Tag Archives: heart failure

Introduction That renal and cardiac disease appear inseparable from an epidemiological perspective is unsurprising, since they share many risk factors, notably hypertension, diabetes and inflammation. To date, however, our focus on the disparate specialities of ‘cardiology’ and ‘nephrology’ has reinforced a perception of each system as separate. The Cardiorenal Forum (CRF) was established to challenge this perspective. The most recent meeting, last autumn, ‘Optimising care at the cardiorenal interface’ was organised by the Royal College of Physicians, the British Cardiovascular Society and the Renal Association, in association wit

We reviewed the use of DS1500 applications for state financial benefits for patients dying from cancer (n=54) and heart failure (n=24) in one primary care practice. There was a marked inequality in favour of those with cancer, both in terms of DS1500 application form usage (cancer 33% versus heart failure 0%), but also access to palliative care service referrals (cancer 54% versus heart failure 8%) and discussion in Gold Standards Framework practice meetings (cancer 61% versus heart failure 4%). There should be equal provision of a ‘gold standard’ of care for patients with terminal disease irrespective of aetiology. Background High-qualit

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Coffee consumption shows CHD benefits in women A meta-analysis of a number of cohorts studies published in the International Journal of Cardiology (2009;137:216-25) demonstrates that habitual coffee consumption may be associated with a lower risk of coronary heart disease (CHD) in women. Analysis of data from 21 cohort studies showed that moderate coffee consumption (of up to four cups of coffee per day) were associated with a 18% reduction in risk of CHD in women.  The investigators note that such an effect was unlikely to be caused by chance. Further benefits have been shown from a meta-analysis published in the Archives of Internal Medici

Introduction A large number of studies have documented a high rate of co-occurrence of psychiatric morbidity and chronic medical conditions, such as bronchial asthma, diabetes, hypertension and heart disease.1,2Specifically, in heart failure (HF), psychiatric complications such as depression and anxiety are very common.3,4 In Africa, most especially Nigeria, HF is quite common with attendant high morbidity and mortality rates.5,6 Studies have shown that co-morbid psychiatric disorders delay recovery from HF, increasing length of hospital stay, with associated poorer prognosis and increased mortality.7,8 Despite the importance of co-morbid psy

GISSI-HF shows benefit for PUFA in heart failure Two new studies from the Italian GISSI group show that n-3 polyunsaturated fatty acids (PUFA) supplementation improves morbidity and mortality in those with symptomatic heart failure, but statins don’t have any benefit in the same type of patients. The results were presented during a hotline session at the Congress and published simultaneously in The Lancet (Lancet 2008; DOI:10.1016/S0140-6736[08]61239-8, and Lancet 2008;DOI:10.1016/S0140-6736[08]61240-4). Long-term administration of PUFA reduced all-cause mortality by 9%, which the investigators say was a modest effect, and they also cut

Introduction Renal artery stenosis (RAS), traditionally the preserve of the nephrologist, is a condition of increasing interest to the cardiologist. Ninety per cent of RAS is caused by atherosclerosis and the risk factors for renal atherosclerosis and coronary atherosclerosis are the same. Furthermore, the presence of RAS alters the prognosis of co-existent cardiac disease, most notably cardiac failure and ischaemic heart disease, both directly1–3 and via its sequelae of renal failure and hypertension. Finally, the treatments for the disease, both medical and interventional, are familiar to the cardiologist, who can employ much of the knowl

A recent survey of primary care trusts (PCTs) in England found that only 26% currently offered or had previously offered natriuretic peptides for use in primary care.4 Clinicians and healthcare purchasers (PCTs in the UK) still harbour concerns about appropriate cut-offs, the extra cost of BNP/NT proBNP assays, which assay to use (BNP or NT proBNP/point-of-care or laboratory assay), lack of expedient referral pathways for patients with a raised BNP/NT proBNP level and absence of cost-benefit/effectiveness data from a prospective primary care study. Landmark studies such as the Hillingdon heart failure study5 confirmed the high negative predic

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Setting an example The primary care-based heart failure service in Gloucestershire is now four years old and has promising data from its 2006 audit. The audit comprises data from all patients (n=524) with left ventricular systolic dysfunction managed by the service throughout 2006. Results showed all-cause mortality in this high-risk group of only 8.2%, with half of these patients dying at home. In the group of patients who had died during 2006, almost one third had previously discussed and indicated the place they wished to be cared for during the final phase of their illness, with the vast majority opting for home. In over 70% of these case