Tag Archives: heart failure

Introduction Sodium-glucose cotransporter 2 inhibitors Sodium-glucose cotransporter 2 inhibitors (SGLT2i) demonstrate prognostic benefits independent of glycaemic control, most notably in the EMPA-REG OUTCOME trial.1 Subsequent large-scale randomised-controlled trials (RCTs) of SGLT2i consistently demonstrated improved cardiovascular outcomes irrespective of type 2 diabetes (T2D), extending to populations with heart failure (HF) and chronic kidney disease (CKD). This has culminated in the inclusion of SGLT2i in most T2D, HF and CKD guidelines.2 Frailty There is no universally accepted definition of frailty, which may be understood to be an ag

Obscure origin of the ejection fraction metric Only rarely have investigators revealed the origins of the popular metric called ejection fraction (EF), while, for example, referring to William Harvey or to a psychiatrist.1 Recently, a position paper reported that in 1918 MacKenzie ‘measured’ EF using heart rate and pulse pressure.2 However, one thing is clear: a rigorously documented foundation is absent.3 Fact is that more than a century ago Bardeen directly calculated the ratio of left ventricular (LV) stroke volume (SV) and end-diastolic volume (EDV).4 Indeed, there is no single published paper that explains, in full detail, what the e

Introduction Ventricular tachycardia (VT) is a well-recognised arrhythmia, commonly caused by scar-related aetiology. Here, we present the case of a patient in their mid-thirties with incessant VT refractory to combination anti-arrhythmic therapy and antitachycardia pacing (ATP). This report highlights the clinical challenges encountered during management and explores therapeutic strategies, offering insights into the complexities of addressing drug-resistant VT. The discussion emphasises the importance of individualised treatment approaches in challenging cases, considering the risks and benefits of available interventions. Case A patient in

Introduction Exercise-based cardiac rehabilitation (ExCR) is integral to the management of people with chronic heart failure (CHF).1 It not only improves quality of life (QoL), but is likely to reduce hospital admissions and mortality in this population.1 In response to this evidence, offering a personalised ExCR to all patients with stable CHF is included in the current National Institute for Health and Care Excellence (NICE) guidelines.2 Most CHF diagnoses (up to 80%) occur during an inpatient stay for acute decompensated heart failure (ADHF).3 An admission presents the opportunity for most people with CHF to be offered ExCR. CHF is associa

Introduction Performance-enhancing drug (PED) use is a growing concern in physique-focused sports. While cardiovascular risks are known, severe heart failure in young, healthy individuals is rare. PED use is often driven by competitive desires and body image issues, frequently linked to disorders like body dysmorphic disorder (BDD). This case report details a young bodybuilder with newly diagnosed BDD who developed severe heart failure from long-term PED abuse. It emphasises the potential cardiovascular risks in seemingly healthy individuals and the need for early, multidisciplinary intervention addressing both physical and psychological asp

Introduction Goals of care for patients with HF are to provide symptom relief, improve prognosis and quality of life, and prevent hospitalisations. Patients with HF are often complex, and multi-disciplinary input is recommended so that patients receive evidence-based treatments and maximise their quality of life.1 In the UK, the National Health Service (NHS) encompasses both hospital and community HF services, which work together to keep people living with HF supported and well-managed.2 Community HF teams provide specialist care for patients with HF, and community services are structured around outpatient appointments in healthcare settings

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