636 results found
Cowie MR, O'Connor CM, 2022, The Digital Future Is Now, JACC-HEART FAILURE, Vol: 10, Pages: 67-69, ISSN: 2213-1779
Heart Failure (HF) and Sleep-Disordered-Breathing (SDB) are two common conditions that frequently overlap and have been studied extensively in the past three decades. Obstructive Sleep Apnea (OSA) may result in myocardial damage, due to intermittent hypoxia increased sympathetic activity and transmural pressures, low-grade vascular inflammation and oxidative stress. On the other hand, central sleep apnoea and Cheyne-Stokes respiration (CSA-CSR) occurs in HF, irrespective of ejection fraction either reduced (HFrEF), preserved (HFpEF) or mildly reduced (HFmrEF). The pathophysiology of CSA-CSR relies on several mechanisms leading to hyperventilation, breathing cessation and periodic breathing. Pharyngeal collapse may result at least in part from fluid accumulation in the neck, owing to daytime fluid retention and overnight rostral fluid shift from the legs. Although both OSA and CSA-CSR occur in HF, the symptoms are less suggestive than in typical (non-HF related) OSA. Overnight monitoring is mandatory for a proper diagnosis, with accurate measurement and scoring of central and obstructive events, since the management will be different depending on whether the sleep apnea in HF is predominantly OSA or CSA-CSR. SDB in HF are associated with worse prognosis, including higher mortality than in patients with HF but without SDB. However, there is currently no evidence that treating SDB improves clinically important outcomes in patients with HF, such as cardiovascular morbidity and mortality.
Cowie MR, Flett A, Cowburn P, et al., 2021, Real-world evidence in a national health service: results of the UK CardioMEMS HF System Post-Market Study, ESC HEART FAILURE, ISSN: 2055-5822
Pieske B, Wachter R, Shah SJ, et al., 2021, Effect of Sacubitril/Valsartan vs Standard Medical Therapies on Plasma NT-proBNP Concentration and Submaximal Exercise Capacity in Patients With Heart Failure and Preserved Ejection Fraction The PARALLAX Randomized Clinical Trial, JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, Vol: 326, Pages: 1919-1929, ISSN: 0098-7484
Cowie MR, Deanfield J, 2021, Cardiovascular Medicine at a Crossroads in the United Kingdom., Circulation, Vol: 144, Pages: 1457-1458
Butler J, Stebbins A, Melenovsky V, et al., 2021, Vericiguat and health status outcomes in heart failure with reduced ejection fraction: insights from the VICTORIA trial, Publisher: OXFORD UNIV PRESS, Pages: 786-786, ISSN: 0195-668X
Singhal AA, Ng S, Cowie M, 2021, Patient flow through a specialist heart failure clinic: a time and motion study, Publisher: WILEY, Pages: 168-168, ISSN: 1388-9842
Singhal AA, Pan J, Cassimon B, et al., 2021, What happens in a heart failure clinic? A retrospective cohort study, Publisher: WILEY, Pages: 168-169, ISSN: 1388-9842
Thevathasan L, Sendaydiego A, Schoonheim P, et al., 2021, Effect of online medical education on cardiologists and primary care physicians intent to change and actual change in treatment of HFrEF with angiotensin receptor neprilysin inhibitors, Publisher: WILEY, Pages: 294-294, ISSN: 1388-9842
Singhal A, Riley JP, Cowie MR, 2021, Clinician experiences of 1 year of telemedicine heart failure clinics: The VIDEO-HF study, Publisher: WILEY, Pages: 302-302, ISSN: 1388-9842
Singhal AA, Tandon J, Ringrose T, et al., 2021, Designing an educational app for patients with heart failure, Publisher: WILEY, Pages: 301-302, ISSN: 1388-9842
Cowie MR, Linz D, Redline S, et al., 2021, Sleep Disordered Breathing and Cardiovascular Disease JACC State-of-the-Art Review, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol: 78, Pages: 608-624, ISSN: 0735-1097
Mullens W, Auricchio A, Martens P, et al., 2021, Optimized implementation of cardiac resynchronization therapy: a call for action for referral and optimization of care, EUROPACE, Vol: 23, Pages: 1324-+, ISSN: 1099-5129
