468 results found
Cowie MR, 2019, Is the digital revolution the dawn of a golden age or just the next fad?, Cardiovasc Res
Bottle A, Cowie MR, 2019, Letter in reference to "Defining a 'frequent admitter' phenotype among patients with repeat heart failure admissions"., European Journal of Heart Failure, ISSN: 1388-9842
Hallen J, Maggioni AP, Lopez-De-Sa E, et al., 2019, Reproducibility of in-hospital worsening heart failure event adjudication in the RELAX-AHF-EU trial, EUROPEAN JOURNAL OF HEART FAILURE, ISSN: 1388-9842
Cowie MR, 2019, Exploring digital technology's potential for cardiology., Eur Heart J, Vol: 40, Pages: 2283-2284
Platz E, Jhund PS, Girerd N, et al., 2019, Expert consensus document: Reporting checklist for quantification of pulmonary congestion by lung ultrasound in heart failure, EUROPEAN JOURNAL OF HEART FAILURE, Vol: 21, Pages: 844-851, ISSN: 1388-9842
Komajda M, Schoepe J, Wagenpfeil S, et al., 2019, Physicians' guideline adherence is associated with long-term heart failure mortality in outpatients with heart failure with reduced ejection fraction: the QUALIFY international registry, EUROPEAN JOURNAL OF HEART FAILURE, Vol: 21, Pages: 921-929, ISSN: 1388-9842
Javed F, Tamisier R, Pepin J-L, et al., 2019, Association of serious adverse events with Cheyne-Stokes respiration characteristics in patients with systolic heart failure and central sleep apnoea: A SERVE-Heart Failure substudy analysis., Respirology
BACKGROUND AND OBJECTIVE: Increases in Cheyne-Stokes respiration (CSR) cycle length (CL), lung-to-periphery circulation time (LPCT) and time to peak flow (TTPF) may reflect impaired cardiac function. This retrospective analysis used an automatic algorithm to evaluate baseline CSR-related features and then determined whether these could be used to identify patients with systolic heart failure (HF) who experienced serious adverse events in the Treatment of Sleep-Disordered Breathing with Predominant Central Sleep Apnea by Adaptive Servo Ventilation in Patients with Heart Failure (SERVE-HF) substudy. METHODS: A total of 280 patients had overnight diagnostic polysomnography data available; an automated algorithm was applied to quantify CSR-related features. RESULTS: Median baseline CL, LPCT and TTPF were similar in the control (n = 152) and adaptive servo-ventilation (ASV, n = 156) groups. In both groups, CSR-related features were significantly longer in patients who did (n = 129) versus did not (n = 140) experience a primary endpoint event (all-cause death, life-saving cardiovascular intervention or unplanned hospitalization for worsening HF): CL, 61.1 versus 55.1 s (P = 0.002); LPCT, 36.5 versus 31.5 s (P < 0.001); TTPF, 15.20 versus 13.35 s (P < 0.001), respectively. This finding was independent of treatment allocation. CONCLUSION: Patients with systolic HF and central sleep apnoea who experienced serious adverse events had longer CSR CL, LPCT and TTPF. Future studies should examine an independent role for CSR-related features to enable risk stratification in systolic HF.
Mccambridge JJ, Keane C, Walshe M, et al., 2019, The care pathway prior to hospitalisation with acute decompensated heart failure: a comparison between two healthcare systems, Publisher: WILEY, Pages: 442-442, ISSN: 1388-9842
Cuchiara MPCM, Kall CMMY, Boehmer JB, et al., 2019, Cardiac autonomic nerves stimulation improves hemodynamics and clinical status in advanced heart failure patients, Publisher: WILEY, Pages: 30-30, ISSN: 1388-9842
Brahmbhatt DH, Cowie MR, 2019, Remote management of heart failure: an overview of telemonitoring technologies, Cardiac Failure Review, Vol: 5, Pages: 86-92, ISSN: 2057-7540
Technological advances have enabled increasingly sophisticated attempts to remotely monitor heart failure. This should allow earlier identification of decompensation, better adherence to lifestyle changes and medication and interventions (such as diuretic dosage changes) that reduce the need for hospitalisation. This review discusses telemonitoring approaches in heart failure, and the evidence for their impact. It is not difficult to collect data remotely, but converting more data into better decision-making that improves the outcome of care is challenging. Policy-makers and technology companies are enthusiastic about the potential of digital technologies to transform healthcare and bring expertise to the patient, rather than the other way round, but guideline writers are not yet convinced, due to the lack of consistent findings in randomised trials.
