Pumping Marvellous

New Heart FailureDevice

Many patients with heart failure have enlarged hearts, which occurs as the heart loses its ability to pump and leads to tiredness and breathlessness. The theory behind the device is that by protecting the heart from the effects of adrenaline, which causes the heart to work faster and enlarge, it will begin to shrink and pump more efficiently.

The device, which is similar to a pacemaker, is fitted under the patient’s skin in the chest and attached to the vagus nerve that leads to both the heart and brain. It is an approach that is being used to treat depression and epilepsy currently but may have other beneficial effects. Once activated the device uses electrical pulses to stimulate the nerve to help improve cardiac function and life expectancy.

The vagus nerve is part of the autonomic nervous system, which controls functions of the body that are not under voluntary control, such as heart rate. It passes through the neck as it travels between the chest, abdomen and the lower part of the brain.

The trial sponsored by Boston Scientific Corporation involves 96 patients at 25 sites across Europe. The Bristol team are co-ordinating the trial across the UK, which is expected to finish in 2013. The trial is called: NECTAR-HF (Neural Cardiac Therapy for Heart Failure) and is an international clinical study which will examine whether vagal nerve stimulation can restore autonomic balance and therefore improve heart function and inhibit progression of heart failure.

Julian Paton said: “More than a million adults in the UK suffer from heart failure, this new treatment has to date shown promising results in both animals and humans and could offer new hope in improving both the quality and longevity of life for UK patients. We have no idea how it works but are planning a sub-study to work this out.”

Angus Nightingale added: “It is really exciting that Bristol is at the cutting edge of new research into heart failure. This is a great example of research where collaboration between clinicians and scientists in Bristol is making a difference to patients with heart problems. We are the first team to implant a vagal nerve stimulator into a patient in the UK. The idea behind this is that chronic autonomic imbalance is believed to be a risk factor of the progression of heart failure and adverse cardiovascular events. The stimulation should alter the balance of the system and improve cardiac function.”

Is Telehealth really the solution?

There is currently a lot of reporting in the press on “Telehealth” trials and how it could save the NHS £billions by remotely monitoring a patients condition. I suppose what they are intimating is it’s like having a nurse at the other end of the phone 24hrs a day 7 days a week. We do agree that this approach is a good addition to services for people with long term conditions that need managing however what a machine can’t help you with is the emotional isolation from information that a human can give. The output is black and white.

It is all well a good that these systems can save valuable resource in the long term however our opinion is that if clinicians become over reliant then patients will inevitably make mistakes, not be consistent how they use the telehealth system, a bit like forgetting to take your prescribed medicines and therefore you get to a “what’s the point in having it” as misinformation is worse than no information sometimes. You will also have the spectre of “Big Brother” looking over your shoulder. Many patients are brusied and battered with the torrent of information that they recieve and a lot of the time if this information is not delivered correctly it can be seen as “Big Brother” telling you what to do. The system is great for producing Health Data.

There is a place for “Telehealth” in the pathway to self management but it is only one element and should be treated as an information provider not as a golden solution. Unfortunatley the obsession with this system has led to yet another justification that it’s all about saving money.

Revolutionary Treatment for Heart Failure

This is a truly amazing breakthrough in removing fluid from patients – this is maybe one of the most revolutionary breakthroughs in HF treatment – You need to listen to this http://soundcloud.com/pumping-marvellous/bbc

Seaweed Juice may save Heart Attack patients?

An Australian grandmother had a liquid derived from seaweed injected into her  heart, in a world-first procedure poised to dramatically boost heart attack  survival rates. Pauline Fulton underwent the treatment in a Melbourne hospital two weeks ago,  two days after she suffered a major heart attack. Dr. William van Gaal, a cardiologist who performed the procedure, said it  could revolutionize treatment for heart attack patients and save lives.

Many who suffer major heart attacks later die of heart failure after their  heart becomes enlarged as it compensates for the damage, van Gaal said.

But it was hoped the liquid, bio-absorbable cardiac matrix, would prevent the  heart enlarging, and heart failure developing.

In the 30-minute procedure, van Gaal injected 0.13 fluid ounces of the  “liquid device” into the blocked artery, which was absorbed by the damaged heart  muscle.

It then formed a gel that acted as a scaffold to support the heart muscle as  it recovered and prevented the organ becoming bigger, he said. After six weeks,  the liquid device, which had no side-effects, would dissolve and be excreted  from the body through the kidneys.

Standard treatment was to give patients tablets to prevent their heart  enlarging, but they were not always effective, van Gaal said.

Fulton, 64, became the first of 300 patients who will have the experimental  treatment in a worldwide study.

It could be routine treatment within three years, van Gaal said.

Read more: http://www.foxnews.com/health/2012/04/27/seaweed-liquid-saves-heart-attack-victim-in-world-first-treatment/#ixzz1tFtOZc8k

Medtronic Device for Heart Failure gets approval in the US

Medical device maker Medtronic said on Tuesday that the U.S. Food and Drug Administration had approved its implantable heart defibrillator with resynchronization therapy for a wider group of patients.

The FDA approved the device, known as CRT-D, for heart failure patients with mild symptoms. This treatment potentially can improve survival, reduce hospitalisations and prevent the disease from getting worse, Medtronic said. The latest approval could increase the number of patients eligible to get the device by 620,000 worldwide, including nearly 200,000 in the United States, the company said.

Heart failure affects more than 22 million people worldwide, including around 1 million in the UK and more than 5.8 million in the United States. Previously the defibrillators, which help the heart’s lower chambers beat in a more synchronized way, were only approved by the FDA to treat certain patients with moderate-to-severe heart failure.