Shah SJ, Cowie MR, Wachter R, et al., 2021, Baseline characteristics of patients in the PARALLAX trial: insights into quality of life and exercise capacity in heart failure with preserved ejection fraction, EUROPEAN JOURNAL OF HEART FAILURE, Vol: 23, Pages: 1541-1551, ISSN: 1388-9842
Axson E, Bottle R, Cowie M, et al., 2021, The relationship between heart failure and the risk of acute exacerbation of COPD, Thorax, Vol: 76, Pages: 807-814, ISSN: 0040-6376
Rationale: Heart failure (HF) management in chronic obstructive pulmonary disease (COPD) is often delayed or suboptimal.Objectives: To examine the effect of HF and HF medication use on moderate-to-severe COPD exacerbations.Methods and Measurements: Retrospective cohort studies from 2006-2016 using nationally-representative English primary care electronic healthcare records linked to national hospital and mortality data. COPD patients with diagnosed and possible HF were identified. Possible HF defined as continuous loop diuretic use in the absence of a non-cardiac indication. Incident exposure to HF medications was defined as ≥2 prescriptions within 90 days with no gaps >90 days during ≤6 months of continuous use; prevalent exposure as 6+ months continuous use. HF medications investigated were angiotensin receptor blockers, angiotensin converting enzyme inhibitors, beta-blockers, loop diuretics, and mineralocorticoid receptor antagonists. Cox regression, stratified on sex and age; further adjusted for patient characteristics, was used to determine the association of HF on exacerbation risk.Main Results: 86,795 COPD patients were categorized as; no evidence of HF (n=60,047); possible HF (n=8,476); newly diagnosed HF (n=2,066). Newly diagnosed HF (adjusted hazard ratio (aHR): 1.45, 95% confidence interval (CI): 1.30, 1.62) and possible HF (aHR: 1.65, 95%CI: 1.58, 1.72) similarly increased exacerbation risk. Incident and prevalent use of all HF medications were associated with increased exacerbation risk. Prevalent use was associated with reduced exacerbation risk compared with incident use.Conclusions: Earlier opportunities to improve diagnosis and management of HF in the COPD population are missed. Managing HF may reduce exacerbation risk in the longer term.
Fisser C, Bureck J, Gall L, et al., 2021, Ventricular arrhythmia in heart failure patients with reduced ejection fraction and central sleep apnoea, ERJ Open Research, Vol: 7, Pages: 1-11, ISSN: 2312-0541
Cheyne–Stokes respiration (CSR) may trigger ventricular arrhythmia in patients with heart failure with reduced ejection fraction (HFrEF) and central sleep apnoea (CSA). This study determined the prevalence and predictors of a high nocturnal ventricular arrhythmia burden in patients with HFrEF and CSA (with and without CSR) and to evaluate the temporal association between CSR and the ventricular arrhythmia burden. This cross-sectional ancillary analysis included 239 participants from the SERVE-HF major sub-study who had HFrEF and CSA, and nocturnal ECG from polysomnography. CSR was stratified in ≥20% and <20% of total recording time (TRT). High burden of ventricular arrhythmia was defined as >30 premature ventricular complexes (PVCs) per hour of TRT. A sub-analysis was performed to evaluate the temporal association between CSR and ventricular arrhythmias in sleep stage N2. High ventricular arrhythmia burden was observed in 44% of patients. In multivariate logistic regression analysis, male sex, lower systolic blood pressure, non-use of antiarrhythmic medication and CSR ≥20% were significantly associated with PVCs >30·h−1 (OR 5.49, 95% CI 1.51–19.91, p=0.010; OR 0.98, 95% CI 0.97–1.00, p=0.017; OR 5.02, 95% CI 1.51–19.91, p=0.001; and OR 2.22, 95% CI 1.22–4.05, p=0.009; respectively). PVCs occurred more frequently during sleep phases with versus without CSR (median (interquartile range): 64.6 (24.8–145.7) versus 34.6 (4.8–75.2)·h−1 N2 sleep; p=0.006). Further mechanistic studies and arrhythmia analysis of major randomised trials evaluating the effect of treating CSR on ventricular arrhythmia burden and arrhythmia-related outcomes are warranted to understand how these data match with the results of the parent SERVE-HF study.
