Publications
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Kotecha D, Asselbergs FW, Achenbach S, et al., 2022, CODE-EHR best practice framework for the use of structured electronic healthcare records in clinical research, BMJ-BRITISH MEDICAL JOURNAL, Vol: 378, ISSN: 0959-535X
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- Citations: 10
Amirova A, Lucas R, Cowie MR, et al., 2022, Perceived barriers and enablers influencing physical activity in heart failure: A qualitative one-to-one interview study, PLOS ONE, Vol: 17, ISSN: 1932-6203
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- Citations: 2
McBeath K, Cowie MR, 2022, Heart failure: classification and pathophysiology, Medicine (United Kingdom), Vol: 50, Pages: 471-478, ISSN: 1357-3039
Heart failure (HF) is a clinical syndrome in which there are characteristic signs and symptoms (e.g. oedema, breathlessness, fatigue) resulting from an underlying abnormality of cardiac function. Understanding the cause of the cardiac dysfunction and the body's response to it is essential in effective management. HF can present acutely, for example as a consequence of an acute myocardial infarction, or in a chronic form in which acute decompensation can then occur. HF results in a plethora of changes in the heart, at the cellular, microscopic and macroscopic levels, with the heart remodelling in response to these abnormal conditions. The underlying cardiac dysfunction also triggers the activation of an array of neuro-hormonal compensatory mechanisms that ultimately become deleterious to cardiac and other organ function; these include sodium and fluid retention, increased sympathetic tone, altered breathing patterns, arrhythmia and, in more advanced stages, an inflammatory state with immune activation.
Hernandez AF, Albert NM, Allen LA, et al., 2022, Multiple cArdiac seNsors for mAnaGEment of Heart Failure (MANAGE-HF) - Phase I Evaluation of the Integration and Safety of the HeartLogic Multisensor Algorithm in Patients With Heart Failure, JOURNAL OF CARDIAC FAILURE, Vol: 28, Pages: 1245-1254, ISSN: 1071-9164
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- Citations: 14
Cowie MR, Cleland JGF, 2022, The COVID-19 pandemic and heart failure: lessons from GUIDE-HF, EUROPEAN HEART JOURNAL, Vol: 43, Pages: 2619-2621, ISSN: 0195-668X
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- Citations: 5
Jankowska EA, Liu P, Cowie MR, et al., 2022, Personalized care of patients with heart failure - REWOLUTION HF international survey on patients' needs and perceptions, Publisher: WILEY, Pages: 137-137, ISSN: 1388-9842
Rayman G, Akpan A, Cowie M, et al., 2022, Managing patients with comorbidities: future models of care., Future Healthc J, Vol: 9, Pages: 101-105, ISSN: 2514-6645
One in four adults in the UK have two or more medical conditions. One in three adults admitted to hospital in the UK have five or more conditions. People with multimorbidity have poorer functional status, quality of life and health outcomes, and are higher users of ambulatory and inpatient care than those without multimorbidity. The entire healthcare system needs to change so that it can provide a better service for patients with multimorbidity. The system of healthcare professional education needs to change also. Clinical decision support has a clear role in the management of patients with multimorbidity. But, until now, clinical decision support tools have offered no support when dealing with patients with comorbidities; they have covered single conditions only. In light of this, BMJ Best Practice recently launched the Comorbidities Manager. This enables healthcare professionals to add a patient's comorbidities to an existing management plan and get a tailored plan instantly. This article outlines the importance of taking into account comorbidities when managing patients and the role that the BMJ Comorbidities Manager can play in this regard.
