Tag Archives: heart failure

NICE heart failure guidelines The latest National Institute for Health and Care Excellence (NICE) guidelines for management of chronic heart failure (NG 106)1 were presented by Dr Abdallah Al-Mohammed (Sheffield Teaching Hospitals). It was fascinating to hear Dr Al-Mohammed describe his work on producing the guidelines with respect to what recommendations the authors are permitted to include and how recommendations may be presented. Key changes include the removal of a history of a previous myocardial infarction from the initial assessment of a patient with suspected chronic heart failure. Other changes include the guidelines now using the te

There is no precise definition of what constitutes a HFSN, and the exact number of HFSNs and where they are located is not well understood. Therefore, one of the key recommendations of the inquiry was that Health Education England should work with the Royal College of Nursing and the Nursing and Midwifery Council to ascertain the number and location of HFSNs. Despite this recommendation, no particular body appeared to come forward to undertake this crucial piece of work. At the Pumping Marvellous Foundation’s Heart Failure Summit 2017,3 which was comprised of multi-stakeholders, the commitment was made by the charity, supported by an unres

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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