Halliday B, Vazir A, Owen R, et al., 2021, Heart rate as a marker of relapse during withdrawal of therapy in recovered dilated cardiomyopathy, JACC: Heart Failure, Vol: 9, Pages: 509-517, ISSN: 2213-1779
Objective: To determine the relationship between heart rate and relapse amongst patients in the TRED-HF trial. Background: Understanding markers and mechanisms of relapse amongst patients with recovered dilated cardiomyopathy (DCM) might enable personalised management.Methods: The relationship between serial heart rate measurements and relapse was examined amongst patients TRED-HF, a randomised trial which examined the safety and feasibility of withdrawing heart failure therapy amongst 51 patients with recovered DCM over 6 months. In total, 25 patients were randomised to therapy withdrawal and 26 to continue therapy, of whom 25 subsequently began therapy withdrawal in a single arm crossover phase.Results: The mean heart rate (standard deviation) for those who had therapy withdrawn and did not relapse was 64.6bpm (10.7) at baseline and 74.7bpm (10.4) at follow-up compared to 68.3bpm (11.3) and 86.1bpm (11.8) for those who relapsed. After adjusting for baseline heart rate, patients who had therapy withdrawn and relapsed had a 10.4bpm (95% confidence intervals [CIs] 4.0-16.8) greater rise in heart rate compared to patients who had therapy withdrawn and did not relapse (p=0.002). After adjusting for age, log NT-pro-BNP and LVEF, heart rate (per 10bpm - hazard ratio: 1.65, 95%CI 1.10-2.57, p=0.01) and change in heart rate from baseline (per 10bpm - hazard ratio: 1.70, 95%CI 1.12-2.57, p=0.01) were associated with relapse. The results remained qualitatively the same after adjusting for beta-blocker dose.Conclusion: For patients with DCM and improved LVEF, the rise in heart rate after withdrawing treatment identifies patients who are more likely to relapse. Whether the increase in heart rate is a marker or mediator of relapse requires investigation.
Savarese G, Bodegard J, Norhammar A, et al., 2021, Heart failure drug titration, discontinuation, mortality and heart failure hospitalization risk: a multinational observational study (US, UK and Sweden), EUROPEAN JOURNAL OF HEART FAILURE, Vol: 23, Pages: 1499-1511, ISSN: 1388-9842
Bleakley C, de Marvao A, Morosin M, et al., 2021, Utility of echocardiographic right ventricular subcostal strain in critical care., Eur Heart J Cardiovasc Imaging
AIMS: Right ventricular (RV) strain is a known predictor of outcomes in various heart and lung pathologies but has been considered too technically challenging for routine use in critical care. We examined whether RV strain acquired from the subcostal view, frequently more accessible in the critically ill, is an alternative to conventionally derived RV strain in intensive care. METHODS AND RESULTS: RV strain data were acquired from apical and subcostal views on transthoracic echocardiography (TTE) in 94 patients (35% female), mean age 50.5 ± 15.2 years, venovenous extracorporeal membrane oxygenation (VVECMO) (44%). RV strain values from the apical (mean ± standard deviation; -20.4 ± 6.7) and subcostal views (-21.1 ± 7) were highly correlated (Pearson's r -0.89, P < 0.001). RV subcostal strain correlated moderately well with other echocardiography parameters including tricuspid annular plane systolic excursion (r -0.44, P < 0.001), RV systolic velocity (rho = -0.51, P < 0.001), fractional area change (r -0.66, P < 0.01), and RV outflow tract velocity time integral (r -0.49, P < 0.001). VVECMO was associated with higher RV subcostal strain (non-VVECMO -19.6 ± 6.7 vs. VVECMO -23.2 ± 7, P = 0.01) but not apical RV strain. On univariate analysis, RV subcostal strain was weakly associated with survival at 30 days (R2 = 0.04, P = 0.05, odds ratio =1.08) while apical RV was not (P = 0.16). CONCLUSION : RV subcostal deformation imaging is a reliable surrogate for conventionally derived strain in critical care and may in time prove to be a useful diagnostic marker in this cohort.
