Publications
710 results found
Axson E, Sundaram V, Bloom C, et al., 2020, Temporal trends in the incidence of heart failure among patients with COPD and its association with mortality, Annals of the American Thoracic Society, Vol: 17, Pages: 939-948, ISSN: 1546-3222
Rationale: Heart failure (HF) is a common comorbidity in the chronic obstructive pulmonary disease (COPD) population, but previous research has shown under recognition. Objectives: To determine the incidence of HF in a prevalent COPD cohort. To determine the association of incident HF with short- and long-term mortality of patients with COPD. Methods: Crude incidence of HF in the HF-naïve primary care COPD population was calculated for each year from 2006-2016 using UK data from the Clinical Practice Research Datalink (CPRD). Patients with COPD were identified using a validated code list and were required to be over 35 years old at COPD diagnosis, have a history of smoking, and have documented airflow obstruction. Office of National Statistics provided mortality data for England. Adjusted mortality rate ratios (aMRR) from Poisson regression were calculated for patients with COPD and incident HF (COPD-iHF) in 2006, 2011, and 2015 and compared temporally with patients with COPD and without incident HF (COPD-no HF) in those years. Regression was adjusted for age, sex, BMI, severity of airflow limitation, smoking status, history of cardiovascular disease, and diabetes. Results: We identified 95,987 HF-naïve patients with COPD. Crude incidence of HF was steady from 2006-2016 (1.18 per 100 person-years (95%CI: 1.09, 1.27)). Patients with COPD-iHF experienced greater than threefold increase in one-year mortality and twofold increase in five-year and 10-year mortality compared with patients with COPD-no HF, with no change based on year of HF diagnosis. Mortality of patients with COPD-iHF did not improve over time, comparing incident HF in 2011 (1-year aMRR 1.26, 95%CI: 0.83, 1.90; 5-year aMRR 1.26, 95%CI: 0.98, 1.61) and 2015 (1-year aMRR 1.63, 95%CI: 0.98, 2.70) with incident HF in 2006. Conclusions: The incidence of HF in the UK COPD population was stable in the last decade. Survival of patients with COPD and incident HF has not improved over time in England. Be
Fox KAA, Anand SS, Aboyans V, et al., 2020, Xarelto plus acetylsalicylic acid: treatment patterns and outcomes in patients with Atherosclerosis (XATOA): Rationale and design of a prospective registry study to assess rivaroxaban 2.5 mg twice daily plus aspirin for prevention of atherothrombotic events in coronary artery disease, periphera artery disease, or both, American Heart Journal, Vol: 222, Pages: 166-173, ISSN: 0002-8703
Patients with coronary artery disease (CAD), peripheral artery disease (PAD), or both remain at risk of cardiovascular events (including peripheral ischemic events), even when they receive the current guideline-recommended treatment. The phase III COMPASS trial demonstrated that treatment with rivaroxaban vascular dose 2.5 mg twice daily plus aspirin (dual pathway inhibition [DPI] regimen) significantly reduced the risk of major adverse cardiovascular events (including peripheral ischemic events) and increased the risk of major bleeding, but not fatal bleeding or intracranial hemorrhage, versus aspirin alone in patients with CAD, PAD, or both. The results of the COMPASS trial supported the regulatory approval of the DPI regimen in several geographic regions. However, it is unclear whether the patients selected for treatment with the DPI regimen in clinical practice will have a similar risk profile and event rates compared with the COMPASS trial population. The prospective post-approval XATOA registry study aims to assess treatment patterns, as well as ischemic and bleeding outcomes in patients with CAD, PAD, or both, who receive DPI therapy in routine clinical practice. Up to 10,000 patients from at least 400 centers in 22 countries will be enrolled and followed up for a minimum of 12 months, and all treatment will be at the discretion of the prescribing physician. The primary objective of the XATOA study will be to describe early treatment patterns, while ischemic and bleeding outcomes will be described as a secondary objective.