Adeniji M, Brimicombe J, Cowie MR, et al., 2022, Prioritising electrocardiograms for manual review to improve the efficiency of atrial fibrillation screening., Pages: 3239-3242
Screening for atrial fibrillation (AF) could reduce the incidence of stroke by identifying undiagnosed AF and prompting anticoagulation. However, screening may involve recording many electrocardiograms (ECGs) from each participant, several of which require manual review which is costly and time-consuming. The aim of this study was to investigate whether the number of ECG reviews could be reduced by using a model to prioritise ECGs for review, whilst still accurately diagnosing AF. A multiple logistic regression model was created to estimate the likelihood of an ECG exhibiting AF based on the mean RR-interval and variability in RR-intervals. It was trained on 1,428 manually labelled ECGs from 144 AF screening programme participants, and evaluated using 11,443 ECGs from 1,521 participants. When using the model to order ECGs for review, the number of reviews for AF participants was reduced by 74% since no further reviews are required after an AF ECG is identified; however, it did not impact the number of reviews in non-AF participants (the vast majority of participants), so the overall number of reviews was reduced by 3% with no missed AF diagnoses. When using the model to also exclude ECGs from review, the overall number of reviews was reduced by 28% with no missed AF diagnoses, and by 53% with only 4% of AF diagnoses missed. In conclusion, the workload can be reduced by using a model to prioritise ECGs for review. Ordering ECGs alone only provides only a moderate reduction in workload. The additional use of a threshold to exclude ECGs from review provides a much greater reduction in workload at the expense of some missed AF diagnoses. Clinical Relevance-This shows the potential benefit of using a model to prioritise electrocardiograms for review in order to reduce the manual workload of AF screening.
Jankowska EA, Liu P, Cowie MR, et al., 2022, Personalized care of patients with heart failure - REWOLUTION HF international survey on cardiologists' educational needs, Publisher: WILEY, Pages: 119-120, ISSN: 1388-9842
Fisser C, Gall L, Bureck J, et al., 2022, Effects of Adaptive Servo-Ventilation on Nocturnal Ventricular Arrhythmia in Heart Failure Patients With Reduced Ejection Fraction and Central Sleep Apnea-An Analysis From the SERVE-HF Major Substudy, FRONTIERS IN CARDIOVASCULAR MEDICINE, Vol: 9, ISSN: 2297-055X
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- Citations: 1
Bleakley C, de Marvao A, Morosin M, et al., 2022, Utility of echocardiographic right ventricular subcostal strain in critical care, EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING, Vol: 23, Pages: 820-828, ISSN: 2047-2404
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- Citations: 1
Butler J, Stebbins A, Melenovsky V, et al., 2022, Vericiguat and Health-Related Quality of Life in Patients With Heart Failure With Reduced Ejection Fraction: Insights From the VICTORIA Trial, CIRCULATION-HEART FAILURE, Vol: 15, ISSN: 1941-3289
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- Citations: 8
McBeath KCC, Angermann CE, Cowie MR, 2022, Digital Technologies to Support Better Outcome and Experience of Care in Patients with Heart Failure, CURRENT HEART FAILURE REPORTS, Vol: 19, Pages: 75-108, ISSN: 1546-9530
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- Citations: 6
Cowie MR, McBeath KCC, Angermann CE, 2022, The Digital Future of Heart Failure Care, CURRENT HEART FAILURE REPORTS, Vol: 19, Pages: 109-113, ISSN: 1546-9530
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- Citations: 1
Leclercq C, Witt H, Hindricks G, et al., 2022, Wearables, telemedicine, and artificial intelligence in arrhythmias and heart failure: Proceedings of the European Society of Cardiology: Cardiovascular Round Table, EUROPACE, ISSN: 1099-5129
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- Citations: 18
Levy P, Naughton MT, Tamisier R, et al., 2022, Sleep apnoea and heart failure, EUROPEAN RESPIRATORY JOURNAL, Vol: 59, ISSN: 0903-1936
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- Citations: 12
Ho MH, Huang D, Ho C-W, et al., 2022, Body volume is the major determinant of worsening renal function in acutely decompensated heart failure with reduced left ventricular ejection fraction, POSTGRADUATE MEDICAL JOURNAL, Vol: 98, Pages: 333-340, ISSN: 0032-5473
Konstam MA, Mann DL, Udelson JJE, et al., 2022, Advances in Our Clinical Understanding of Autonomic Regulation Therapy Using Vagal Nerve Stimulation in Patients Living With Heart Failure, FRONTIERS IN PHYSIOLOGY, Vol: 13
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- Citations: 6
Bottle R, Newson R, Faitna P, et al., 2022, Changes in heart failure management and long-term mortality over ten years: observational study, Open Heart, Vol: 9, ISSN: 2053-3624
Objectives: To estimate the long-term survival of two cohorts of people diagnosed with heart failure 10 years apart and to assess differences in patient characteristics, clinical guideline compliance and survival by diagnosis setting.Methods Data: for patients aged 18 and over with a new diagnosis of heart failure in the Clinical Practice Research Datalink in 2001–2002 (5966 patients in 156 practices) and 2011–2012 (12 827 patients in 331 practices). Survival rates since diagnosis were described using Kaplan-Meier plots. Compliance with national guidelines was summarised.Results: 2011/2012 patients were older than those diagnosed a decade before, with lower blood pressure and cholesterol but more comorbidity and healthcare contacts. For those diagnosed in 2001/2002, the 5-year survival was 40.0% (40.2% in the 2011/2012 cohort), 10-year survival was 20.8%, and 15-year survival 11.1%. Improvement in survival between the two time periods was seen only in those diagnosed in primary care (5-year survival 46.0% vs 57.4%, compared with 33.9% and 32.6% for hospital-diagnosed patients).Beta-blocker use rose from 24.3% to 39.1%; renin–angiotensin system blockers rose from 31.8% to 54.3% (both p<0.001). There was little change for loop diuretics and none for thiazide diuretics. For the 9963 patients with symptoms recorded by their general practitioner before diagnosis, brain natriuretic peptide (BNP) testing was low, but echocardiogram use rose from 8.3% to 19.3%, and specialist referral rose from 7.2% to 24.6% (all p<0.001).
