597 results found
McCambridge J, Keane C, Walshe M, et al., 2020, The prehospital patient pathway and experience of care with acute heart failure: a comparison of two health care systems, ESC HEART FAILURE, ISSN: 2055-5822
Halliday B, Owen R, Gregson J, et al., 2020, Myocardial remodelling after withdrawing therapy for heart failure in patients with recovered dilated cardiomyopathy – insights from TRED-HF, European Journal of Heart Failure, ISSN: 1388-9842
Zannad F, Cowie MR, 2020, VERTIS-CV More Evidence That Sodium Glucose Cotransporter 2 Inhibition Brings Rapid and Sustained Heart Failure Benefit, CIRCULATION, Vol: 142, Pages: 2216-2218, ISSN: 0009-7322
Chen Y, Postmus D, Cowie MR, et al., 2020, Using joint modelling to assess the association between a time-varying biomarker and a survival outcome: an illustrative example in respiratory medicine., Eur Respir J
Mullens W, Auricchio A, Martens P, et al., 2020, Optimized Implementation of cardiac resynchronization therapy - a call for action for referral and optimization of care., Eur J Heart Fail
Cardiac resynchronization therapy (CRT) is one of the most effective therapies for heart failure with reduced ejection fraction and leads to improved quality of life, reductions in heart failure hospitalization rates and reduces all-cause mortality. Nevertheless, up to two-thirds of eligible patients are not referred for CRT. Furthermore, post implantation follow-up is often fragmented and suboptimal, hampering the potential maximal treatment effect. This joint position statement from three ESC Associations, HFA, EHRA and EACVI focuses on optimized implementation of CRT. We offer theoretical and practical strategies to achieve more comprehensive CRT referral and post-procedural care by focusing on four actionable domains; (I) overcoming CRT under-utilization, (II) better understanding of pre-implant characteristics, (III) abandoning the term 'non-response' and replacing this by the concept of disease modification, and (IV) implementing a dedicated post-implant CRT care pathway.
Nielsen JC, Kautzner J, Casado-Arroyo R, et al., 2020, Remote monitoring of cardiac implanted electronic devices: legal requirements and ethical principles - ESC Regulatory Affairs Committee/EHRA joint task force report, EUROPACE, Vol: 22, Pages: 1742-+, ISSN: 1099-5129
Cowie MR, 2020, DAPA-HF: does dapagliflozin provide "bang for your buck" as a treatment for HFrEF?, European Journal of Heart Failure, Vol: 22, Pages: 2157-2159, ISSN: 1388-9842
Elliott P, Cowie MR, Franke J, et al., 2020, Development, validation and implementation of biomarker testing in cardiovascular medicine state-of-the-art: Proceedings of the European Society of Cardiology - Cardiovascular Round Table., Cardiovasc Res
Many biomarkers that could be used to assess ejection fraction, heart failure, or myocardial infarction fail to translate into clinical practice because they lack essential performance characteristics or fail to meet regulatory standards for approval. Despite their potential, new technologies have added to the complexities of successful translation into clinical practice. Biomarker discovery and implementation requires a standardised approach that includes: identification of a clinical need; identification of a valid surrogate biomarker; stepwise assay refinement, demonstration of superiority over current standard-of-care; development and understanding of a clinical pathway; and demonstration of real-world performance. Successful biomarkers should improve efficacy or safety of treatment, while being practical at a realistic cost. Everyone involved in cardiovascular healthcare, including researchers, clinicians, and industry partners, are important stakeholders in facilitating the development and implementation of biomarkers. This paper provides suggestions for a development pathway for new biomarkers, discusses regulatory issues and challenges, and suggestions for accelerating the pathway to improve patient outcomes. Real life examples of successful biomarkers-high sensitivity cardiac troponin (hs-cTn), T2* cardiovascular magnetic resonance (CMR) imaging, and echocardiography-are used to illustrate the value of a standardised development pathway in the translation of concepts into routine clinical practice.