Diaz T, Marin y Kall C, Boehmer J, et al., 2020, Cardiac Autonomic Nerves Stimulation Improves Hemodynamics and Clinical Status in Advanced Heart Failure Patients, 40th Annual Meeting and Scientific Sessions of the International-Society-for-Heart-and-Lung-Transplantation (ISHLT), Publisher: ELSEVIER SCIENCE INC, Pages: S156-S156, ISSN: 1053-2498
Diaz T, Marin Y Kall C, Boehmer J, et al., 2020, Cardiac Autonomic Nerves Stimulation Improves Hemodynamics and Clinical Status in Advanced Heart Failure Patients., J Heart Lung Transplant, Vol: 39
PURPOSE: Despite heart failure therapy advances, symptomatic congestion and low cardiac output in acute heart failure is a leading cause of mortality and morbidity. The purpose of this study was to investigate transvenous cardiac autonomic nerve stimulation (CANS) effects on in-hospital hemodynamics and clinical status. METHODS: The study was a single-center, open label, clinical investigation of CANS. Twenty two subjects with LVEF <40% and at least two signs and symptoms of congestion were consented and enrolled. A purpose-built electrical stimulation catheter was placed in the left brachiocephalic vein via left subclavian vein access and connected to a purpose-built bedside neurostimulator used to deliver CANS therapy in-hospital for up to 96 hrs. RESULTS: The subjects had a mean baseline NT-proBNP of 10,518 pg/mL, LVEF of 25%, pulmonary capillary wedge pressure (PCWP) of 20 mmHg and presented with symptoms. CANS therapy was provided for a mean duration of 70 hrs. There were no device or study related adverse events reported. During CANS therapy mean cardiac index increased (1.8 to 2.0 L/min./m2), mean systemic vascular resistance decreased (24 to 20 WU), and mean PCWP decreased (20 to 14 mmHg) with stable MAP and HR. At discharge, mean edema pitting score improved 2 points, mean 6 minute hall walk distance (6MHW) increased 92 m and mean KCCQ-12 increased 12 points. At 30 day follow-up, edema pitting score improved 3 points, 6MHW increased 102 m and mean KCCQ-12 improved 38 points from baseline. Hemodynamic and clinical improvements occurred in the presence of stable medical management. Patients received at least 80 mg/day of furosemide, had minimal change to existing heart failure medical management, received no new IV vasoactive therapies, and a majority of the patients (17/22) received no furosemide dose uptitration during CANS Therapy. CONCLUSION: Alongside concomitant medical therapy, CANS holds promise as a tool to improve in-hospital hemodynamics and rel
Ferreira JP, Duarte K, Woehrle H, et al., 2020, Biomarkers in patients with heart failure and central sleep apnoea: findings from the SERVE-HF trial, ESC Heart Failure, Vol: 7, Pages: 503-511, ISSN: 2055-5822
AimsThe Treatment of Sleep‐Disordered Breathing with Predominant Central Sleep Apnoea by Adaptive Servo Ventilation in Patients with Heart Failure trial investigated the effects of adaptive servo‐ventilation (ASV) (vs. control) on outcomes of 1325 patients with heart failure and reduced ejection fraction (HFrEF) and central sleep apnoea (CSA). The primary outcome (a composite of all‐cause death or unplanned HF hospitalization) did not differ between the two groups. However, all‐cause and cardiovascular (CV) mortality were higher in the ASV group. Circulating biomarkers may help in better ascertain patients' risk, and this is the first study applying a large set of circulating biomarkers in patients with both HFrEF and CSA.Methods and resultsCirculating protein‐biomarkers (n = 276) ontologically involved in CV pathways, were studied in 749 (57% of the trial population) patients (biomarker substudy), to investigate their association with the study outcomes (primary outcome, CV death and all‐cause death). The mean age was 69 ± 10 years, and > 90% were male. The groups (ASV vs. control and biomarker substudy vs. no biomarker) were well balanced. The “best” clinical prognostic model included male sex, systolic blood pressure < 120 mmHg, diabetes, loop diuretic, cardiac device, 6‐min walking test distance, and N‐terminal pro BNP as the strongest prognosticators. On top of the “best” clinical prognostic model, the biomarkers that significantly improved both the discrimination (c‐index) and the net reclassification index (NRI) of the model were soluble suppression of tumorigenicity 2 for the primary outcome; neurogenic locus notch homolog protein 3 (Notch‐3) for CV‐death and all‐cause death; and growth differentiation factor 15 (GDF‐15) for all‐cause death only.ConclusionsWe studied 276 circulating biomarkers in patients with HFrEF and central sleep apnoea; of these biomarkers, three added significant prognostic information on top of the
