Tag Archives: heart failure

Introduction Professor Stephen Westaby Many of us have watched severe heart failure patients die miserably during haemorrhagic pulmonary oedema. The first for me was my 60-year-old grandfather when I was seven years old. Not something that was easily forgotten. Months later, in 1955, I watched the first episode of ‘Your life in their hands’ from the Hammersmith Hospital. They talked of open heart surgery using something called cardiopulmonary bypass. It was then, in the backstreets of a northern steel town, that I decided to be a heart surgeon. Figure 1. Skull pedestal power delivery Fifty years later, when the BBC resurrected the series,

Prevalence Among patients with a diagnosis of heart failure (HF), it is reported that up to 40-50% may have HFpEF.1 HFpEF also accounts for an increasing proportion of HF-related hospitalisations.2 There is a strong association between HFpEF, older age, and cardiovascular and non-cardiovascular comorbidities. As life expectancy and comorbidity rates rise, the proportion of HF patients with HFpEF and resulting impact of HFpEF on healthcare services is projected to increase. Clinical presentation Patients with HFpEF experience similar symptoms and signs to patients with HF with reduced ejection fraction (HFrEF), including breathlessness, fatig

Introduction When COVID-19 struck, changing not only how we work as clinicians, but how patients wish their care to be managed, it provided the necessary impetus to undertake such transformation work. During the pandemic an estimated 23,000 diagnoses of heart failure (HF) were missed with an associated 44% drop in referrals for diagnostic echocardiography compared with 2019.1 During a six-week period of the second wave, another study found that there was a 41% decline in HF-related admissions and a 34% decline in heart attack admissions.2 Such reductions in admissions were seen during the first wave and were noted to contribute to more than 2

There are many major challenges in managing cardiorenal syndrome, its prevalence is high (in 30% of hospitalised patients with heart failure),5 it is associated with a wide range of comorbidities, its diagnostic criteria remain arbitrary, the fine balance between potential damage and therapeutic effect with the current medical treatment is hard to strike, its prognosis remains poor and its prevention has been hardly explored by the medical profession. Prevention is better than cure Prevention of cardiorenal syndrome, as in other medical conditions, would be much more fruitful than any treatment once occurred. The current prevention of cardior

Introduction Heart failure (HF) is a clinical syndrome characterised by breathlessness, leg swelling and fatigue, which is caused by a primary cardiac abnormality. HF can be categorised into HF with a reduced ejection fraction (HFrEF; ejection fraction <50%) or HF with a preserved ejection fraction (HFpEF; ejection fraction >50%).1 It was estimated in 2012, in Ireland, that 90,000 people had HF, with another 160,000 people at risk of developing the disease.2 There are also an estimated 10,000 new cases of HF every year.2 Both prevalence and incidence have likely increased since 2012 due to the ageing population and increases in comorbid

Contents Prevalence, causes, diagnosis and guidelines for treatment Mohamed Eltayeb, Vishnu Ashok, Iain Squire United Kingdom treatment of iron deficiency in heart failure: are we missing opportunities? Chun Shing Kwok, Sarah McDermott, Sadie Bennett, Simon Duckett Intravenous iron therapies and their differences Paul Foley Iron deficiency – the invisible comorbidity in HF: prioritising QoL as a target for treatment Jacquelyn Hooper, Nick Hartshorne-Evans, Colin Cunnington, Fozia Zahir Ahmed Conclusions Iain Squire

Pathophysiology Anaemia is a common comorbidity in heart failure (HF) and is strongly associated with disease severity, prognosis and mortality.1 The pathophysiology behind the high prevalence of anaemia in HF, and its association with adverse outcomes, is complex and multi-factorial.2 Some of the key factors involved include renal impairment, chronic inflammation, medications and haematinic deficiency, in particular iron deficiency (ID).3 ID is typically defined as a serum ferritin level <30 µg/L and transferrin saturation <20%.4 ID has better predictive value in identifying risk of long-term unfavourable outcomes in patients with chr

Introduction Iron deficiency in patients with heart failure with reduced ejection fraction (HFrEF) is common, affecting 60% of patients with hospitalisation for heart failure or worsening heart failure in the outpatient setting.1 Patients with heart failure are iron deficient for multiple reasons, including poor nutrition, malabsorption, reduced intracellular uptake of iron and blood loss.2 Two meta-analyses of randomised-controlled trials (RCTs) have shown the benefits of restoring iron levels in improving quality of life, exercise tolerance and reducing hospitalisation for heart failure, although, as of yet, no mortality benefit has been se

Introduction Iron deficiency has a major impact on cellular function, which is important in patients with heart failure with reduced ejection fraction because the prevalence is high. Interestingly, iron deficiency is not synonymous with anaemia – 50–73% of heart failure (HF) patients are iron deficient, yet 46% are not anaemic.1 The familiar response to treatment with iron, an increase in haemoglobin, does not always occur with iron treatment in patients with heart failure, yet replenishment does improve mitrochondrial function. It is notable that iron-containing proteins have a vital role in cellular energy metabolism. Remarkably, very

Introduction Despite significant advances in treatment, many patients with heart failure (HF) have poor outcomes, with one- and five-year mortality worse than most cancers.1 In view of this, improving quality of life (QoL) for patients with HF is considered a key target for treatment.2-4 Among patients with HF, iron deficiency (ID) is prevalent and affects up to 50% of patients.5 Like HF, ID is not only associated with increased morbidity and mortality, but it is also associated with reduced QoL.6,7 As the predominant symptoms of ID (fatigue, breathlessness and lethargy) particularly with anaemia, are often indistinguishable from those of HF,