Voors AA, Mulder H, Reyes E, et al., 2021, Renal function and the effects of vericiguat in patients with worsening heart failure with reduced ejection fraction: insights from the VICTORIA (Vericiguat Global Study in Subjects with HFrEF) trial, European Journal of Heart Failure, Vol: 23, Pages: 1313-1321, ISSN: 1388-9842
AimsVericiguat reduced the primary composite outcome of cardiovascular death or heart failure (HF) hospitalization in patients with worsening HF with reduced ejection fraction (HFrEF) and a lower limit of baseline estimated glomerular filtration rate (eGFR) of 15 mL/min/1.73 m2. We evaluated the relationship between the efficacy of vericiguat and baseline and subsequent changes in renal function.Methods and resultsIn VICTORIA, core laboratory serum creatinine was measured at baseline (n = 4956) and weeks 16, 32, and 48. Worsening renal function (WRF), defined as an increase ≥0.3 mg/dL in creatinine from baseline to week 16, was assessed via a Cox model with respect to subsequent primary events. Mean age was 69 years, 24% were female, and mean baseline eGFR was 61 mL/min/1.73 m2. During 48 weeks of treatment, the trajectories in eGFR and creatinine with vericiguat were similar to placebo (P = 0.50 and 0.18). The beneficial effects of vericiguat on the primary outcome were not influenced by baseline eGFR (interaction P = 0.48). WRF occurred in 15% of patients and was associated with worse outcomes (adjusted hazard ratio 1.28, 95% confidence interval 1.11–1.47; P < 0.001), but the beneficial effects of vericiguat on the primary outcome were similar in patients with or without WRF (interaction P = 0.76).ConclusionRenal function trajectories were similar between vericiguat- and placebo-treated patients and the beneficial effects of vericiguat on the primary outcome were consistent across the full range of eGFR and irrespective of WRF.
Singhal A, Tandon J, Ringrose T, et al., 2021, DESIGNING AN EDUCATIONAL APP FOR PATIENTS WITH HEART FAILURE, Publisher: BMJ PUBLISHING GROUP, Pages: A98-A99, ISSN: 1355-6037
Singhal A, Ng S, Cowie M, 2021, PATIENT FLOW THROUGH A SPECIALIST HEART FAILURE CLINIC: A TIME AND MOTION STUDY, Publisher: BMJ PUBLISHING GROUP, Pages: A106-A107, ISSN: 1355-6037
Singhal A, Pan J, Cassimon B, et al., 2021, WHAT ACTUALLY HAPPENS IN A SPECIALIST HEART FAILURE CLINIC?, Publisher: BMJ PUBLISHING GROUP, Pages: A103-A104, ISSN: 1355-6037
Singhal A, Riley J, Cowie M, 2021, CLINICIAN EXPERIENCES OF 1 YEAR OF TELEMEDICINE HEART FAILURE CLINICS: THE VIDEO-HF STUDY, Publisher: BMJ PUBLISHING GROUP, Pages: A90-A90, ISSN: 1355-6037
Bottle R, Faitna P, Aylin P, et al., 2021, Five-year outcomes following left ventricular assist device implantation in England, Open Heart, Vol: 8, Pages: 1-6, ISSN: 2053-3624
Objective Implant rates of mechanical circulatory supports such as left ventricular assist devices (LVAD) have steadily increased in the last decade. We assessed the utility of administrative data to provide information on hospital use and outcomes.Methods Using 2 years of national hospital administrative data for England linked to the death register, we identified all patients with an LVAD and extracted hospital activity for 5 years before and after the LVAD implantation date.Results In the two index years April 2011 to March 2013, 157 patients had an LVAD implanted. The mean age was 50.9 (SD 15.4), and 78.3% were men. After 5 years, 92 (58.6%) had died; the recorded cause of death was noncardiovascular in 67.4%. 42 (26.8%) patients received a heart±lung transplantation. Compared with the 12 months before implantation, the 12 months after but not including the month of implantation saw falls in total inpatient and day case admissions, a fall in admissions for heart failure (HF), a rise in non-HF admissions, a fall in emergency department visits not ending in admission and a rise in outpatient appointments (all per patient at risk). Postimplantation complications were common in the subsequent 5 years: 26.1% had a stroke, 23.6% had a device infection and 13.4% had a new LVAD implanted.Conclusions Despite patients’ young age, their mortality is high and their hospital use and complications are common in the 5 years following LVAD implantation. Administrative data provide important information on resource use in this patient group.