Javed F, Tamisier R, Pepin J-L, et al., 2020, 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, Vol: 25, Pages: 305-311, ISSN: 1323-7799
- Author Web Link
- Cite
- Citations: 13
Zakeri R, Morgan JM, Phillips P, et al., 2020, Impact of remote monitoring on clinical outcomes for patients with heart failure and atrial fibrillation: results from the REM-HF trial, EUROPEAN JOURNAL OF HEART FAILURE, Vol: 22, Pages: 543-553, ISSN: 1388-9842
- Author Web Link
- Cite
- Citations: 20
Axson E, Ragutheeswaran K, Sundaram V, et al., 2020, Hospitalisation and mortality in patients with comorbid COPD and heart failure: a systematic review and meta-analysis, Respiratory Research, Vol: 21, Pages: 1-13, ISSN: 1465-9921
BackgroundDiscrepancy exists amongst studies investigating the effect of comorbid heart failure (HF) on the morbidity and mortality of chronic obstructive pulmonary disease (COPD) patients.MethodsMEDLINE and Embase were searched using a pre-specified search strategy for studies comparing hospitalisation, rehospitalisation, and mortality of COPD patients with and without HF. Studies must have reported crude and/or adjusted rate ratios, risk ratios, odds ratios (OR), or hazard ratios (HR).ResultsTwenty-eight publications, reporting 55 effect estimates, were identified that compared COPD patients with HF with those without HF. One study reported on all-cause hospitalisation (1 rate ratio). Two studies reported on COPD-related hospitalisation (1 rate ratio, 2 OR). One study reported on COPD- or cardiovascular-related hospitalisation (4 HR). One study reported on 90-day all-cause rehospitalisation (1 risk ratio). One study reported on 3-year all-cause rehospitalisation (2 HR). Four studies reported on 30-day COPD-related rehospitalisation (1 risk ratio; 5 OR). Two studies reported on 1-year COPD-related rehospitalisation (1 risk ratio; 1 HR). One study reported on 3-year COPD-related rehospitalisation (2 HR). Eighteen studies reported on all-cause mortality (1 risk ratio; 4 OR; 24 HR). Five studies reported on all-cause inpatient mortality (1 risk ratio; 4 OR). Meta-analyses of hospitalisation and rehospitalisation were not possible due to insufficient data for all individual effect measures. Meta-analysis of studies requiring spirometry for the diagnosis of COPD found that risk of all-cause mortality was 1.61 (pooled HR; 95%CI: 1.38, 1.83) higher in patients with HF than in those without HF.ConclusionsIn this systematic review, we investigated the effect of HF comorbidity on hospitalisation and mortality of COPD patients. There is substantial evidence that HF comorbidity increases COPD-related rehospitalisation and all-cause mortality of COPD patients. The effect of HF
Cowie MR, 2020, The Inaugural ESC digital summit: The first European Society of Cardiology (ESC) digital summit took place in Tallinn, Estonia, during October 2019, European Heart Journal, Vol: 41, Pages: 731-732, ISSN: 0195-668X
Cowie MR, de Groote P, McKenzie S, et al., 2020, Rationale and design of the CardioMEMS Post-Market Multinational Clinical Study: COAST, ESC Heart Failure, Vol: 7, Pages: 865-872, ISSN: 2055-5822
AimsChronic heart failure reduces quality and quantity of life and is expensive for healthcare systems. Medical treatment relies on guideline‐directed therapy, but clinical follow‐up and remote management is highly variable and poorly effective. New remote management strategies are needed to maintain clinical stability and avoid hospitalizations for acute decompensation.Methods and resultsThe CardioMEMS Post‐Market Study is a prospective, international, single‐arm, multicentre, open‐label study (NCT02954341) designed to examine the feasibility of haemodynamic guided heart failure management using a small pressure sensor permanently implanted in the pulmonary artery (PA). Daily uploaded PA pressures will be reviewed weekly to remotely guide medical management of patients with persistent NYHA Class III symptoms at baseline and a hospitalization in the prior 12 months. The study will enrol up to 800 patients from 85 sites across the United Kingdom, Europe, and Australia. The primary safety endpoint will assess device or system‐related complications or sensor failures after 2 years of follow‐up. Efficacy will be estimated after 1 year of follow‐up comparing HF hospitalization rates before and after sensor implantation. Observational endpoints will include mortality, patient, and investigator monitoring compliance, PA pressure changes, quality of life, and several pre‐defined subgroup analyses.ConclusionsThe CardioMEMS Post‐Market Study will investigate the generalizability of remote haemodynamic guided HF management in a number of national settings. The results may support the more widespread implementation of this novel clinical management approach.
