illness (treatment burden).10,11 Medications were reported as part of ‘troublesome self-care’.12 But it appears that the burden lies not in