Tag Archives: heart failure

Introduction Acute heart failure (AHF) has been defined by the European Society of Cardiology (ESC) as the rapid onset of, or change in, symptoms and signs of heart failure, and is a life-threatening condition that requires immediate medical attention.1 These symptoms and signs include shortness of breath at rest or during exertion, fatigue, pulmonary or peripheral fluid retention, a cough, and evidence of an abnormality of the structure or function of the heart at rest.2-4 This change in cardiac function results in an urgent need for therapy, and AHF is among the most common causes of hospitalisation.5 AHF can, therefore, be seen to represen

An overlooked form of SDB Professor Martin Cowie Another form of sleep apnoea – central sleep apnoea with Cheyne Stokes respiration (CSA-CSR) – has received less in-depth investigation than OSA. Nonetheless, it carries significant importance, particularly in heart failure patients. Moderate-to-severe forms have been reported to occur in up to 50% of chronic heart failure patients.4-7 Unlike OSA patients, whose loud night-time snores are punctuated with dramatic apnoeic episodes, CSA-CSR patients exhibit a different style of breathing. In this patient group, night-time breathing follows a waxing and waning pattern in which successive breat

Our letter from Nepal below shows underuse of beta blockers is a widespread problem As outlined in the recent European Society of Cardiology (ESC) guidelines for the treatment of heart failure,1 the pivotal trials with beta blockers were conducted in patients with continuing symptoms and a persistently low ejection fraction (EF), despite treatment with an ACE inhibitor and, in most cases, a diuretic. Despite this, “there is consensus that these treatments are complementary and that a beta blocker and an ACE inhibitor should both be started as soon as possible after diagnosis of heart failure with reduced ejection fraction (HF-REF)”.1

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Mineralocorticoid receptor antagonists Professor Faiez Zannad (Université de Lorraine, Nancy, France), the first of two guest lecturers, who has been an investigator in three major randomised controlled trials (RCT) of mineralocorticoid receptor antagonists (MRA) in heart failure,1-3 opened the first session. There was a particular focus on the recent EMPHASIS-HF trial,3 which recruited heart failure (HF) patients with left ventricular systolic dysfunction (ejection fraction [EF] ≤30%, or EF 30-35% with QRS duration >130 ms) and mild symptoms (New York Heart Association [NYHA] class II). Eplerenone treatment resulted in a 37% relative

Multipolar left ventricular pacing to optimise acute haemodynamic response to cardiac resynchronisation therapy SY Ahsan (presenting author), B Sabberwal, C Hayward, P Lambiase, M Thomas, GG Babu, S Aggarwal, MD Lowe, AWC Chow The Heart Hospital, Institute of Cardiovascular Science, University College Hospitals NHS Foundation Trust, London Purpose: Cardiac resynchronisation therapy (CRT) reduces morbidity and mortality in a sub-group of patients with heart failure, though up to 30% of patients have no benefit. CRT patients are heterogeneous and an individualised approach to CRT may be needed to increase response rate. We evaluated the impact

Introduction As doctors and scientists we are accustomed to breaking down problems and simplifying complex pathology in order to focus our management and identify possible targets for future therapies. The pathophysiology of cardiorenal disease is no different but, as yet, attempts to elucidate the complex interaction between heart and kidneys has failed. Although cardiac and renal disease are often diagnosed together, it is clear that a straightforward causal relationship does not exist. Disease in either serves as a risk factor for disease in the other and perpetuates the progression of that disease, but why this is so is unclear. Whilst th

First UK operation for HF with nerve-stimulating implant The UK’s first operation to tackle heart failure (HF) with a novel nerve-stimulating device was performed recently at Glenfield Hospital, Leicester. The operation was part of the INOVATE-HF clinical trial, a global investigation to determine the safety and efficacy of the an implantable electrical stimulation device (CardioFit,® BioControl Medical), designed to improve heart function in patients with HF. The study will evaluate the system’s ability to reduce hospitalisation and death among patients with HF, while also exploring whether combined treatment with the system and pres

Heart failure The recommendations on devices, drugs and diagnosis in heart failure were developed by the ESC in collaboration with a heart failure association of the ESC. There have been several major updates since the previous guidance published in 2008.  The new updates include: In devices, left ventricular assist devices (LVADs) have been hailed as a step change in the management of heart failure. LVADs are more reliable and lead to fewer complications than in 2008. Until now, LVADs have been used as a temporary measure in patients awaiting a heart transplant. Professor John McMurray (Glasgow, UK), chairperson of the ESC Clinical Practice

Optimised beta blocker therapy in heart failure: is there space for additional heart rate control? Dear Sirs, We undertook a similar audit to Russell et al.1 within the heart failure service of a district general hospital auditing the case notes of 96 patients attending over three months. Applying the SHIFT inclusion and exclusion criteria, we identified only seven patients (6.7%) eligible for ivabradine. Using the SHIFT dataset the number needed to treat to prevent a single hospitalisation due to heart failure was 22.2 Extrapolating our data, over 12 months, we would expect to identify approximately 28 suitable patients. Treating 28 patients