Tag Archives: heart failure

There is incontrovertible, large-scale, randomised-controlled evidence for morbidity and mortality benefit of beta-blockers in heart failure (trials include MERIT-HF, COPERNICUS, CIBIS II),1-3 she said, but the evidence for adverse effects in lung disease is based on animal studies, case reports and small scale human studies.4 Beta blockade in COPD, however, is fully endorsed by The European Society of Cardiology (ESC), National Institute for Clinical Excellence (NICE) and Cochrane reviews.5-7 Dr Hardman’s presentation highlighted for trainees an important area where significant improvements can be achieved. Cardiac and respiratory func

Historically, CR programmes have been under funded and under resourced; this has resulted predominantly from the absence of a CR specific tariff resulting in the inclusion of the service into the broader cardiology tariff or service level agreements between commissioners and providers. This could be about to change with the proposed introduction of payment by results recognising CR programmes as cost-effective interventions that produce substantial health benefits.2 Resources Resources, at the most basic level, are defined as appropriately qualified staff to deliver exercise programmes within suitable venues. Current recommendations for exerc

The licence follows the results of the SHIfT trial, involving more than 6,000 people, which demonstrated that patients with chronic systolic heart failure and a heart rate over 70 bpm had an 18% reduction (ARR = 4.2% p<0.0001) in the composite primary end point of cardiovascular death and hospitalisation due to heart failure. Ivabradine selectively lowers heart rate and the study showed benefits were greater in patients with higher heart rates (>75 bpm). Within the indication, Servier says ivabradine reduced the risk of death from heart failure by 39% (ARR 2.2% p=0.0006), the risk of death from all types of cardiovascular disease by 17%

Introduction Landmark qualitative studies published within the last decade highlighted inequalities in end-of-life care between people with advanced heart failure (HF) and cancer.1-8 A palliative approach and access to specialist palliative care (SPC) services for people with advanced HF is now underlined in national and international policy.9-14 However, those with HF are still more likely to die in hospital in the UK than cancer patients,15 and UK 2010 national audit figures document less than 4% of people with HF referred for palliative care.16 Hospice referral seems higher in the USA and Canada.17,18 We have previously reported retrospect

Introduction Beta-adrenoceptor blocking drugs (beta blockers) are an established prognostic therapy for chronic heart failure (HF).1-4 Of the many proposed mechanisms mediating these favourable effects, that of heart rate (HR) control is gaining interest. The Systolic Heart Failure Treatment with Iƒ Inhibitor Ivabradine Trial (SHIFT) reported that ivabradine significantly reduced a combined end point of cardiovascular death or HF hospitalisations in a relatively high-risk HF population with an elevated resting HR.5 HR control, therefore, appears to be both a modifiable risk factor and a disease modifying variable in patients with impaired l

Introduction Clinical trials for new heart failure treatments have traditionally focused on mortality and hospitalisations as primary end points.1,2 Although clearly important, these end points tell us little about how heart failure (HF) patients experience their illness and treatment in their day-to-day life. HF may affect patients’ quality of life more than many other chronic diseases, including diabetes and arthritis.3,4 Symptoms and quality of life, as reported by patients, are correlated with mortality and hospitalisations,5-7 suggesting that these concepts may be indicative of an underlying process that ultimately manifests in death a

Bureaucracy The mortality rate for heart failure remains unchanged with 11.6% of heart failure (HF) admissions dying as inpatients, and 33% mortality at around one year, according to the most recent data from the National Heart Failure Audit.  This was presented to the meeting by Professor Theresa McDonagh (King’s College Hospital, London). Data collection continues to improve with 85% of NHS trusts submitting data over the preceding 12 month period, she said.  Access to cardiology services was associated with improved outcomes and a higher usage of evidence-based therapy and subsequent access to outpatient HF services. The likely challen

Introduction Heart failure is one of the most common conditions in industrialised society. Today, in the UK, around 900,000 people have heart failure with a further similar number who have yet to develop symptoms.1 Heart failure is predominantly a disease of the elderly, and the increasing age of the population, combined with improvements in the treatment of ischaemic heart disease (IHD), account for the increasing prevalence. Heart failure has a poor prognosis: just under 40% of patients diagnosed with heart failure die within a year, depending on initial severity, although, thereafter, mortality is less than 10% per year. This suggests that

PARTNER: transcatheter valves just as good as surgery for high risk aortic stenosis Transcatheter aortic valve implantation (TAVI) is just as effective at reducing mortality as surgery for severe aortic stenosis in elderly patients whose age and overall health posed high risks for conventional surgery, according to the results of the PARTNER (Placement of AoRTic TraNscathetER Valve trial). However, stroke rates were higher in the trancatheter group. The transcatheter approach involves delivering a bioprosthetic valve to its target location with a catheter using either transfemoral access or trans-apical access (through the ribs) if peripheral

Neurohormonal blockade A cardiac resynchronisation therapy pacemaker (CRT-P), provides cardiac resynchronisation therapy and diagnostics to assist in patient management The meeting set off to a stimulating start with Professor Theresa McDonagh (Kings College Hospital, Chair of the British Society of Heart Failure) reviewing primarily the growing evidence for aldosterone antagonists in the management of systolic heart failure (HF). Large clinical trials have established the role of aldosterone antagonists, such as spironolactone, in severe systolic HF (Randomised Aldactone Evaluation Study – RALES) and eplerenone in acute myocardial infarcti