Hayhoe B, Kim D, Aylin P, et al., 2019, Adherence to guidelines in management of symptoms suggestive of heart failure in primary care, Heart, Vol: 105, Pages: 678-685, ISSN: 1355-6037
Objective Clinical guidelines on heart failure (HF) suggest timings for investigation and referral in primary care. We calculated the time for patients to achieve key elements in the recommended pathway to diagnosis of HF.Methods In this observational study, we used linked primary and secondary care data (Clinical Practice Research Datalink, a database of anonymised electronic records from UK general practices) between 2010 and 2013. Records were examined for presenting symptoms (breathlessness, fatigue, ankle swelling) and key elements of the National Institute for Health and Care Excellence-recommended pathway to diagnosis (serum natriuretic peptide (NP) test, echocardiography, specialist referral).Results 42 403 patients were diagnosed with HF, of whom 16 597 presented in primary care with suggestive symptoms. 6464 (39%) had recorded NP or echocardiography, and 6043 (36%) specialist referral. Median time from recorded symptom(s) to investigation (NP or echocardiography) was 292 days (IQR 34–844) and to referral 236 days (IQR 42–721). Median time from symptom(s) to diagnosis was 972 days (IQR 337–1468) and to treatment with HF-relevant medication 803 days (IQR 230–1364). Factors significantly affecting timing of referral, treatment and diagnosis included patients’ sex (p=0.001), age (p<0.001), deprivation score (p=0.001), comorbidities (p<0.001) and presenting symptom type (p<0.001).Conclusions Median times to investigation or referral of patients presenting in primary care with symptoms suggestive of HF considerably exceeded recommendations. There is a need to support clinicians in the diagnosis of HF in primary care, with improved access to investigation and specialist assessment to support timely management.
Diaz T, Marin y Kall C, Boehmer J, et al., 2019, Cardiac Autonomic Nerves Stimulation Improves Hemodynamics: A Pilot Study in Advanced Heart Failure Patients, 39th Annual Meeting and Scientific Sessions of the International-Society-for-Heart-and-Lung-Transplantation (ISHLT), Publisher: ELSEVIER SCIENCE INC, Pages: S141-S141, ISSN: 1053-2498
Frederix I, Caiani EG, Dendale P, et al., 2019, ESC e-Cardiology Working Group Position Paper: Overcoming challenges in digital health implementation in cardiovascular medicine., Eur J Prev Cardiol, Pages: 2047487319832394-2047487319832394
Cardiovascular disease is one of the main causes of morbidity and mortality worldwide. Despite the availability of highly effective treatments, the contemporary burden of disease remains huge. Digital health interventions hold promise to improve further the quality and experience of cardiovascular care. This position paper provides a brief overview of currently existing digital health applications in different cardiovascular disease settings. It provides the reader with the most relevant challenges for their large-scale deployment in Europe. The potential role of different stakeholders and related challenges are identified, and the key points suggestions on how to proceed are given. This position paper was developed by the European Society of Cardiology (ESC) e-Cardiology working group, in close collaboration with the ESC Digital Health Committee, the European Association of Preventive Cardiology, the European Heart Rhythm Association, the Heart Failure Association, the European Association of Cardiovascular Imaging, the Acute Cardiovascular Care Association, the European Association of Percutaneous Cardiovascular Interventions, the Association of Cardiovascular Nursing and Allied Professions and the Council on Hypertension. It relates to the ESC's action plan and mission to play a pro-active role in all aspects of the e-health agenda in support of cardiovascular health in Europe and aims to be used as guiding document for cardiologists and other relevant stakeholders in the field of digital health.