Cowie MR, Lamy A, Levy P, et al., 2020, Health economic evaluation of rivaroxaban in the treatment of patients with chronic coronary artery disease or peripheral artery disease, Cardiovascular Research, Vol: 116, Pages: 1918-1924, ISSN: 0008-6363
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.
Yadegarfar ME, Gale CP, Dondo TB, et al., 2020, Association of treatments for acute myocardial infarction and survival for seven common comorbidity states: a nationwide cohort study, BMC Medicine, Vol: 18, Pages: 1-12, ISSN: 1741-7015
BackgroundComorbidity is common and has a substantial negative impact on the prognosis of patients with acute myocardial infarction (AMI). Whilst receipt of guideline-indicated treatment for AMI is associated with improved prognosis, the extent to which comorbidities influence treatment provision its efficacy is unknown. Therefore, we investigated the association between treatment provision for AMI and survival for seven common comorbidities.MethodsWe used data of 693,388 AMI patients recorded in the Myocardial Ischaemia National Audit Project (MINAP), 2003–2013. We investigated the association between comorbidities and receipt of optimal care for AMI (receipt of all eligible guideline-indicated treatments), and the effect of receipt of optimal care for comorbid AMI patients on long-term survival using flexible parametric survival models.ResultsA total of 412,809 [59.5%] patients with AMI had at least one comorbidity, including hypertension (302,388 [48.7%]), diabetes (122,228 [19.4%]), chronic obstructive pulmonary disease (COPD, 89,221 [14.9%]), cerebrovascular disease (51,883 [8.6%]), chronic heart failure (33,813 [5.6%]), chronic renal failure (31,029 [5.0%]) and peripheral vascular disease (27,627 [4.6%]).Receipt of optimal care was associated with greatest survival benefit for patients without comorbidities (HR 0.53, 95% CI 0.51–0.56) followed by patients with hypertension (HR 0.60, 95% CI 0.58–0.62), diabetes (HR 0.83, 95% CI 0.80–0.87), peripheral vascular disease (HR 0.85, 95% CI 0.79–0.91), renal failure (HR 0.89, 95% CI 0.84–0.94) and COPD (HR 0.90, 95% CI 0.87–0.94). For patients with heart failure and cerebrovascular disease, optimal care for AMI was not associated with improved survival.ConclusionsOverall, guideline-indicated care was associated with improved long-term survival. However, this was not the case in AMI patients with concomitant heart failure or cerebrovascular disease. There is therefore a need fo
Zakeri R, Morgan JM, Phillips P, et al., 2020, Prevalence and prognostic significance of device-detected subclinical atrial fibrillation in patients with heart failure and reduced ejection fraction, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 312, Pages: 64-70, ISSN: 0167-5273
Miro O, Rossello X, Platz E, et al., 2020, Risk stratification scores for patients with acute heart failure in the Emergency Department: A systematic review, EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE, Vol: 9, Pages: 375-398, ISSN: 2048-8726
Kim D, Hayhoe B, Aylin P, et al., 2020, Health service use by patients with heart failure living in a community setting: a cross-sectional analysis in North West London, BRITISH JOURNAL OF GENERAL PRACTICE, Vol: 70, Pages: E563-E572, ISSN: 0960-1643
Cowie MR, Fisher M, 2020, SGLT2 inhibitors: mechanisms of cardiovascular benefit beyond glycaemic control, NATURE REVIEWS CARDIOLOGY, Vol: 17, Pages: 761-772, ISSN: 1759-5002
Singhal A, Cowie MR, 2020, The role of wearables in heart failure., Current Heart Failure Reports, Vol: 17, Pages: 125-132, ISSN: 1546-9530
PURPOSE OF REVIEW: This review discusses how wearable devices-sensors externally applied to the body to measure a physiological signal-can be used in heart failure (HF) care. RECENT FINDINGS: Most wearables are marketed to consumers and can measure movement, heart rate, and blood pressure; detect and monitor arrhythmia; and support exercise training and rehabilitation. Wearable devices targeted at healthcare professionals include ECG patch recorders and vests, patches, and textiles with in-built sensors for improved prognostication and the early detection of acute decompensation. Integrating data from wearables into clinical decision-making has been slow due to clinical inertia and concerns regarding data security and validity, lack of evidence of meaningful impact, interoperability, regulatory and reimbursement issues, and legal liability. Although few studies have assessed how best to integrate wearable technologies into clinical practice, their use is rapidly expanding and may support improved decision-making by patients and healthcare professionals along the whole patient pathway.
