Pumping Marvellous

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Social and welfare factors and Heart Failure

There is an increasing trend in heart failure, mainly due to the aging of the population. However researchers at Western Infirmary in Glasgow have looked at the impact of social and economic deprivation in the diagnosis and treatment of heart failure in over 2,000 people taking part in a health project.

The researchers found that the incidence of heart failure increases significantly with increasing social deprivation. Those patients falling into the social deprivation category were 44%  more likely to develop heart failure than more affluent patients. And those in the deprived groups had 23%  fewer follow up visits each year with their general practitioner. However, prescribed treatment did not differ with social or economic status. More needs to be learned  about why socioeconomic factors influence heart failure, so that outcomes for all can be improved.

We are glad that there is now evidence which needs to be put to clinicians that socioeconomic factors do have a dramatic effect on Heart Failure outcomes.

Heart Failure Nurses Conference

On Wednesday 8th of May, Pumping Marvellous hosted a conference with the East Lancashire Hospital Trusts Heart Failure Nursing Team where over 80 Nurses attended and learn’t about the innovative approach to heart failure patient management. Pumping Marvellous founder Nick Hartshorne-Evans represented the patient voice and gave his story of what happened to him and the resulting after effects of a diagnosis of heart failure.

Both the nursing team and the charity have received great feedback and we will be doing this on a regular basis. This just highlights the needs and requirement of parity in care for patients and their carers.

Heart Failure Nurses Conference with 80 attendees

Pharmacists and their useful role in managing Heart Failure 

A review shows that pharmacists play a very useful role in managing heart failure. Their involvement reduces the risk of hospitalisation which both improves patient quality of life and reduces the public health burden of heart failure.

Medications for heart failure include angiotensin-converting enzyme (ACE) inhibitors and beta-blockers. The problem is that these are under-used. A multi-disciplinary approach, including input from a pharmacist, could perhaps improve outcomes for the patient with heart failure. Researchers at the University of Alberta, Edmonton, Canada, have looked back at research on heart failure that has involved input from a pharmacist.

The researchers found 12 studies covering over 2,000 patients with heart failure where care given by a pharmacist was compared with usual care. In seven studies, the pharmacist was the key person, helping with medication, education, adherence, and communication with the physician. In other studies, the pharmacist was part of a team looking after the patient with heart failure. The team analyzed whether involvement of the pharmacist reduced mortality and hospitalisation for both all causes and for heart failure.

There was no overall reduction in mortality with pharmacist intervention. But there was a significant reduction in hospitalisation rates, by around one third, both overall and for heart failure if the pharmacist was involved.

Heart failure is one of the leading causes of hospitalisation. These hospitalisations are, the researchers say, too often attributed to problems with medication. Therefore, more input from the pharmacist, who is the one who knows most about medication, might be expected to decrease the risk of hospitalisation.

It is also not clear from the current study what kind of pharmacist intervention makes the most difference when it comes to looking after patients with heart failure. But the finding that their work can reduce hospitalizations by one third underlines the key role medication plays in managing heart failure. Therefore, a pharmacist should always be involved in caring for the patient with heart failure.

Gene Therapy for UK Heart Failure Patients 

British Heart Foundation (Photo credit: Wikipedia)

Patients with severe heart failure are to be treated with gene therapy for the first time in Britain.Earlier clinical trials have suggested the treatment could reverse damaging changes inside cardiac cells that weaken the muscle and reduce the ability of the heart to pump blood.

The condition affects up to 1,000,000  people in the UK.

Doctors backed by the British Heart Foundation will give 100 patients an infusion of a harmless virus that has been genetically engineered to carry an extra gene, called SERCA2a.

The virus infects cardiac cells. Once inside, the gene becomes activated and makes a protein crucial to normal beating of the heart.

Dr Alexander Lyon, consultant cardiologist at The Royal Brompton Hospital, is leading the Cupid 2 trial. He said: “When the heart muscle is injured it activates a series of compensatory changes, but over time fatigue sets in which results in the natural version of this gene switching off. ”When the gene is repaired it produces more of the functional protein and the problem is reversed.”

The first patients will be given the treatment in the next three to six weeks at hospitals in London and Glasgow.

They will be tracked and compared to another group of study volunteers who will receive a dummy treatment.

A previous pilot study in the United States found the treatment dramatically reduced emergency hospitalisations and deaths.

The 39 patients given the gene are still in a stable condition after three years.