Patel HC, Hayward C, Patel KS, et al., 2020, Impact on survival of combination inhalers in patients with COPD at high risk of cardiovascular events, International Journal of Cardiology, Vol: 300, Pages: 237-244, ISSN: 0167-5273
BackgroundChronic 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.MethodsA 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.ResultsThe 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).ConclusionsAmong 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.
Bottle A, Cowie MR, 2020, Letter in reference to "Defining a 'frequent admitter' phenotype among patients with repeat heart failure admissions", European Journal of Heart Failure, Vol: 22, Pages: 384-385, ISSN: 1388-9842
Singhal A, Cowie MR, 2020, Wearable devices in cardiology, Heart and Metabolism, Pages: 12-16, ISSN: 1566-0338
Wearables-sensors that are externally applied to the body to measure a signal and transmit or record the data for further analysis-are an industry worth billions of dollars annually. It is technically feasible to measure activity, blood pressure, and pulse, and to detect arrhythmia and potential heart failure decompensation via wearables. Relatively few studies have assessed the clinical value of wearables, and many remain curiosities or consumer "toys." However, through attention to demonstrating accuracy and added value, it is possible for some technologies to be incorporated into diagnostic and treatment decision-making. Barriers to such transition include patient and physician acceptability, difficulties in incorporating the data into electronic medical records, and lack of reimbursement or regulatory approval. Cardiologists are becoming increasingly familiar with this developing field, but pressure for implementation may come more from the consumer than from the health care system.
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, ISSN: 1099-5129
- Author Web Link
- Cite
- Citations: 9
Axson EL, Sundaram V, Bloom CI, et al., 2020, The Effect of Unrecognised and Confirmed Heart Failure on Acute Exacerbations of Chronic Obstructive Pulmonary Disease, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Cowie M, Schope J, Wagenpfeil S, et al., 2019, Treatment Uptitration Patterns in Patients With Heart Failure With Reduced Ejection Fraction: Data From International Qualify Survey, Resuscitation Science Symposium (ReSS), Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: E999-E999, ISSN: 0009-7322
Witte K, Hasenfuss G, Kloppe A, et al., 2019, Cost-effectiveness of a cardiac contractility modulation device in heart failure with normal QRS duration, ESC Heart Failure, Vol: 6, Pages: 1178-1187, ISSN: 2055-5822
AimsThe objective of this paper is to assess whether cardiac contractility modulation (via the Optimizer System) plus standard of care (SoC) is a cost‐effective treatment for people with heart failure [New York Heart Association (NYHA) III, left ventricular ejection fraction of 25–45%, and narrow QRS] compared against SoC alone from the perspective of the English National Health Service.Methods and resultsWe developed a regression equation‐based cost‐effectiveness model, using individual patient data from three randomized control trials (FIX‐HF‐5 Phases 1 and 2, and FIX‐HF‐5C) to populate the majority of parameters. A series of regression equations predicted NYHA class over time, mortality, all‐cause hospitalization rates, and health‐related quality of life. We conducted the analysis in line with the National Institute for Health and Care Excellence reference case, modelling costs from an English National Health Service perspective, and considering outcomes in quality‐adjusted life years (QALYs) over a patient lifetime perspective. Our base case analysis produced an incremental cost per additional QALY of GBP22 988 (€25 750) when comparing Optimizer + SoC to SoC alone. This result was not sensitive to parameter uncertainty but was sensitive to the time horizon over which costs and QALYs were captured and the duration over which a survival benefit with Optimizer + SoC can be assumed to apply.ConclusionsCardiac contractility modulation is likely to be cost‐effective in people with heart failure with reduced ejection fraction, NYHA III, and narrow QRS, provided that the treatment benefit can be maintained beyond the duration of the existing clinical trial follow‐up. This analysis supports the current recommendations of the European Society of Cardiology that this therapy may be considered for such patients.