Anderson LJ, Squire IB, Cowie MR, 2019, Global lessons from deaths from heart failure in UK hospitals., Heart
Cowie MR, Zakeri R, 2019, Preventing Heart Failure at the Population Level Conventional Cardiovascular Risk Factor Management Should Continue, JACC-HEART FAILURE, Vol: 7, Pages: 214-216, ISSN: 2213-1779
Do TNP, Do QH, Cowie MR, et al., 2019, Effect of the Optimize Heart Failure Care Program on clinical and patient outcomes – The pilot implementation in Vietnam, IJC Heart and Vasculature, Vol: 22, Pages: 169-173, ISSN: 2352-9067
© 2019 Background: The Ho-Chi-Minh-city Heart Institute in Vietnam took part in the Optimize Heart Failure (OHF) Care Program, designed to improve outcomes following heart failure (HF) hospitalization by increasing patient awareness and optimizing HF treatment. Methods: HF patients hospitalized with left ventricular ejection-fraction (LVEF) <50% were included. Patients received guideline-recommended HF treatment and education. Clinical signs, treatments and outcomes were assessed at admission, discharge, 2 and 6 months (M2, M6). Patients’ knowledge and practice were assessed at M6 by telephone survey. Results: 257 patients were included. Between admission and M2 and M6, heart rate decreased significantly, and clinical symptoms improved significantly. LVEF increased significantly from admission to M6. 85% to 99% of patients received education. At M6, 45% to 78% of patients acquired knowledge and adhered to practice regarding diet, exercise, weight control, and detection of worsening symptoms. High use of renin-angiotensin-aldosterone-system inhibitors (91%), mineralocorticoid-receptor-antagonists (77%) and diuretics (85%) was noted at discharge. Beta-blocker and ivabradine use was less frequent at discharge but increased significantly at M6 (from 33% to 51% and from 9% to 20%, respectively, p < 0.001). There were no in-hospital deaths. Readmission rates at 30 and 60 days after discharge were 8.3% and 12.5%, respectively. Mortality rates at 30 days, 60 days and 6 months were 1.2%, 2.5% and 6.4%, respectively. Conclusions: The OHF Care Program could be implemented in Vietnam without difficulty and was associated with high usage of guideline-recommended drug therapy. Although education was delivered, patient knowledge and practice could be further improved at M6 after discharge.
Kim D, Hayhoe B, Aylin P, et al., Variation in the route to heart failure diagnosis in English primary care: retrospective cohort study, British Journal of General Practice, ISSN: 0960-1643
Brough CEP, Rao A, Haycox AR, et al., 2019, Real-world costs of transvenous lead extraction: the challenge for reimbursement, EUROPACE, Vol: 21, Pages: 290-297, ISSN: 1099-5129
Gallagher AM, Lucas R, Cowie MR, 2019, Assessing health-related quality of life (HR-QoL) in heart failure patients attending an outpatient clinic - a pragmatic approach, ESC Heart Failure, Vol: 6, Pages: 3-9, ISSN: 2055-5822
AimsImproving quality of life (QoL) in heart failure patients is a key management objective. Validated health‐related QoL (HR‐QoL) measurement tools have been incorporated into clinical trials but not routinely into daily practice. The aims of this study were to investigate the acceptability and feasibility of implementing validated HR‐QoL instruments into heart failure clinics and to examine the impact of patient characteristics on HR‐QoL.Methods and resultsOne hundred and sixty‐three patients attending heart failure clinics at a UK tertiary centre were invited to complete three HR‐QoL assessments: the Minnesota Living with Heart Failure Questionnaire (MLHFQ); the EuroQoL 5D‐3L (EQ‐5D‐3L); and the Kansas City Cardiomyopathy Questionnaire (KCCQ) in that order. Data on patient demographics, co‐morbidities, New York Heart Association (NYHA) class, plasma B‐type natriuretic peptide (BNP), renal function, and left ventricular ejection fraction were recorded. 94% of patients attending clinic were willing to participate. The EQ‐5D‐3L had all questions answered by 92% of patients, compared with 86% and 51% for the MLHFQ and KCCQ, respectively. HR‐QoL significantly correlated with NYHA class using each tool (MLHFQ, r = 0.59; KCCQ, r = −0.61; EQ‐5D‐3L, r = −0.44, all P < 0.01). However, within each NYHA class, there was a widespread of HR‐QoL scores. There was no association between patient demographics, left ventricular ejection fraction, plasma B‐type natriuretic peptide, or renal function with HR‐QoL using any tool.ConclusionsHealth‐related QoL assessment by validated questionnaire was acceptable to patients and feasible to perform in routine practice. Although NYHA class correlated significantly with HR‐QoL scores, there was high variability in HR‐QoL within each NYHA class, highlighting its limitation as the sole assessment of HR‐QoL. Clinicians should encourage the assessment of HR‐QoL to facilitate patient‐centred care and make more specific use of HR‐Q
Bottle A, Kim D, Hayhoe B, et al., 2019, Frailty and comorbidity predict first hospitalisation after heart failure diagnosis in primary care: population-based observational study in England, Age and Ageing, ISSN: 1468-2834
