Tag Archives: heart failure

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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Introduction Acute heart failure (AHF) syndromes are the leading cause of hospitalisation in patients over 65 years of age in the UK, accounting for 67,000 admissions per year.1 The immediate management of AHF focuses on symptom relief and stabilisation of the patient’s haemodynamic profile – traditionally achieved with a combination of oxygen, diuretics and nitrate therapy.1-5 Recent guidelines from the National Institute for Health and Care Excellence (NICE),1 and the European Society of Cardiology (ESC),5 have highlighted the poor-quality evidence base for many of these interventions.3,4,6 The ESC guidelines (updated in 2016) state th

Landmark trials in heart failure – 30 years from CONSENSUS With 2017 marking the 30th year since the publication of CONSENSUS,1 which first reported a reduction in mortality with enalapril versus placebo in patients with advanced heart failure (HF), the BCS held a dedicated session to review the seminal clinical trials and advances in chronic heart failure management in this period. Dr Rosita Zakeri (Royal Brompton Hospital, London) reviewed this session for us and spoke to the BJC afterwards. Rosita Zakeri The era of vasodilator therapy for heart failure began in the 1990s. Professor Karl Swedberg (University of Gothenberg, Sweden) began

Introduction Hospital doctors have a professional responsibility to complete an accurate and comprehensive discharge summary with relevant clinical details. It is fundamental that any healthcare professional supporting the aftercare of a heart failure patient is briefed on the diagnosis, clinical progress, treatment and follow-up arrangements following hospitalisation. The purpose of a discharge summary is to share important clinical information about a patient’s hospital episode with their GP and other healthcare professionals responsible for providing continuing care. However, discharge summaries often fail to communicate effectively.1 In

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Systems of heart failure delivery Best practice tariff There is now a ‘best practice tariff’ (BPT) programme for heart failure (and for many other conditions). Professor Iain Squire (University of Leicester) reviewed the implications of this and discussed National Institute for Health and Care Excellence (NICE) quality standards for chronic heart failure (CHF). The first year of the BPT (April 2015–March 2016) was voluntary but it has been compulsory since the beginning of the 2016–2017 financial year. For the financial year 2016–2017, the tariff is worth a 5% uplift in the amount a trust is paid for each and every admission. It is

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