Singhal A, Cowie MR, 2021, Digital health: implications for heart failure management., Card Fail Rev, Vol: 7, Pages: 1-7, ISSN: 2057-7540
Digital health encompasses the use of information and communications technology and the use of advanced computing sciences in healthcare. This review covers the application of digital health in heart failure patients, focusing on teleconsultation, remote monitoring and apps and wearables, looking at how these technologies can be used to support care and improve outcomes. Interest in and use of these technologies, particularly teleconsultation, have been accelerated by the coronavirus disease 2019 pandemic. Remote monitoring of heart failure patients, to identify those patients at high risk of hospitalisation and to support clinical stability, has been studied with mixed results. Remote monitoring of pulmonary artery pressure has a consistent effect on reducing hospitalisation rates for patients with moderately severe symptoms and multiparameter monitoring shows promise for the future. Wearable devices and apps are increasingly used by patients for health and lifestyle support. Some wearable technologies have shown promise in AF detection, and others may be useful in supporting self-care and guiding prognosis, but more evidence is required to guide their optimal use. Support for patients and clinicians wishing to use these technologies is important, along with consideration of data validity and privacy and appropriate recording of decision-making.
Elliott P, Cowie MR, Franke J, et al., 2021, Development, validation, and implementation of biomarker testing in cardiovascular medicine state-of-the-art: proceedings of the European Society of Cardiology-Cardiovascular Round Table, CARDIOVASCULAR RESEARCH, Vol: 117, Pages: 1248-1256, ISSN: 0008-6363
Bottle A, Faitna P, Aylin P, et al., 2021, Five-year survival and use of hospital services following ICD and CRT implantation: comparing real-world data with RCTs, ESC Heart Failure, Vol: 8, Pages: 2438-2447, ISSN: 2055-5822
AimsGuidelines recommend the use of an implantable cardioverter-defibrillator (ICD) and/or cardiac resynchronization therapy (CRT) device based on the results of randomized controlled trials (RCTs), typically with selected patients and short follow-up.Methods and resultsWe describe the 5 year survival rate and use of hospital services following ICD and CRT implantation in England from April 2011 to March 2013 using the national hospital administrative database covering emergency department visits, inpatient admissions, and clinic appointments, linked to the national death register. Five-year survival was 64% after ICD implantation and 58% after CRT implantation, with median survival times of 6.8 and 6.2 years, respectively. Hospital use was high in both device groups, for the 5 years prior and after implantation, peaking around the implantation date. Most hospital activity was not primarily related to heart failure. Healthcare costs were dominated by admissions, but emergency department and clinic activity were both high. Only the CRT group saw total per-patient costs fall after the index month (implantation), driven by a slight fall in the heart failure admission rate. Patients were typically older than in the trials, but with similar co-morbidity except for substantially more atrial fibrillation and less dementia. Survival and device complications were similar to the RCTs.ConclusionsClinical and cost-effectiveness assessments of ICD and CRT implantation are supported by real-world data, although the prevalence of atrial fibrillation remains substantially higher than in the RCTs.
Mullens W, Martens P, Witte K, et al., 2021, Why mechanical dyssynchrony remains relevant to cardiac resynchronization therapy: Reply, EUROPEAN JOURNAL OF HEART FAILURE, Vol: 23, Pages: 844-845, ISSN: 1388-9842
Cowie MR, Lam CSP, 2021, Remote monitoring and digital health tools in CVD management, NATURE REVIEWS CARDIOLOGY, Vol: 18, Pages: 457-458, ISSN: 1759-5002
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