Background: frailty has only recently been recognised as important in patients with heart failure (HF), but little has been done to predict the first hospitalisation after diagnosis in unselected primary care populations. Objectives: to predict the first unplanned HF or all-cause admission after diagnosis, comparing the effects of comorbidity and frailty, the latter measured by the recently validated electronic frailty index (eFI). Design: observational study. Setting: primary care in England. Subjects: all adult patients diagnosed with HF in primary care between 2010 and 2013. Methods: we used electronic health records of patients registered with primary care practices sending records to the Clinical Practice Research Datalink (CPRD) in England with linkage to national hospital admissions and death data. Competing-risk time-to-event analyses identified predictors of first unplanned hospitalisation for HF or for any condition after diagnosis. Results: of 6,360 patients, 9% had an emergency hospitalisation for their HF, and 39% had one for any cause within a year of diagnosis; 578 (9.1%) died within a year without having any emergency admission. The main predictors of HF admission were older age, elevated serum creatinine and not being on a beta-blocker. The main predictors of all-cause admission were age, comorbidity, frailty, prior admission, not being on a beta-blocker, low haematocrit and living alone. Frailty effects were largest in patients aged under 85. Conclusions: this study suggests that frailty has predictive power beyond its comorbidity components. HF patients in the community should be assessed for frailty, which should be reflected in future HF guidelines.
Halliday BP, Wassall R, Lota A, et al., 2019, Withdrawal of pharmacological treatment for heart failure in patients with recovered dilated cardiomyopathy (TRED-HF): an open-label, pilot, randomised trial, The Lancet, Vol: 393, Pages: 61-73, ISSN: 0140-6736
BackgroundPatients with dilated cardiomyopathy whose symptoms and cardiac function have recovered often ask whether their medications can be stopped. The safety of withdrawing treatment in this situation is unknown.MethodsWe did an open-label, pilot, randomised trial to examine the effect of phased withdrawal of heart failure medications in patients with previous dilated cardiomyopathy who were now asymptomatic, whose left ventricular ejection fraction (LVEF) had improved from less than 40% to 50% or greater, whose left ventricular end-diastolic volume (LVEDV) had normalised, and who had an N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) concentration less than 250 ng/L. Patients were recruited from a network of hospitals in the UK, assessed at one centre (Royal Brompton and Harefield NHS Foundation Trust, London, UK), and randomly assigned (1:1) to phased withdrawal or continuation of treatment. After 6 months, patients in the continued treatment group had treatment withdrawn by the same method. The primary endpoint was a relapse of dilated cardiomyopathy within 6 months, defined by a reduction in LVEF of more than 10% and to less than 50%, an increase in LVEDV by more than 10% and to higher than the normal range, a two-fold rise in NT-pro-BNP concentration and to more than 400 ng/L, or clinical evidence of heart failure, at which point treatments were re-established. The primary analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02859311.FindingsBetween April 21, 2016, and Aug 22, 2017, 51 patients were enrolled. 25 were randomly assigned to the treatment withdrawal group and 26 to continue treatment. Over the first 6 months, 11 (44%) patients randomly assigned to treatment withdrawal met the primary endpoint of relapse compared with none of those assigned to continue treatment (Kaplan-Meier estimate of event rate 45·7% [95% CI 28·5–67·2]; p=0·0001). After 6 months, 25 (96%) of 2
Halliday BP, Wassail R, Lota AS, et al., 2019, Brief Comment Video to the Recommended Article of the Month, REVISTA PORTUGUESA DE CARDIOLOGIA, Vol: 38, Pages: 71-71, ISSN: 0870-2551
Halliday BP, Wassall R, Lota A, et al., 2018, Withdrawal of Pharmacological Heart Failure Therapy in Recovered Dilated Cardiomyopathy - A Randomised Controlled Trial (TRED-HF), Scientific Sessions of the American-Heart-Association (AHA) / Resuscitation Science Symposium, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: E761-E761, ISSN: 0009-7322
Cowie MR, Gallagher AM, Simonds AK, 2018, Treating central sleep apnoea in heart failure: is pull better than push?, European Journal of Heart Failure, Vol: 20, Pages: 1755-1759, ISSN: 1388-9842
Camm AJ, Camm POCCAJ, Luscher DOREDACOCTF, et al., 2018, The Esc Textbook of Cardiovascular Medicine, Publisher: European Society of Cardiology, ISBN: 9780198784906
This third edition of The ESC Textbook of Cardiovascular Medicine is a ground-breaking initiative from the European Soceity of Cardiology that transforms reference publishing in cardiovascular medicine to better serve the changing needs of ...
