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Tag Archives: heart failure

July 2019 Br J Cardiol 2019;26(3) doi:10.5837/bjc.2019.023

Heart failure specialist nurse care: more questions than answers!

Angela Graves, Nick Hartshorne-Evans

Abstract

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

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Introduction

July 2019 Br J Cardiol 2019;26(suppl1):S3 doi:10.5837/bjc.2019.s01

Introduction

Pardeep S Jhund, John J V McMurray

Abstract

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

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Applying PARADIGM-HF to the use of sacubitril/valsartan in clinical practice

July 2019 Br J Cardiol 2019;26(suppl 1):S4-S8 doi:10.5837/bjc.2019.s02

Applying PARADIGM-HF to the use of sacubitril/valsartan in clinical practice

Pardeep S Jhund, John J V McMurray

Abstract

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

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Initial experience of introducing sacubitril/valsartan in a UK heart failure service

July 2019 Br J Cardiol 2019;26(suppl 1):S15-S19 doi:10.5837/bjc.2019.s04

Initial experience of introducing sacubitril/valsartan in a UK heart failure service

Richard J Crawley, Geraint Morton, Navneet Kalsi, Paul R Kalra, Kaushik Guha

Abstract

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

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May 2019 Br J Cardiol 2019;26:63–6 doi:10.5837/bjc.2019.019

Use of Frailsafe criteria to determine frailty syndrome in older persons admitted with decompensated HF

Janine Beezer, Titilope Omoloso, Helen O’Neil, John Baxter, Deborah Mayne, Samuel McClure, Janet Oliver, Zoe Wyrko, Andy Husband

Abstract

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

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May 2019 Br J Cardiol 2019;26:50

Quick takes from ACC.19: The American College of Cardiology 68th Annual Scientific Sessions

Gerald Chi, Syed Hassan Abbas Kazmi, C. Michael Gibson

Abstract

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

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Pacing supplement: Drugs with devices in the management of heart failure

October 2018 Br J Cardiol 2018;25(suppl 3):S20–S24 doi:10.5837/bjc.2018.s15

Pacing supplement: Drugs with devices in the management of heart failure

Balrik Singh Kailey, Christopher Allen, Badrinathan Chandrasekaran

Abstract

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

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August 2018 Br J Cardiol 2018;25:97–101 doi:10.5837/bjc.2018.025

Impact of hyperkalaemia in managing cardiorenal patients – a healthcare professional perspective

Navneet Kalsi, Sarah Birkhoelzer, Philip Kalra, Paul Kalra

Abstract

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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Prescribing glucose-lowering drugs for patients with cardiac disease

June 2018 Br J Cardiol 2018;25:73–6 doi:10.5837/bjc.2018.016

Prescribing glucose-lowering drugs for patients with cardiac disease

Miles Fisher, Emma Johns, Gerry McKay

Abstract

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January 2018 doi:10.5837/bjc.2018.002 Online First

Variability in use of IV nitrates and diuretics in acute HF: a ‘virtual patient’ clinical decision-making study

Alison Carr, Fosca De Iorio, Martin R Cowie

Abstract

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

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