Tag Archives: heart failure

Findings The audit’s aim was to give a first insight into the provisioning of heart failure nurse services in the UK and sought to look at employer organisations and field of practice, case-load management, access to diagnostics and monitoring, grading and skills, the make-up of the multi-disciplinary team (MDT), and qualitative feedback as to current progress and concerns within teams. The audit was performed via an online digital platform, with considerable resources being employed to reach teams and encourage them to complete the audit. It is believed that up to 75–80% of teams participated in the audit, accounting for 532 full-time n

The PARADIGM-HF (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) study is the key randomised-controlled trial that underpins the clinical use of sacubitril/valsartan, which demonstrated significantly improved clinical outcomes in patients with HFrEF, in comparison with angiotensin-converting enzyme (ACE) inhibition.1 Patients with HFrEF in the routine-care setting represent a clinically heterogeneous population, with a high incidence of comorbidities. Our first article dives deep into the PARADIGM-HF data, and presents the results of key subgroup analyses that support the use o

Introduction The PARADIGM-HF (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial demonstrated that the angiotensin receptor/neprilysin inhibitor (ARNI), sacubitril/valsartan (formerly known as LCZ696), was superior to enalapril in reducing the occurrence of adverse cardiovascular (CV) outcomes in patients with heart failure with reduced ejection fraction (≤40%; HFrEF).1,2 The trial was terminated early, on the advice of the independent safety monitoring board, on the basis of clear benefits. These included:1 a 20% relative risk reduction (4.7% absolute risk reduction [ARR

Introduction Heart failure (HF) remains a significant problem globally.1 In the UK, the prevalence is estimated at over 500,000 individuals,2 with care representing 2% of National Health Service (NHS) resources (approximately £2.3 billion).3 A large proportion of the economic burden relates to lengthy and recurrent hospitalisations. Despite advancements, HF is still associated with a poor prognosis. The National Heart Failure Audit from England and Wales demonstrates an in-hospital mortality rate of around 9%, and a one-year mortality of just over 23%.4 Treatment for patients suffering from HF with reduced ejection fraction (HFrEF) is primar

Introduction Frailty is a distinctive health state, related to the ageing process, in which multiple body systems gradually lose their in-built reserves, and is related to poorer outcomes.1 There have been numerous tools developed to identify frailty,2-4 often these tools are complex and not suitable for identifying patients at the time of admission to hospital, requiring a comprehensive geriatric assessment to validate them. The British Geriatrics Society developed the Frailsafe5,6 checklist, which was piloted across 12 UK hospitals in 2014 as part of the Frailsafe collaborative. The tool used three screening indicators to identify patients

ACC.19 was held in New Orleans, US PARTNER 3 and Evolut Low Risk add to evidence base for TAVR Prior literature suggests that transcatheter aortic-valve replacement (TAVR) is non-inferior or even superior to standard surgical aortic-valve replacement (SAVR) among high and intermediate surgical risk patients with aortic stenosis (AS). Two pivotal studies have now addressed the efficacy and safety of TAVR in AS patients at low mortality risk from surgery. PARTNER 3 (ClinicalTrials.gov: NCT02675114) was an open-label trial that randomised 1,000 subjects with severe AS at low mortality risk from surgery into either TAVR with a third-generation ba

Introduction Device therapy has revolutionised the landscape of heart failure over the past 10 years. Prior to device therapy, the most important trials in heart failure (HF) management centred on pharmacotherapy. The CONSENSUS (Cooperative North Scandinavian Enalapril Survival Study) trial (1987),1 showed the importance of optimal blockade of the renin–angiotensin–aldosterone system (RAAS). Similarly, CIBIS-II (Cardiac Insufficiency Bisoprolol Study II) (1999)2 and RALES (Randomized Aldactone Evaluation Study) (1999)3 trials did the same for beta-blockade and spironolactone, respectively. This century, device therapy has also become part

Introduction Modulation of the RAAS is an integral part of the management for patients with chronic heart failure, prior myocardial infarction and diabetic nephropathy. Evidence from large scale trials demonstrates the clear prognostic benefit of angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists and more recently angiotensin receptor neprilysin inhibitors for these high-risk groups.1-3 The use of these agents, particularly in combination, can be associated with hyperkalaemia, although the incidence is unknown.4 A clear trend exists between the development of hyperkalaemia and

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Introduction Acute heart failure (AHF) syndromes are the leading cause of hospitalisation in patients over 65 years of age in the UK, accounting for 67,000 admissions per year.1 The immediate management of AHF focuses on symptom relief and stabilisation of the patient’s haemodynamic profile – traditionally achieved with a combination of oxygen, diuretics and nitrate therapy.1-5 Recent guidelines from the National Institute for Health and Care Excellence (NICE),1 and the European Society of Cardiology (ESC),5 have highlighted the poor-quality evidence base for many of these interventions.3,4,6 The ESC guidelines (updated in 2016) state th