Publications
710 results found
Amirova A, Lucas R, Cowie MR, et al., 2021, Perceived barriers and enablers influencing physical activity in heart failure: a qualitative one-to-one interview study
<jats:title>Abstract</jats:title><jats:p>In heart failure (HF), increased physical activity is associated with improved quality of life, reduced hospitalisation, and increased longevity and is an important aim of treatment. However, physical activity levels in individuals living with HF are typically extremely low. This qualitative study with one-to-one interviews systematically explores perceived clinical, environmental, and psychosocial barriers and enablers in older adults (>70 years old) living with HF. Semi-structured interviews (N = 16) based on the Theoretical Domains Framework elicited 78 belief statements describing the barriers and enablers to physical activity. Theoretical domains containing these beliefs and corresponding constructs that were both pervasive and common were deemed most relevant. These were: concerns about physical activity (Beliefs about Consequences), self-efficacy (Beliefs about Capabilities), social support (Social Influences), major health event (Environmental Context and Resources), goal behavioural (Goal), action planning (Behavioural Regulation). This work extends the limited research on the modifiable barriers and enablers for physical activity participation by individuals living with HF. The research findings provide insights for cardiologists, HF-specialist nurses, and physiotherapists to help co-design and deliver a physical activity intervention more likely to be effective for individuals living with HF.</jats:p>
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
- Author Web Link
- Cite
- Citations: 54
Halliday BP, Owen R, Gregson J, et al., 2021, Longitudinal Changes in Clinical and Imaging Variables During Withdrawal of Heart Failure Therapy in Patients with Recovered Dilated Cardiomyopathy: An Analysis from TRED-HF, Annual Scientific Sessions of the American-Heart-Association / Resuscitation Science Symposium, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322
Cowie MR, Deanfield J, 2021, Cardiovascular Medicine at a Crossroads in the United Kingdom, CIRCULATION, Vol: 144, Pages: 1457-1458, ISSN: 0009-7322
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 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
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
- Author Web Link
- Cite
- Citations: 13
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
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 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
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
- Author Web Link
- Cite
- Citations: 55
Cowie MR, Linz D, Redline S, et al., 2021, Sleep Disordered Breathing and Cardiovascular Disease <i>JACC</i> State-of-the-Art Review, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol: 78, Pages: 608-624, ISSN: 0735-1097
- Author Web Link
- Cite
- Citations: 56
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 (Withdrawn Publication. See vol. 25, 2023), EUROPACE, Vol: 23, Pages: 1324-+, ISSN: 1099-5129
- Author Web Link
- Cite
- Citations: 13
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.
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
- Author Web Link
- Cite
- Citations: 16
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
Nielsen JC, Kautzner J, Casado-Arroyo R, et al., 2021, Remote monitoring of cardiac implanted electronic devices: legal requirements and ethical principles - ESC Regulatory Affairs Committee/EHRA joint task force report (vol 22, pg 1742, 2020), EUROPACE, Vol: 23, Pages: 843-843, ISSN: 1099-5129
Asteggiano R, Cowie MR, Richter D, et al., 2021, Survey on e-health knowledge and usage in general cardiology of the Council of Cardiology Practice and the Digital Health Committee., Eur Heart J Digit Health, Vol: 2, Pages: 342-347
The Council for Cardiology Practice of the European Society of Cardiology (ESC), in collaboration with the Digital Health Committee (DHC), undertook an electronic survey with 15 question multiple-choice questionnaire sent to 32 461 members of the ESC with the aim to assess the knowledge and usage of digital health (DH) technologies (DHTs) by office-based cardiologists. Of 559 respondents, 57% graded their knowledge about DH as 'fair' and three quarters identified the correct definition of DH. Clinical information systems, mHealth Apps, and telemedicine were the most frequently used DHTs, but 41% of respondents had concerns about their ethical and data transparency. Lack of legal clarity, low patient motivation, limited DH literacy, and poor access to DH were perceived as the main barriers to the adoption of DH. Seventy percent of the respondents were aware of the DH pages on the ESC website and 76% of the educational sessions in the DH area during the ESC Congress 2019. Only 16% had not read articles on DH. Eight-eight percent of responders declared that they would 'probably' or definitely attend future educational initiatives on DHT.
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
- Author Web Link
- Cite
- Citations: 1
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
- Author Web Link
- Cite
- Citations: 8
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
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.