Tag Archives: heart failure

Introduction The prevalence of heart failure (HF) in the UK is estimated to be 920,000, with 200,000 new diagnoses every year.1 HF is the most common cause of admission for people over 65 years old and accounts for 2% of the National Health Service (NHS) total budget, which is approximately £2 billion. Seventy per cent of these costs are attributed to HF hospitalisation, amounting to £3,796 per episode of HF hospital admission, based on an average length of stay of 13 days.2 Additionally, untreated heart failure with reduced ejection fraction (HFrEF) has a mortality rate of approximately 40%,3,4 therefore, evidence-based pharmacological tre

Introduction Takotsubo cardiomyopathy (TTCM) is an often reversible injury of the myocardium caused by catecholamine excess, usually after a stressor.1 The first case series were described by Tsuchihashi et al. three decades ago, and it was named due to the resemblance of the left ventricle (LV) in ventriculography to a Japanese pot used to catch octopuses. It usually affects post-menopausal women and has a typical form involving the mid and apical segments of the LV (apical ballooning), and atypical forms (mid, basal and focal TTCM).2 Mid-ventricular TTCM is a rare variant that affects the mid-segments of the LV, and accounts for 14.6% of pa

Introduction Dr Cong Ying Hey Disparities in cardiovascular (CV) morbidity and mortality are among the major health and social care concerns in our modern society. In the UK, people living in the most deprived areas are four times more likely to die prematurely from CV disease (CVD) than those living in the least deprived areas.1 To address the disparities in CV outcomes, it is imperative to recognise the presence of inequalities at different interfaces of cardiology services. This article, therefore, aims to provide a focused discussion concerning potential measures to reduce health inequalities in cardiology through the lens of the challeng

This supplement provides a user’s guide to what’s new in the guidelines for the diagnosis and treatment of heart failure. This primarily relates to recommendations provided in the updated (2021) European Society of Cardiology (ESC) guidelines for the diagnosis and treatment of acute and chronic heart failure. The articles summarise the contemporary guidance with respect to the diagnosis and investigation of patients presenting with heart failure; drug therapy (including the early implementation of the ‘four pillars’ of drug treatment for heart failure with reduced ejection fraction); and recommendations on lifestyle, rehabilitation,

Introduction The heart failure (HF) community has seen huge advances in the care of HF, and we see a turning point in the narrative of doom and gloom, which has traditionally been associated with HF – we see cause for optimism. We recognise the urgency of putting these advances to prompt use, as demonstrated by the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic HF.1 The 2021 updated guidelines make it clear that we have the means to diagnose HF early, to classify it more accurately, the tools to change the HF trajectory, and the duty and ability to intervene – and to do so early. Diagnosis While the ESC diagnost

Introduction Heart failure (HF) is a common condition and the majority of patients have multiple co-morbidities. It is therefore essential that all healthcare professionals (HCPs) are familiar with the contemporary management of these patients. Whilst HF specialists are integral to the delivery of optimal patient care, it is important to ensure that therapies are optimised at every opportunity and enable the best care for patients in the context of acute or chronic non-cardiovascular illness. Current practice is often suboptimal; for example, in the latest national HF audit (England and Wales), the number of patients leaving hospital on thre

Introduction The 2021 European Society of Cardiology Congress saw the release of an update of the ESC guidelines for the diagnosis and treatment of acute and chronic heart failure (HF).1 This timely and comprehensive new set of guidelines is particularly noteworthy because of its inclusion of the Patient Forum as full members of the task force; a first for ESC HF guidance. HF management programmes Evident within the updated guidance is an emphasis on putting patients at the centre of HF care and empowering them to take ownership of their condition. Since the 2016 ESC HF guidelines2 were published, a growing body of evidence has placed increa

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