479 results found
Vardas P, Cowie M, Dagres N, et al., 2020, The electrocardiogram endeavour: from the Holter single-lead recordings to multilead wearable devices supported by computational machine learning algorithms., Europace, Vol: 22, Pages: 19-23
This review aims to provide a comprehensive recapitulation of the evolution in the field of cardiac rhythm monitoring, shedding light in recent progress made in multilead ECG systems and wearable devices, with emphasis on the promising role of the artificial intelligence and computational techniques in the detection of cardiac abnormalities.
Ferreira JP, Duarte K, Woehrle H, et al., 2019, Bioprofiles and mechanistic pathways associated with Cheyne-Stokes respiration: insights from the SERVE-HF trial, CLINICAL RESEARCH IN CARDIOLOGY, ISSN: 1861-0684
Cowie MR, Lamy A, Levy P, et al., 2019, Health economic evaluation of rivaroxaban in the treatment of patients with chronic coronary artery disease or peripheral artery disease., Cardiovasc Res
AIMS: In the COMPASS trial, rivaroxaban 2.5 mg twice daily (bid) plus acetylsalicylic acid (ASA) 100 mg once daily (od) performed better than ASA 100 mg od alone in reducing the rate of cardiovascular disease, stroke, or myocardial infarction (MI) in patients with coronary artery disease (CAD) and peripheral artery disease (PAD). A Markov model was developed to assess the cost-effectiveness of rivaroxaban plus ASA vs. ASA alone over a lifetime horizon, from the UK National Health System perspective. METHODS AND RESULTS: The base case analysis assumed that patients entered the model in the event-free health state, with the possibility to experience ≤2 events, transitioning every three-month cycle, through acute and post-acute health states of MI, ischaemic stroke (IS), or intracranial haemorrhage (ICH), and death. Costs, quality-adjusted life-years (QALYs), life years-all discounted at 3.5%-and incremental cost-effectiveness ratios (ICERs) were calculated. Deterministic and probabilistic sensitivity analyses were conducted, as well as scenario analyses. In the model, patients on rivaroxaban plus ASA lived for an average of 14.0 years with no IS/MI/ICH, and gained 9.7 QALYs at a cost of £13 947, while those receiving ASA alone lived for an average of 12.7 years and gained 9.3 QALYs at a cost of £8126. The ICER was £16 360 per QALY. This treatment was cost-effective in 98% of 5000 iterations at a willingness-to-pay threshold of £30 000 per QALY. CONCLUSION: This Markov model suggests that rivaroxaban 2.5 mg bid plus ASA is a cost-effective alternative to ASA alone in patients with chronic CAD or PAD.
Patel HC, Hayward C, Patel KS, et al., 2019, Impact on survival of combination inhalers in patients with COPD at high risk of cardiovascular events., Int J Cardiol
BACKGROUND: Chronic obstructive pulmonary disease (COPD) and cardiovascular disease often co-exist and are both leading causes of death worldwide. Published data have previously suggested trends toward improved survival for patients taking long-acting β agonists combined with inhaled corticosteroids (LABA-ICS) through beneficial actions on the respiratory and cardiovascular systems. We sought to explore this in a real-world setting. METHODS: A population-based longitudinal propensity score-matched cohort study was conducted in the United Kingdom, 1998-2015. Patients were identified from the Clinical Practice Research Datalink (CPRD) which is linked to Hospital Episode Statistics (HES) and Office for National Statistics (ONS) mortality records. All patients had a validated diagnosis of COPD and were at high risk for cardiovascular events (history of myocardial infarction, diabetes mellitus, ischaemic heart disease, stroke and peripheral arterial disease). The primary outcome was all-cause mortality. RESULTS: The treatment group was composed of 2687 new users of LABA-ICS with COPD and comparisons were made in a control population of 2687 COPD patients prescribed LABAs alone. At three years follow-up death occurred in 358 (13.3%) patients in the treatment group and 427 (15.9%) patients in the control group. The use of LABA-ICS was modestly associated with improved survival compared to use of LABAs (hazard ratio 0.82, 95% CI 0.71-0.95, P = 0.007). CONCLUSIONS: Among patients with COPD with either established cardiovascular disease or at high risk of an index cardiovascular event, LABA-ICS inhaled therapy, compared with LABAs alone, was associated with a significantly improved survival.
Marin y Kall C, Boehmer J, Cowie M, et al., 2019, Cardiac Autonomic Nerve Stimulation Improves Hemodynamics and Clinical Status in Advanced Heart Failure Patients, 31st Annual Symposium on Transcatheter Cardiovascular Therapeutics (TCT), Publisher: ELSEVIER SCIENCE INC, Pages: B86-B86, ISSN: 0735-1097
Kim D, Hayhoe B, Aylin P, et al., 2019, Route to heart failure diagnosis in English primary care: a retrospective cohort study of variation, British Journal of General Practice, Vol: 69, Pages: e697-e705, ISSN: 0960-1643
BACKGROUND: Despite the existence of evidence-based guidelines supporting the identification of heart failure (HF) in primary care, the proportion of patients diagnosed in this setting remains low. Understanding variation in patients' routes to diagnosis will better inform HF management. AIM: To identify the factors associated with variation in patients' routes to HF diagnosis in primary care. DESIGN AND SETTING: A retrospective cohort study of 13 897 patients diagnosed with HF between 1 January 2010 and 31 March 2013 in English primary care. METHOD: This study used primary care electronic health records to identify routes to HF diagnosis, defined using the National Institute for Health and Care Excellence (NICE) guidelines, and adherence to the NICE-recommended guidelines. Multilevel logistic regression was used to investigate factors associated with the recommended route to HF diagnosis, and funnel plots were used to visualise variation between practices. RESULTS: Few patients (7%, n = 976) followed the recommended route to HF diagnosis. Adherence to guidelines was significantly associated with younger age (P = 0.001), lower deprivation level (P = 0.007), HF diagnosis source (P<0.001), not having chronic pulmonary disease (P<0.001), receiving further consultation for symptom(s) suggestive of HF (P<0.001), and presenting with breathlessness (P<0.001). Route to diagnosis also varied significantly between GP practices (P<0.001). CONCLUSION: The significant association of certain patient characteristics with route to HF diagnosis and the variation between GP practices raises concerns about equitable HF management. Further studies should investigate reasons for this variation to improve the diagnosis of HF in primary care. However, these must consider the complexities of a patient group often affected by frailty and multiple comorbidities.
