Tag Archives: safety

Introduction Three important lines of evidence have informed the debate on optimal anticoagulation for people at risk of stroke: Meta-analyses have generally supported the findings from the ENGAGE-AF TIMI-481 and Hokusai-VTE2 trials, in terms of comparable efficacy and reduced bleeding risk with non-vitamin K antagonist oral anticoagulants (NOACs) versus warfarin in patients at risk of stroke, or with acute venous thromboembolism (VTE), respectively.3-8 The randomised Birmingham Atrial Fibrillation Treatment of the Aged Study (BAFTA) trial confirmed the superiority of anticoagulation versus aspirin in elderly patients with atrial fibrillati

Introduction Even with modern high spatial and temporal resolution scanners, image quality obtained during computed tomography (CT) coronary angiography (CTCA) remains highly dependent on stable, regular, low heart rates. To achieve this pre-scan oral and/or intravenous beta blockade is widely used. Anecdotal and published reports suggest a wide variation in the route of administration and quantities of beta blocker used, particularly the intravenous route.1-7 Doses used are commonly far in excess of that recommended by the British National Formulary (BNF)8 to achieve adequate heart rate reduction. This study examines the current CTCA-relate

Introduction In many centres, patients stay overnight after their pacing procedure. Most would prefer to get home quicker, and reduced length of stay would result in healthcare savings. Various centres have reported high rates of patient satisfaction,1 and significant cost-savings with day-case pacing,2,3 although this practice is not widespread. A recent survey,4 revealed variation in practice across Europe with many centres routinely mandating a one or two night hospital stay. The safety of day-case pacing was described more than 25 years ago.5,6 Since then, the implant rates of both bradycardia (simple) and more complex devices (cardiac re

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We believe that the new guideline2 will be a major advance in stroke prevention in AF. We would suggest that Professor Brady and colleagues, in their focus on non-vitamin K oral anticoagulants (NOACs), have overlooked the importance of a number of crucial aspects of the guideline. It represents a paradigm change in stroke management. The GDG were very keen to promote the concept that, whereas previously risk assessment was undertaken to define patients at high risk of stroke requiring anticoagulation, under the new guideline anticoagulation has become the norm for all but the lowest-risk patients. It represents a considerable simplification

Feasibility of using CTCA in patients with acute low-to-intermediate likelihood chest pain in a DGH Dear Sirs, I would like to make three points about this paper:1 1. The summary states “results suggest that it is feasible to use computed tomography coronary angiography (CTCA)…in place of exercise tolerance testing (ETT) at no extra cost”. The body of the article shows “CTCA had a higher cost compared with ETT. The overall cost per patient was £375 with CTCA vs. £309 with ETT, but this was not statistically significant (p=0.28)”. The lack of significance is attributable to the small size of the data-set, and it does not allow a co

Introduction Exercise is well recognised as a tool for assessment, prevention and management of cardiovascular disease.1 Cardiac patients are encouraged to attend cardiac rehabilitation programmes including elements of supervised exercise. Such programmes can reduce mortality and morbidity rates by up to 27%.2,3 Despite the benefits derived from participation in exercise-based cardiac rehabilitation, exercise itself may act as a trigger for myocardial ischaemia or cardiac arrest in patients with established coronary heart disease.4 During rehabilitation, cardiovascular event rates range from 12.3 to 37.4 per million patient hours of exercise.

This supplement is a report from the inaugural meeting of the Cardiometabolic Forum, jointly organised by the British Journal of Cardiology and HEART UK – The Cholesterol Charity. The meeting was held at the Royal Pharmaceutical Society, London, on 24th November 2011. Meeting chairs were Dr Dermot Neely (Royal Victoria Infirmary, Newcastle upon Tyne) for HEART UK, and Dr Henry Purcell (Royal Brompton Hospital, London, and Editor) for BJC. We hope this supplement will provide readers with an independent overview on recent developments in our knowledge of cholesterol metabolism and its implications for clinical practice. Speakers Dermot Neely

Statins represent the cornerstone of treatment in guidelines for lipid management.1 The clinical benefits have been confirmed by meta-analysis of major prospective studies which showed that statins reduced cardiovascular risk by about one fifth per mmol/L reduction in low-density lipoprotein (LDL) cholesterol, largely irrespective of the initial lipid profile, the presence of diabetes, or other presenting characteristics.2,3 More intensive regimens produced further incremental benefit, compared with conventional-dose statin therapy.4 Among patients at higher risk, such as those with pre-existing coronary heart disease (CHD) or with diabetes,

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