Tag Archives: heart failure

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

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

Case An 81-year-old woman presented to our cardiac centre with acute onset ischaemic sounding chest pain during week 4 of the first COVID-19 lockdown in the UK. She reported increasing anxiety since the start of isolation. The onset of chest pain was related to a package dropped off by her family and occurred within an hour of receiving it. Although welcome, this caused her a mixed extreme of emotions as it both heightened her sense of loneliness and anxiety, while at the same time caused her pleasure from family contact. Her past medical history included permanent atrial fibrillation (AF), hypertension, hypercholesterolaemia and iron deficie

Introduction Cardiorenal syndromes (CRS) are defined as a spectrum of disorders affecting the heart and kidney, in which acute or chronic dysfunction of one organ leads to acute or chronic dysfunction of the other.1,2 Management of this condition can be challenging as it portends significant morbidity due to symptom burden, as well as recurrent hospitalisations and increased mortality.1-3 In addition, as there is a relative paucity of evidence-based therapy, management strategies for CRS have been largely empirical and goal-directed towards improvement of function of one organ, frequently at the cost of the other. For instance, acute kidney i

A 72-year-old woman was referred to our cardiology service with increasing dyspnoea on exertion. Her background history was notable for haemochromatosis, type 2 diabetes mellitus, chronic kidney disease (stage 3a), treated pulmonary tuberculosis and known pericardial calcification. Echocardiography (figure 1A) demonstrated a calcified structure evident on the apical four-chamber view, which appeared to indent the right ventricle. Computed tomography (CT) of the thorax (figure 1B) demonstrated extensive and circumferential pericardial calcification with a maximal thickness of up to 20 mm in the right atrial pericardial region, 12 mm in the inf

The British Society for Heart Failure (BSH) has therefore produced a position statement designed to help easily identify and prioritise patients that should be considered for review. It will also support local teams to identify a lead clinician that they can contact for advice. BSH recommends that the following patients are considered for review: New referrals of symptomatic patients with NTproBNP >2,000pg/ml from primary care or recent A&E attendance Known HF patient with symptoms of decompensation Recently discharged patients following admission with acute heart failure Patients with advanced care plans and receiving palliative car