Linz D, Baumert M, Catcheside P, et al., 2018, Assessment and interpretation of sleep disordered breathing severity in cardiology: Clinical implications and perspectives, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 271, Pages: 281-288, ISSN: 0167-5273
Bottle R, Kim D, Aylin P, et al., 2018, Real-world presentation with heart failure in primary care: Do patients selected to follow diagnostic and management guidelines have better outcomes?, Open Heart, Vol: 5, ISSN: 2053-3624
Objective To describe associations between initial management of people presenting with heart failure (HF) symptoms in primary care, including compliance with the recommendations of the National Institute for Health and Care Excellence (NICE), and subsequent unplanned hospitalisation for HF and death.Methods This is a retrospective cohort study using data from general practices submitting records to the Clinical Practice Research Datalink. The cohort comprised patients diagnosed with HF during 2010–2013 and presenting to their general practitioners with breathlessness, fatigue or ankle swelling.Results 13 897 patients were included in the study. Within the first 6 months, only 7% had completed the NICE-recommended pathway; another 18.6% had followed part of it (B-type natriuretic peptide testing and/or echocardiography, or specialist referral). Significant differences in hazards were seen in unadjusted analysis in favour of full or partial completion of the NICE-recommended pathway. Covariate adjustment attenuated the relations with death much more than those for HF admission. Compared with patients placed on the NICE pathway, treatment with HF medications had an HR of 1.16 (95% CI 1.05 to 1.28, p=0.003) for HF admission and 1.03 (95% CI 0.90 to 1.17, p= 0.674) for death. Patients who partially followed the NICE pathway had similar hazards to those who completed it. Patients on no pathway had the highest hazard for HF admission at 1.30 (95% 1.18 to 1.43, p<0.001) but similar hazard for death.Conclusions Patients not put on at least some elements of the NICE-recommended pathway had significantly higher risk of HF admission but non-significant higher risk of death than other patients had.
Brahmbhatt D, Evans L, Riley J, et al., Mapping the processes involved in remote monitoring of heart failure patients at a specialist NHS cardiology clinic, Heart Rhythm Congress
Lennon EY, Kalra P, Reily R, et al., 2018, EVALUATING COMMUNITY HEALTH PRACTITIONERS PERSPECTIVE OF THE HEART FAILURE PATHWAY, Annual Scientific Meeting and AGM of the Irish-Cardiac-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A35-A35, ISSN: 1355-6037
Brahmbhatt DH, Cowie MR, 2018, Heart failure: classification and pathophysiology, Medicine (United Kingdom), Vol: 46, Pages: 587-593, ISSN: 1357-3039
Heart failure (HF) is a clinical syndrome in which there are characteristic signs and symptoms (e.g. oedema, breathlessness, fatigue) resulting from an underlying abnormality of cardiac function. Understanding the cause of the cardiac dysfunction and the body's response to it is essential in effective management. HF can present acutely, for example as a consequence of an acute myocardial infarction, or in a chronic form in which acute decompensation can then occur. HF results in a plethora of changes in the heart, at the cellular, microscopic and macroscopic levels, with the heart remodelling in response to the abnormal conditions. The underlying cardiac dysfunction also triggers the activation of an array of neuro-hormonal compensatory mechanisms that can ultimately become deleterious to cardiac and other organ function; they include sodium and fluid retention, increased sympathetic tone, altered breathing patterns, arrhythmia and, in more advanced stages, an inflammatory state with immune activation.
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