Wachter R, Shah SJ, Cowie MR, et al., 2020, Angiotensin receptor neprilysin inhibition versus individualized RAAS blockade: design and rationale of the PARALLAX trial, ESC Heart Failure, Vol: 7, Pages: 856-864, ISSN: 2055-5822
AIMS: Although the effect of the angiotensin receptor blocker neprilysin inhibitor (ARNI) sacubitril/valsartan on heart failure (HF) hospitalizations and cardiovascular death has been evaluated, its effects on functional capacity in patients with HF and ejection fraction (EF) >40% has yet to be determined. In addition, no prior studies have compared sacubitril/valsartan with angiotensin-converting enzyme inhibitor therapy. We sought to compare the effect of ARNI to background-medication-based individualized comparators (BMICs) on N-terminal pro-B-type natriuretic peptide (NT-proBNP), functional capacity [6 min walk distance (6MWD)], symptoms, and quality of life [Kansas City Cardiomyopathy Questionnaire (KCCQ)] in patients with HF and EF >40% in a randomized clinical trial. METHODS: PARALLAX is a prospective, randomized, controlled, double-blind multicentre clinical trial in patients with chronic symptomatic HF with EF >40%, New York Heart Association (NYHA) class II-IV symptoms, elevated natriuretic peptides, and evidence of structural heart disease. Eligible patients are randomized to sacubitril/valsartan vs. BMIC for cardiovascular and related co-morbidities. BMIC includes (i) enalapril, (ii) valsartan, and (iii) placebo depending on the type of medical therapy prior to enrolment. The primary endpoints are the change in plasma NT-proBNP concentration from baseline to 12 weeks and the change from baseline in 6MWD distance at 24 weeks. The secondary endpoints assess quality of life and symptom burden. CONCLUSIONS: PARALLAX will determine if sacubitril/valsartan compared with standard medical therapy for co-morbidities improves NT-proBNP levels, exercise capacity, quality of life, and symptom burden in HF patients with EF >40%.
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
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
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.
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
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
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
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
Kim D, Hayhoe B, Aylin P, et al., 2020, Health service use by community-dwelling heart failurepatients in a large urban population in NW London, British Journal of General Practice, ISSN: 0960-1643
Background: The complex nature of heart failure (HF) management, often involving multidimensional care, is widely recognised, but overall health service utilisation by HF patients has not previously been described.Aim: To describe overall health service use by community-dwelling adults with HF.Design and Setting: Cross-sectional analysis of prevalent HF cases between 2015 and 2018 using an administrative dataset covering primary care, secondary care, and ‘other’ (community, mental health, and social care) services in North West London (NWL).Methods: Healthcare use of each service was described overall and by individual components of secondary care (e.g. outpatient appointments) and ‘other’ services (e.g. nursing contacts). Usage patterns were identified using k-means cluster analysis using all distinct contacts for the whole study period and visualised by a heatmap. Results: There were 39 301 patients with a prevalent diagnosis of HF between 1 January 2015 and 31 December 2018. 90% used health services during the study period, most commonly outpatient services, GP consultations, unplanned A&E visits and community services. Use of cardiology-specific services ranged from around 3% (cardiology-related community care) to around 20% (outpatient cardiology visits). GP consultations decreased by 11% over our study period. Five clusters of patients were identified, each with significantly different care usage patterns and patient characteristics.Conclusions: HF patients make heavy but heterogeneous use of services. Relatively low and falling use of GP consultations, and apparently low uptake of community rehabilitation services by patients with HF, is concerning and suggests challenges in primary care access and integration of care.
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
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