Tag Archives: mortality

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

Introduction Despite notable advances in care, cardiovascular disease remains a leading cause of morbidity and mortality in the UK.1 Currently, about one million people in the UK are living with heart failure (HF), and the prevalence increases significantly with age.1 There is a strong relationship between HF and increasing age, with 80% of all cases occurring in those aged over 60 years.1 Although mortality from HF has declined, the number of people living with disability has increased, particularly among older people.2 Moreover, about 385,000 people are living with undiagnosed and untreated HF, and people can wait up to three years for a d

Introduction Dr Cong Ying Hey Disparities in cardiovascular (CV) morbidity and mortality are among the major health and social care concerns in our modern society. In the UK, people living in the most deprived areas are four times more likely to die prematurely from CV disease (CVD) than those living in the least deprived areas.1 To address the disparities in CV outcomes, it is imperative to recognise the presence of inequalities at different interfaces of cardiology services. This article, therefore, aims to provide a focused discussion concerning potential measures to reduce health inequalities in cardiology through the lens of the challeng

There is no precise definition of what constitutes a HFSN, and the exact number of HFSNs and where they are located is not well understood. Therefore, one of the key recommendations of the inquiry was that Health Education England should work with the Royal College of Nursing and the Nursing and Midwifery Council to ascertain the number and location of HFSNs. Despite this recommendation, no particular body appeared to come forward to undertake this crucial piece of work. At the Pumping Marvellous Foundation’s Heart Failure Summit 2017,3 which was comprised of multi-stakeholders, the commitment was made by the charity, supported by an unres

Introduction Frailty is a distinctive health state, related to the ageing process, in which multiple body systems gradually lose their in-built reserves, and is related to poorer outcomes.1 There have been numerous tools developed to identify frailty,2-4 often these tools are complex and not suitable for identifying patients at the time of admission to hospital, requiring a comprehensive geriatric assessment to validate them. The British Geriatrics Society developed the Frailsafe5,6 checklist, which was piloted across 12 UK hospitals in 2014 as part of the Frailsafe collaborative. The tool used three screening indicators to identify patients

Introduction Heart failure (HF) is a complex disease, characterised by the reduced capacity of the heart to pump blood, supply or fill with blood, and is a cause of hospitalisation.1 HF is rapidly growing in developed and developing countries, with an estimated prevalence of more than 37 million individuals.2 HF is associated with a high rate of hospitalisation and it is a major cause of morbidity and mortality worldwide.1-3 Existing studies have shown that several comorbid factors and biomarkers are associated with HF and its prognosis.4 Recent studies have associated subclinical hypothyroidism with increased blood pressure, insulin resistan

Introduction Atrial fibrillation (AF) is a supraventricular tachyarrhythmia characterised by uncoordinated activation of the atria. AF is a progressive disease and represents the most common serious disorder of cardiac rhythm. The incidence and prevalence of the disease increase progressively with age and is more common among men.1–5 AF is associated with higher mortality and cardiovascular (CV) morbidity.6–13 Specifically, AF is a recognised risk factor for stroke, with the proportion of strokes attributable to AF increasing exponentially with age.1,2,7,14–17 Although clinicians are most concerned about stroke risk among AF patients, c

Dear Sirs, Research on sex difference in mortality after myocardial infarction (MI) since the 1990s has been debated and increased. Several observational studies have shown that younger women, in particular, seemed to have higher mortality rates than men of similar age during the two-year or longer follow-up, although these studies were mainly from the USA.1-3 Recent American studies have also found that, even after full adjustment for potential risk factors, excess risk for in-hospital mortality for women was still noted, particularly among those <50 years old with acute ST-segment elevation MI, leading to 98% (odds ratio [OR] 1.98, 95% c

Introduction Following observations that smokers experience decreased mortality following acute myocardial infarction (acute MI [AMI]) in comparison with non-smokers,1 the term ‘smoker’s paradox’ was introduced into scientific discourse more than 25 years ago.2 The ‘smoker’s paradox’ following various reperfusion strategies, however, is argued not to be due to any benefit from smoking itself but simply due to smokers being likely to undergo such procedures at a much younger age, and, hence, having, on average, lower comorbidity. In a recent systematic review (with a search by September 2010)2 of 17 studies presenting adjusted tota

Caffeine intake may reduce risk of type 2 diabetes Coffee and caffeine intake may significantly reduce the incidence of type 2 diabetes, according to a new meta-analysis published in the European Journal of Clinical Nutrition.  Pertinent studies were identified by a search of PubMed and EMBASE. The fixed- or random-effect pooled measure was selected based on between-study heterogeneity. Dose–response relationship was assessed. Commenting on the implications of this study (doi: 10.1007/s00394-013-0603-x), London general practitioner Dr Sarah Jarvis said: “There is growing evidence to suggest that moderate coffee consumption, that’s four