Professor Sian Harding, head of the British Heart Foundation’s Centre for Regenerative Medicine at Imperial College London, whose team developed the therapy, said: “It’s been a painstaking, 20-year process to find the right gene and make a treatment that works. ”But we’re thrilled to be working with cardiologists to set up human trials that could help people living with heart failure.”

Economic costs of Heart Failure set to Sky Rocket 

The journal “Circulation” has published today that the number of Americans with heart failure could rise 46%, from 5 million in 2012 to 8 million in 2030, new research says. This should be awake call for the UK considering similar public health profiles.

Also potentially the direct and indirect costs of treating the condition could more than double, from $31 billion to $70 billion, over the same time period.

This means that by 2030, every U.S. taxpayer could be paying $244 a year to care for heart failure patients, according to the American Heart Association policy statement. It said the findings highlight the need for strategies to prevent and treat heart failure.

Heart failure is the leading cause of hospitalisation for Americans over age 65. The rising number of people with heart failure is the result of an aging population and an increase in the rates of conditions that contribute to heart failure, such as high blood pressure, diabetes and heart disease.

“If we don’t improve or reduce the incidence of heart failure by preventing and treating the underlying conditions, there will be a large monetary and health burden on the country,” said Dr. Paul Heidenreich in an American Heart Association news release. “The costs will be paid for by every adult, not just every adult with heart failure.”

“Awareness of risk factors and adequately treating them is the greatest need,” said Heidenreich, a professor of medicine at Stanford University School of Medicine and director of a chronic heart failure research initiative at the VA Health Care System in Palo Alto, Calif.

The statement includes recommendations on how to tackle the issue. These include the following:

• More effective distribution and use of therapy recommended in guidelines to prevent heart failure and improve patient survival.
• Improving the coordination of care when hospitalised patients go home in order to help them achieve better outcomes and reduce their risk of having to return to the hospital.
• Specialised training for physicians, nurses, pharmacists and other health care professionals on advanced heart failure care.
• Improving heart failure prevention and care for minority groups and lower-income people.
• Increasing access to palliative and hospice care for patients with heart failure in advanced stages.

The statement was published online April 24 in the journal Circulation: Heart Failure.

Warfarin in decline, alternatives on the Up? 

Pulse magazine is reporting that GPs are increasingly prescribing the newer anticoagulant alternatives to warfarin for the prevention of stroke, although their uptake has been slower than expected due to cost concerns.

An analysis of NHS primary care prescribing data for the past three years shows a fourteen-fold increase in the use of the newer anticoagulants dabigatran, rivaroxaban and apixaban in 2012, compared with 2011.

There was also a 9% increase in the use of warfarin from 2011 to 2012, leading experts to conclude that newer anticoagulants are being reserved for patients who are unsuitable for warfarin.

Pulse reported last year that following the NICE approval of dabigatran in March for certain patients with atrial fibrillation, CCGs put restrictions in place to limit use of the drug, with some warning its use as an alternative to warfarin could ramp up primary care drug budgets by as much as 20%.

This looks to have put a lid on demand, alongside concerns about the safety profile of some of the newer alternatives.

The figures from the NHS Information Centre Prescribing and Primary Care Services show that the total number of NHS prescriptions in 2012 for warfarin rose to 10.2 million prescriptions dispensed last year, compared with 9.4 million in 2011.

The total prescribed items for dabigatran – including those prescribed in patients with atrial fibrillation and venous thromboembolism – went up from around 3,200 in 2011, to 48,300 in 2012. Prescriptions for rivaroxaban and apixaban also rose, but their use remains much lower than that of dabigatran.

To read the full article from Pulse click here 

St Augustines RC High School in Billington gets a defibrillator

35 teachers and support staff went through an intensive AED familiarisation along with basic life saving skills with Pumping Marvellous and the North West Ambulance Service.

St Augustines RC High School in Billington gets a defibrillator

St Augustines RC High School in Billington gets a defibrillator

Heart Failure breath test 

A single exhaled breath could detect heart failure, according to new research. Dr. Raed Dweik of the Cleveland Clinic, led the study, which is published in the Journal of the American College of Cardiology.

Dweik said the answer lies in the ‘breathprint.’

“We consistently kept finding that patients with heart failure had a different breathprint,” Dweik said. “So, you analyse their breath; you always find there is something different about it than patients who do not have heart failure.”