Zeymer U, Aboyans V, Cowie MR, et al., 2022, USE OF DUAL PATHWAY INHIBITION FOR SECONDARY PREVENTION IN PATIENTS WITH ATHEROTHROMBOTIC DISEASE: THE PROSPECTIVE REAL-WORLD XATOA STUDY, Publisher: ELSEVIER SCIENCE INC, Pages: 1746-1746, ISSN: 0735-1097
Halliday B, Owen R, Gregson J, et al., 2022, Changes in clinical and imaging variables during withdrawal of heart failure therapy in recovered dilated cardiomyopathy, ESC Heart Failure, Vol: 9, ISSN: 2055-5822
Aims: To profile the changes in non-invasive clinical, biochemical and imaging markers during withdrawal of therapy in patients with recovered dilated cardiomyopathy, providing insights into the pathophysiology of relapse.Methods: Clinical, biochemical and imaging data from patients during phased withdrawal of therapy in the randomised or single-arm cross-over phases of TRED-HF were profiled. Clinical variables were measured at each study visit and imaging variables were measured at baseline, 16 weeks and 6 months. Results: Amongst the 49 patients (35% women, mean age 53.6 years [standard deviation 11.6]) who withdrew therapy, 20 relapsed. Increases in mean heart rate (7.6 beats per minute [95% CIs 4.5,10.7]), systolic blood pressure (6.6mmHg [95% CI 2.7,10.5]) and diastolic blood pressure (5.8mmHg [95% CI 3.1,8.5]) were observed within 4-8 weeks of starting to withdraw therapy. A rise in mean LV mass (5.1g/m2 [95%CI 2.8,7.3]) and LV end-diastolic volume (3.9ml/m2 [95% CI 1.1,6.7]) and a reduction in mean LV ejection fraction (-4.2 [95% CI -6.6, -1.8]) were seen by 16 weeks, the earliest imaging follow-up. Plasma NT-pro-BNP fell immediately after withdrawing beta-blockers and only tended to increase 6 months after beginning therapy withdrawal (mean change in log NT-pro-BNP at 6 months: 0.2, 95% CI -0.1,0.4). Conclusion: Changes in plasma NT-pro-BNP are a late feature of relapse, often months after a reduction in LV function. A rise in heart rate and blood pressure are observed soon after withdrawing therapy in recovered dilated cardiomyopathy, typically accompanied or closely followed by early changes in LV structure and function.