Adeleke Y, Matthew D, Porter B, et al., 2019, Improving the quality of care for patients with or at risk of atrial fibrillation: an improvement initiative in UK general practices, Open Heart, Vol: 6, ISSN: 2053-3624
Objective Atrial fibrillation (AF) is a growing problem internationally and a recognised cause of cardiovascular morbidity and mortality. The London borough of Hounslow has a lower than expected prevalence of AF, suggesting poor detection and associated undertreatment. To improve AF diagnosis and management, a quality improvement (QI) initiative was set up in 48 general practices in Hounslow. We aimed to study whether there was evidence of a change in AF diagnosis and management in Hounslow following implementation of interventions in this QI initiative.Methods Using the general practice information system (SystmOne), data were retrospectively collected for 415 626 patients, who were actively registered at a Hounslow practice between 1 January 2011 and 31 August 2018. Process, outcome and balancing measures were analysed using statistical process control and interrupted time series regression methods. The baseline period was from 1 January 2011 to 30 September 2014 and the intervention period was from 1 October 2014 to 31 August 2018.Results When comparing the baseline to the intervention period, (1) the rate of new AF diagnoses increased by 27% (relative risk 1.27; 95% CI 1.05 to 1.52; p<0.01); (2) ECG tests done for patients aged 60 and above increased; (3) CHA2DS2-VASc and HAS-BLED risk assessments within 30 days of AF diagnosis increased from 1.7% to 19% and 0.2% to 8.1%, respectively; (4) among those at higher risk of stroke, anticoagulation prescription within 30 days of AF diagnosis increased from 31% to 63% while prescription of antiplatelet monotherapy within the same time period decreased from 17% to 7.1%; and (5) average CHA2DS2-VASc and HAS-BLED risk scores did not change.Conclusion Implementation of interventions in the Hounslow QI initiative coincided with improved AF diagnosis and management. Areas with perceived underdetection of AF should consider similar interventions and methodology.
Cowie MR, 2019, Is the digital revolution the dawn of a golden age or just the next fad?, Cardiovasc Res
Linz D, Baumert M, Desteghe L, et al., 2019, Nightly sleep apnea severity in patients with atrial fibrillation: Potential applications of long-term sleep apnea monitoring., Int J Cardiol Heart Vasc, Vol: 24, ISSN: 2352-9067
In patients with atrial fibrillation (AF), the prevalence of moderate-to-severe sleep-disordered breathing (SDB) ranges between 21% and 72% and observational studies have demonstrated that SDB reduces the efficacy of rhythm control strategies, while treatment with continuous positive airway pressure lowers the rate of AF recurrence. Currently, the number of apneas and hypopneas per hour (apnea-hypopnea-index, AHI) determined during a single overnight sleep study is clinically used to assess the severity of SDB. However, recent studies suggest that SDB-severity in an individual patient is not stable over time but exhibits a considerable night-to-night variability which cannot be detected by only one overnight sleep assessment. Nightly SDB-severity assessment rather than the single-night diagnosis by one overnight sleep study may better reflect the exposure to SDB-related factors and yield a superior metric to determine SDB-severity in the management of AF. In this review we discuss mechanisms of night-to-night SDB variability, arrhythmogenic consequences of night-to-night SDB variability, strategies for longitudinal assessment of nightly SDB-severity and clinical implications for screening and management of SDB in AF patients.
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
Diaz T, Marin y Kall C, Boehmer J, et al., 2019, Cardiac Autonomic Nerves Stimulation Improves Hemodynamics and Clinical Status in Advanced Heart Failure Patients, 23rd Annual Scientific Meeting of the Heart-Failure-Society-of-America (HFSA), Publisher: CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS, Pages: S167-S168, ISSN: 1071-9164
Taylor RS, Sadler S, Dalal HM, et al., 2019, The cost effectiveness of REACH-HF and home-based cardiac rehabilitation compared with the usual medical care for heart failure with reduced ejection fraction: A decision model-based analysis, EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, Vol: 26, Pages: 1252-1261, ISSN: 2047-4873
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
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
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
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.
Khan H, Haldar S, Boyalla V, et al., 2019, Left atrial reverse remodelling is not associated with improved success in treatment of long standing persistent atrial fibrillation, Publisher: OXFORD UNIV PRESS, Pages: 250-250, ISSN: 2047-2404
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
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, Vol: 48, Pages: 347-354, 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.
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
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.
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
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
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