Time filter

Source Type

Clydebank, United Kingdom

Cleland J.G.F.,University of Hull | McDonagh T.,Imperial College London | Rigby A.S.,University of Hull | Yassin A.,University of Hull | And 2 more authors.
Heart | Year: 2011

Objectives: To obtain national data on the clinical characteristics, investigation, management and outcome of patients hospitalised with a diagnosis of heart failure. Method: A survey was carried out of the first 10 patients hospitalised with a primary diagnosis of heart failure each month in 86 hospitals providing services for acute medical admissions in England and Wales from April 2008 until March 2009. The main outcome measures were rates of investigations, treatments and specialist management, length of hospital stay and mortality. Results: The 86 hospitals enrolled 6170 patients with a median age of 78 years (IQR 70-85 years), including 2639 (43%) women. At admission, only 30% of patients were breathless at rest, while 43% had peripheral oedema. Echocardiograms were recorded in 75% of patients and left ventricular ejection fraction (LVEF) was ≤40% in 78%. Natriuretic peptides were rarely measured. Allowing for missing data, >90% of patients were treated with loop diuretics at discharge, 80% with ACE inhibitors or angiotensin receptor blockers, 50% with β-blockers and 30% with aldosterone antagonists. Patients with an LVEF <40% were more likely to receive these agents. Median hospital stay was 9 days (IQR 5-17) and in-patient mortality was 12%. Patients admitted to general medicine rather than cardiology wards were more likely to die (HR=2.5, 95% CI 2.0 to 3.3, p<0.001) even after adjusting for differences (HR=1.9, 95% CI 1.5 to 2.5, p<0.001). Projected 1-year mortality below and above age 75 years was 26% and 56%, with higher rates if managed on general medicine rather than cardiology wards (HR=1.4, 95% CI 1.2 to 1.6, p<0.001). Conclusion The prognosis of patients hospitalised with heart failure remains poor and investigation and treatment suboptimal. Specialist services are associated with higher rates of investigation and treatment and improved outcome. Source

Cowie M.R.,Imperial College London | Collinson P.O.,St. Georges Hospital | Dargie H.,Scottish Advanced Heart Failure Service | Hobbs F.D.R.,University of Birmingham | And 3 more authors.
British Journal of Cardiology | Year: 2010

Plasma natriuretic peptide (NP) testing is not widely used in heart failure clinical practice in the UK or Ireland, despite a large evidence base. This article reports the views of a consensus group that was set up to develop guidance on the place of NP testing for clinicians in primary and secondary care. There is firm evidence for NP testing as part of the heart failure diagnostic pathway. Measuring NPs is also a useful prognostic tool and can help with discharge planning, and there is emerging evidence for use in treatment monitoring particularly in younger patients. For the future, NP measurement might also prove to be useful for screening high-risk patients for asymptomatic left ventricular systolic dysfunction. Copyright Medinews (Cardiology) Limited Reproduction Prohibited. Source

Lang N.N.,Scottish Advanced Heart Failure Service | Badar A.A.,Scottish Advanced Heart Failure Service | Pettit S.J.,Institute of Cardiovascular Medicine and Science | Templeton S.,Scottish Advanced Heart Failure Service | And 2 more authors.
Biomarkers in Medicine | Year: 2014

Aims: Effective cardiac resynchronization therapy may depend upon the distance between left ventricular (LV) and right ventricular (RV) pacing leads. We assessed the influence of lead separation upon circulating NT-proBNP. Materials & methods: In total, 132 patients underwent assessment, including NT-proBNP assay, before and after cardiac resynchronization therapy. 3D lead separation was calculated from postero-anterior and lateral chest radiography. Results: Lead separation correlated with NT-proBNP reduction (r = 0.25; p = 0.004). Circulating NT-proBNP only fell in those with lead separation in the upper two quartiles. Deteriorating NT-proBNP occurred in 44 patients. Lead separation was less in these patients compared with those with an improvement (corrected 3D lead separation: 148.0 ± 5.38 and 170.5 ± 4.21 mm, respectively; p = 0.0018). Conclusion: Left ventricular-right ventricular lead separation correlates with postcardiac resynchronization therapy improvements in circulating NT-proBNP, a powerful marker of heart failure status and prognosis. Attention should be paid to achieving maximal lead separation at implantation. © 2014 Future Medicine Ltd. Source

Lang N.N.,Scottish Advanced Heart Failure Service | Wong C.M.,Scottish Advanced Heart Failure Service | Dalzell J.R.,Scottish Advanced Heart Failure Service | Jansz S.,Scottish Advanced Heart Failure Service | And 2 more authors.
Biomarkers in Medicine | Year: 2014

Aims: The aim of the study was to examine the ease of use and the reproducibility of a novel point-of-care BNP measurement system when used by patients and healthcare providers (HCP). Patients & methods: Patients with symptomatic heart failure were recruited from outpatient clinics at four hospitals. They were provided with brief training and instructional material for the use of the point-of-care BNP measurement system. Finger-prick blood BNP concentration was measured by the HCP and the patient (n = 150). Ease of use and reproducibility of the system were assessed. Results: In total, 80% of the 164 patients who completed a questionnaire on the ease of use of the system found it easy to operate. There was excellent correlation of BNP measurement compared between patients and HCP (r = 0.966; p < 0.001). Conclusion: Patients find the Alere Heart Check BNP measurement system easy to operate. BNP concentration measurements obtained by patients show excellent correlation with those obtained by healthcare providers. © 2014 Future Medicine Ltd. Source

Dalzell J.R.,Scottish Advanced Heart Failure Service | Jackson C.E.,Scottish Advanced Heart Failure Service | Gardner R.S.,Scottish Advanced Heart Failure Service
Expert Review of Cardiovascular Therapy | Year: 2011

Peripartum cardiomyopathy is a rare but potentially devastating complication of pregnancy. Although the definition of this condition has recently been revised by the Heart Failure Association of the European Society of Cardiology, the pathogenesis of peripartum cardiomyopathy is not well understood and relatively little is known about its incidence and prevalence. Hence, peripartum cardiomyopathy is often under-recognized in the clinical setting. A heightened awareness of this condition and its current management options is therefore warranted throughout primary and secondary care. The identification of the putative role of prolactin in the development and progression of this condition has been recently discovered, with preclinical work suggesting beneficial effects of prolactin antagonism. In this article, we review the literature regarding this condition including these recent advances. © 2011 Expert Reviews Ltd. Source

Discover hidden collaborations