Tag Archives: hospitalisation

Introduction Following its discovery and introduction for clinical use in Birmingham, UK almost 250 years ago, digoxin has been used for the treatment of heart failure (HF). Indeed, until the advent of diuretics in the 1950s, it was the only available drug for this condition.1 Digoxin is an unusual drug in many respects. Derived from the foxglove plant, it increases intracellular Ca2+, and as an oral inotrope, is the only drug for chronic use in HF that addresses the primary problem, namely reduced cardiac pumping capacity (figure 1). All the other commonly used drugs for HF act indirectly to either inhibit the adverse neurohormonal response

Many randomised-controlled clinical trials (RCTs), such as DAPA-HF, DELIVER, EMPEROR-Preserved, EMPEROR-Reduced and CREDENCE trials have been conducted, using the different SGLT2 inhibitors, and have reported increased positive outcomes in the HF population.1–6 The mechanism(s) behind the cardiovascular protective effects by SGLT2 inhibitors remains unclear. Pleiotropic effects have been suggested; other plausible mechanisms include improved glycaemic control, reduced albuminuria, reduced blood pressure and amelioration of fluid overload.7 However, the increased use of this class of medications should be undertaken with awareness of the pot

New generation diabetes drugs – a cardiorenal done deal? The meeting was opened by Professor William Herrington (Honorary Consultant Nephrologist, Oxford Kidney Unit) who discussed the impact of the new generation diabetes drugs on kidney outcomes.1 A meta-analysis of over 90,000 patients showed that sodium glucose co-transporter-2 (SGLT2) inhibitors slowed chronic kidney disease (CKD) progression by 37%, and decreased the risk of acute kidney injury, cardiovascular (CV) death or heart failure hospitalisation by 23%, regardless, the presence of diabetes or type of SGLT2 inhibitor used. Implementing these drugs is simple and can be done by

Introduction Sodium-glucose cotransporter-2 inhibitors (SGLT2i) improve symptoms,1 reduce hospitalisations and extend longevity2,3 for patients who have heart failure with reduced ejection fraction (HFrEF). These beneficial effects are observed very early following initiation,4 prompting calls for these agents to be given equal priority to more established therapies,5,6 which has been reflected in recent guidelines.7 Hospitalisation with heart failure (HF) offers the opportunity for optimisation of guideline-directed medical therapy (GDMT) including SGLT2i,8,9 however, the feasibility of doing so has not been reported outside of the artifici

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

Dr Matthew Fay (Westcliffe Medical Practice, Shipley) Honarbakhsh et al. highlight an important point in their paper: when should this be done and who should take responsibility. Their review of patients who have been admitted acutely with AF or atrial flutter, looking at the outcome of anticoagulation if risk factors are present, seems to provide lamentable data, with only 57% being referred for oral anticoagulation. Of course, there may be a question as to whether, with patient-led decision-making, the acute hospital ward is the right environment for a considered and final decision as regards this important question. We need to consider the

Introduction Atrial fibrillation (AF) is the most common cardiac arrhythmia found in clinical practice with increased prevalence in the ageing population.1 It affects 5% of those aged over 65 years and 10% of those aged over 80 years.2 Its prevalence is increasing primarily for two reasons; an increase in the ageing population and advances in medical care leading to survival from underlying conditions closely associated with AF, such as hypertension, coronary heart disease, and cardiac failure.3 It has been described as epidemic in proportion since some researchers have predicted its prevalence will triple by 2050.4 AF can cause significant m