Kouranos V, Khattar RS, Ahmed R, et al., 2022, MODE OF PRESENTATION, PROGNOSIS AND PREDICTORS OF OUTCOME IN A CONTEMPORARY CARDIAC SARCOIDOSIS POPULATION, Publisher: ELSEVIER SCIENCE INC, Pages: 553-553, ISSN: 0735-1097
Ivey-Miranda JB, Wetterling F, Gaul R, et al., 2022, Changes in inferior vena cava area represent a more sensitive metric than changes in filling pressures during experimental manipulation of intravascular volume and tone, EUROPEAN JOURNAL OF HEART FAILURE, Vol: 24, Pages: 455-462, ISSN: 1388-9842
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- Citations: 10
Masip J, Peacok WF, Arrigo M, et al., 2022, Acute Heart Failure in the 2021 ESC Heart Failure Guidelines: a scientific statement from the Association for Acute CardioVascular Care (ACVC) of the European Society of Cardiology, EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE, Vol: 11, Pages: 173-185, ISSN: 2048-8726
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- Citations: 15
Mullens W, Coats A, Seferovic P, et al., 2022, Education and certification on heart failure of the Heart Failure Association of the European Society of Cardiology, EUROPEAN JOURNAL OF HEART FAILURE, Vol: 24, Pages: 249-253, ISSN: 1388-9842
Cowie MR, Flett A, Cowburn P, et al., 2022, Real-world evidence in a national health service: results of the UK CardioMEMS HF System Post-Market Study, ESC Heart Failure, Vol: 9, Pages: 48-56, ISSN: 2055-5822
AimsThe CardioMEMS HF System Post-Market Study (COAST) was designed to evaluate the safety, effectiveness, and feasibility of haemodynamic-guided heart failure (HF) management using a small sensor implanted in the pulmonary artery of New York Heart Association (NYHA) Class III HF patients in the UK, Europe, and Australia.Methods and resultsCOAST is a prospective, international, multicentre, open-label clinical study (NCT02954341). The primary clinical endpoint compares annualized HF hospitalization rates after 1 year of haemodynamic-guided management vs. the year prior to sensor implantation in patients with NYHA Class III symptoms and a previous HF hospitalization. The primary safety endpoints assess freedom from device/system-related complications and pressure sensor failure after 2 years. Results from the first 100 patients implanted at 14 out of the 15 participating centres in the UK are reported here. At baseline, all patients were in NYHA Class III, 70% were male, mean age was 69 ± 12 years, and 39% had an aetiology of ischaemic cardiomyopathy. The annualized HF hospitalization rate after 12 months was 82% lower [95% confidence interval 72–88%] than the previous 12 months (0.27 vs. 1.52 events/patient-year, respectively, P < 0.0001). Freedom from device/system-related complications and pressure sensor failure at 2 years was 100% and 99%, respectively.ConclusionsRemote haemodynamic-guided HF management, using frequent assessment of pulmonary artery pressures, was successfully implemented at 14 specialist centres in the UK. Haemodynamic-guided HF management was safe and significantly reduced hospitalization in a group of high-risk patients. These results support implementation of this innovative remote management strategy to improve outcome for patients with symptomatic HF.Clinical registration number: ClinicalTrials.gov identifier: NCT02954341.
Cowie MR, O'Connor CM, 2022, The digital future is now, JACC: Heart Failure, Vol: 10, Pages: 67-69, ISSN: 2213-1779
Tromp JASPER, Jindal DEVRAJ, Redfern JULIE, et al., 2022, World Heart Federation Roadmap for Digital Health in Cardiology, GLOBAL HEART, Vol: 17, ISSN: 2211-8160
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- Citations: 11
Puyol-Anton E, Ruijsink B, Sidhu BS, et al., 2022, AI-Enabled Assessment of Cardiac Systolic and Diastolic Function from Echocardiography, 3rd International Workshop of Advances in Simplifying Medical Ultrasound (ASMUS), Publisher: SPRINGER INTERNATIONAL PUBLISHING AG, Pages: 75-85, ISSN: 0302-9743
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- Citations: 1
Fox K, Price S, Achenbach S, et al., 2021, The European Society of Cardiology - a digital educator., Journal of European CME, Vol: 10, Pages: 1-7, ISSN: 2161-4083
The mission statement of the European Society of Cardiology (ESC) is "to reduce the burden of cardiovascular disease". The ESC is the leading scientific society for cardiovascular health care professionals across Europe and increasingly the world. Recognising the need for democratisation of education in cardiology, the ESC has for many years embraced the digital world within its education programme. As in all areas of medicine, the COVID-19 pandemic required an agile response to be able to continue to provide not only a digital congress but also education, training and assessment in an almost totally digital world. In this paper we will describe the digital learning activities of the ESC, the successes and the challenges of the transformation that has taken place in the last 18 months as well as an overview of the vision for education, training and assessment in the post-COVID digital era. We understand the need to provide a portfolio of educational styles to suit a diverse range of learners. It is clear that digital CME provides opportunities but it is likely that it will not entirely replace in-person learning. In planning for the future, we regard the provision of digital CME as central to fulfiling our mission.
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