Dweik’s team looked at patients admitted to the hospital with heart failure, and they were asked to exhale once into a special hand-held breath anaylsis device.

The breathprints were compared to a group of patients who did not have heart failure, and results showed higher levels of organic compounds called acetone and pentane in the patients with heart failure.

Dweik’s findings may be able to treat heart failure patients better.

“Many of them get readmitted to the hospital frequently, many within a month of discharge they get back in the hospital, so to be able to identify who has heart failure and who does not and whose heart failure is uncontrolled is very important to be able to manage them appropriately,” Dweik said.

Dweik said someone’s breath can tell a lot about their health.

“We are starting to recognise that our breath has thousands of molecules in it, and these molecules can tell us a lot about our state of health or disease,” he added.

Heart Failure + Depression = Bad Chemistry 

Now we all know how important it is to not get depressed about your condition so certainly to us this is not surprising however this is a strong step in the right direction to demonstrate the importance of being positive.

Depression could make heart failure even more fatal, a new study suggests.

Researchers from the Mayo Clinic in the US found that people with heart failure who are moderately to severely depressed have a 4x higher risk of death, compared with people with heart failure who are not depressed. They also have a 2x higher risk of being hospitalised or having to go to accident and emergency.

The study shows just how important it is to pay attention to patients’ mental health, as “depression is a key driver of healthcare use in heart failure,” study researcher Alanna M. Chamberlain, Ph.D., M.P.H., an assistant professor of epidemiology at the Mayo Clinic, said in a statement. The new study is published in the journal Circulation: Heart Failure.

The findings are based on 402 people with heart failure, with an average age of 73, who were from three Minnesota counties in the US. The study participants completed a survey with nine questions some time between 2007 and 2010 that analyzed their depression status. Then, the participants were followed for about a year and a half.

Researchers found an association between having depression and risk of being hospitalized or dying in the followup period. The risks went up with severity of depression. For example, according to the survey, people with mild depression were 60% more likely to die, and 35% more likely to have to visit the emergency room than those without depression. They were also 16% more likely to be hospitalised.

However, researchers did note a caveat to the findings. “We measured depression with a one-time questionnaire so we cannot account for changes in depression symptoms over time,” Chamberlain said in the statement. “Further research is warranted to develop more effective clinical approaches for management of depression in heart failure patients.”

Similarly, another new study published in the Journal of the American Heart Association shows that anxiety and depression raise risk of death among people with heart disease. Specifically, anxiety doubles risk of death from any cause among heart disease patients, and patients with both anxiety and depression have a tripled risk of dying. That finding, from Duke University researchers, is based on data from 934 people with an average age of 62.

COPD patients may struggle with antibiotic 

The antibiotic clarithromycin is commonly used to treat lower respiratory infections such as pneumonia and sudden worsening of chronic obstructive pulmonary disease (COPD). Previous research has suggested that the use of clarithromycin may increase the risk of heart problems such as heart failure, heart rhythm disorders and sudden cardiac death.

In this study, researchers from the UK  looked at data from about 1,300 patients with sudden worsening of COPD and about 1,600 patients with pneumonia. They found that 26% of the COPD patients who received clarithromycin experienced at least one heart problem over the next year, compared with 18% of those who were not given the antibiotic.

12% of pneumonia patients who received clarithromycin experienced at least one heart problem during the next year, compared with 7% of those who were not given the antibiotic, according to the study by James Chalmers of the University of Dundee, in Scotland.

The findings were published online on March 21 2013 in the journal BMJ.

In COPD patients, there was a significant association between the use of clarithromycin and death from heart-related problems. This association was not seen in pneumonia patients, according to a journal news release. The longer patients with COPD or pneumonia used clarithromycin, the greater their risk of more heart problems. This was not the case with other antibiotics, which suggests an effect specific to clarithromycin, according to the study authors.

Overall, their findings suggest that there would be one additional heart problem for every eight COPD patients and every 11 pneumonia patients who receive clarithromycin, compared to patients who are not given the antibiotic.

The results also suggest that the increased risk of heart problems may last after patients stop taking clarithromycin, possibly due to the effect that the antibiotic has on the inflammation process in patients with chronic lung conditions, the researchers said.

They said their findings need to be confirmed before any changes in the treatment of COPD and pneumonia patients are made. Although the study showed a link between the use of clarithromycin and possible heart problems, it did not establish a cause-and-effect relationship.

Read in full – click here