Axson EL, Sundaram V, Bloom CI, et al., 2019, EFFECT OF INCIDENT HEART FAILURE ON SHORT- AND LONG-TERM MORTALITY OF COPD PATIENTS, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A1-A2, ISSN: 0040-6376
Cowie M, 2019, ADVANCES IN TREATING HEART FAILURE, POSTGRADUATE MEDICAL JOURNAL, Vol: 95, Pages: 685-686, ISSN: 0032-5473
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, Vol: 21, Pages: 1661-1662, ISSN: 1388-9842
- Author Web Link
- Cite
- Citations: 4
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, Pages: 1-11, ISSN: 0300-5860
IntroductionThe SERVE-HF trial included patients with heart failure and reduced ejection fraction (HFrEF) with sleep-disordered breathing, randomly assigned to treatment with Adaptive-Servo Ventilation (ASV) or control. The primary outcome was the first event of death from any cause, lifesaving cardiovascular intervention, or unplanned hospitalization for worsening heart failure. A subgroup analysis of the SERVE-HF trial suggested that patients with Cheyne-Stokes respiration (CSR) < 20% (low CSR) experienced a beneficial effect from ASV, whereas in patients with CSR ≥ 20% ASV might have been harmful. Identifying the proteomic signatures and the underlying mechanistic pathways expressed in patients with CSR could help generating hypothesis for future research.MethodsUsing a large set of circulating protein-biomarkers (n = 276, available in 749 patients; 57% of the SERVE-HF population) we sought to investigate the proteins associated with CSR and to study the underlying mechanisms that these circulating proteins might represent.ResultsThe mean age was 69 ± 10 years and > 90% were male. Patients with CSR < 20% (n = 139) had less apnoea-hypopnea index (AHI) events per hour and less oxygen desaturation. Patients with CSR < 20% might have experienced a beneficial effect of ASV treatment (primary outcome HR [95% CI] = 0.55 [0.34–0.88]; p = 0.012), whereas those with CSR ≥ 20% might have experienced a detrimental effect of ASV treatment (primary outcome HR [95% CI] = 1.39 [1.09–1.76]; p = 0.008); p for interaction = 0.001. Of the 276 studied biomarkers, 8 were associated with CSR (after adjustment and with a FDR1%-corrected p value). For example, higher PAR-1 and ITGB2 levels were associated with higher odds of having CSR < 20%
Cowie MR, Lamy A, Levy P, et al., 2019, COST-EFFECTIVENESS OF RIVAROXABAN IN THE TREATMENT OF PATIENTS WITH CHRONIC CAD OR PAD IN THE UK, Publisher: ELSEVIER SCIENCE INC, Pages: S550-S550, ISSN: 1098-3015
- Author Web Link
- Cite
- Citations: 1
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
- Author Web Link
- Cite
- Citations: 2
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.
Woehrle H, Cowie MR, Wegscheider K, et al., 2019, No effect of adaptive servo-ventilation (ASV) device used on outcomes in SERVE-HF, EUROPEAN RESPIRATORY JOURNAL, Vol: 54, ISSN: 0903-1936
Woehrle H, Cowie MR, Wegscheider K, et al., 2019, Association between symptomatic improvements and outcome: responder analysis of SERVE-HF, International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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.
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, IJC Heart and Vasculature, Vol: 24, Pages: 1-7, 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.
Cowie MR, 2019, Is the digital revolution the dawn of a golden age or just the next fad?, Cardiovasc Res
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
BackgroundThe REACH-HF (Rehabilitation EnAblement in CHronic Heart Failure) trial found that the REACH-HF home-based cardiac rehabilitation intervention resulted in a clinically meaningful improvement in disease-specific health-related quality of life in patients with reduced ejection fraction heart failure (HFrEF). The aims of this study were to assess the long-term cost-effectiveness of the addition of REACH-HF intervention or home-based cardiac rehabilitation to usual care compared with usual care alone in patients with HFrEF.Design and methodsA Markov model was developed using a patient lifetime horizon and integrating evidence from the REACH-HF trial, a systematic review/meta-analysis of randomised trials, estimates of mortality and hospital admission and UK costs at 2015/2016 prices. Taking a UK National Health and Personal Social Services perspective we report the incremental cost per quality-adjusted life-year (QALY) gained, assessing uncertainty using probabilistic and deterministic sensitivity analyses.ResultsIn base case analysis, the REACH-HF intervention was associated with per patient mean QALY gain of 0.23 and an increased mean cost of £400 compared with usual care, resulting in a cost per QALY gained of £1720. Probabilistic sensitivity analysis indicated a 78% probability that REACH-HF is cost effective versus usual care at a threshold of £20,000 per QALY gained. Results were similar for home-based cardiac rehabilitation versus usual care. Sensitivity analyses indicate the findings to be robust to changes in model assumptions and parameters.ConclusionsOur cost-utility analyses indicate that the addition of the REACH-HF intervention and home-based cardiac rehabilitation programmes are likely to be cost-effective treatment options versus usual care alone in patients with HFrEF.
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.