While certain mildly-symptomatic heart failure patients could already receive an implantable defibrillator to protect them from sudden cardiac arrest, they are still vulnerable to a further weakening of their heart. CRT-D therapy works by sending electrical impulses to the heart muscles, improving the blood-pumping capability

Has our idea been stolen?? read on as it shows we are all focussued on the correct areas.

An old-fashioned checklist has the potential to keep patients with heart failure out of hospital — and save money for  health services around the world.

The checklist aims to help ensure that patients stay healthy after discharge, instead of quickly returning to the hospital because their symptoms return or get worse, according to a study of 96 patients presented at the American College of Cardiology‘s annual meeting. The list prompts doctors to make sure that patients understand when and how to take their medications, for example, and how to monitor their blood pressure and modify their diet and exercise.

All patients in the study had been admitted to the hospital for a heart problem. Researchers then randomly assigned half to go through the 27-point checklist before leaving the hospital, and half to get the usual discharge instructions.

Only 2% of patients whose doctors used the checklist were readmitted within a month, compared to 20% of other patients, according to the study, led by Abhijeet Basoor, from St. Joseph Mercy Oakland Hospital in Pontiac, Michigan. Readmission rates continued to be much lower after six months, as well, with 23% of checklist patients returning to the hospital in that time, compared to 42% of others.

Patients whose doctors used the checklist were more likely to be taking the proper drugs for blood pressure, as well, Basoor said. Using the checklist, which incorporates advice from broadly accepted guidelines, should take only a few minutes.

“It’s a reminder to do things that they should be doing anyway,” Basoor said. “If they are doing these things anyway, it shouldn’t add much time.”

The checklist prompts doctors to make sure that patients are taking recommended medications and have been counseled to follow a low-salt diet and to watch for early warning signs that their disease is getting worse, such as leg swelling and weight gain, instead of waiting for an emergency that could send them to the emergency room, Basoor said. The checklist doesn’t require that doctors provide detailed nutritional counseling, but it does prompt them to schedule a consultation with a nutritionist before patients leave the hospital. Studies show a “hospital effect,” Basoor said, with patients more likely to take medications if they are prescribed in a hospital, instead of at a doctor’s office.

In general, about 25% to 40% are readmitted within 30 days of treatment, a problem that costs governments around the globe dearly. Previous studies have shown that half of these readmissions could have been prevented with better care or education.

Educating patients before discharge is a critical part of care, says cardiologist Steven Nissen, of the Cleveland Clinic, who wasn’t involved with the study. That’s because heart failure patients often take a half-dozen drugs or more. Patients sometimes stop taking their medications, or take them irregularly, especially if the drugs don’t offer any immediate symptom relief.

As few as 20% to 50% of patients prescribed a statin to lower cholesterol actually take them, says Nove Kalia of the University of Saskatchewan in Canada. Kalia presented two studies exploring ways to motivate patients to change their behavior. He showed them their coronary artery calcium scoring, an imaging test that uses a CT scanner to take pictures of the heart, which can show patients a build-up of calcium in their hearts. Very high levels of calcium increase the risk of a heart attack. Seeing those images helped patients visualize their heart disease, Kalia said. Among those with high scores, patients who saw images of their hearts were 2½ times as likely to take their statin drugs and more than three times as likely to lose weight. Most patients lost around five to 15 pounds, he said.

Seeing these images can be a “come to Jesus moment” for many patients who aren’t taking their heart risks seriously, said Cam Patterson, chief of cardiology at the University of North Carolina-Chapel Hill, who wasn’t involved in the studies.

Like all CT scans, these tests expose patients to radiation. Even the cheapest versions cost hundreds of dollars, Kalia said. And while he doesn’t advocate performing the scans solely to motivate lifestyle change, Kalia said it makes sense to show the pictures to patients if they’ve already been taken.

Checklists have virtually no costs or side effects, Nissen says.

And while checklists may seem like a simple idea, they’re considered crucial in other high-risk industries, such as aviation, Nissen says. “There is a reason why pilots do a checklist before takeoff,” Nissen says.

Patterson called checklists “a low-tech, innovative way to save money and take better care of patients,” noting that, “Medicare and insurance companies are shining a bright light on heart failure readmission rates. We know they are a significant component of the cost of care for heart failure.”

Atul Gawande, a surgeon at Boston’s Brigham and Women’s Hospital and author of The Checklist Manifesto, noted that the checklist study was very small, and only involved one hospital. He said he would like to see the checklist study evaluted in a peer-reviewed journal to make sure it’s sound.

Peter Pronovost, a physician at Johns Hopkins University who has pioneered the use of checklists to prevent hospital infections and other complications, said making a list is only a first step. Getting hospital staff to use these kinds of standards can be a challenge. He’s found that it’s important for staff to be able to give feedback and for officials to measure their results. Really successful checklists can require changing an institution’s culture so that doctors and others will accept these kind of suggestions from others.

Still, Gawande said, “this is extremely encouraging. … This is exactly the kind of area in which a well-designed checklist would be expected to have a dramatic impact. …They show that the benefits could be extraordinary.”

Heart Stars in the Press

Mirrens story is going out in the Lancashire Evening Post on Saturday – she said she didn’t want to see a photographer today as she needed to get her hair done!!!! so she has agreed tomorrow for the photos and in the press Saturday!!!! be on the website as well

Visit Heart Stars

Listen to Pumping Marvellous on the BBC iPlayer

If you missed our Chair Nick talk about the new “Heart school” project then this is your chance to listen again. The programmes were broadcast over the BBC Asian Network and Radio Lancashire.

BBC Asian Network UK wide - Presenter – Rozina Sini – Reporter Rahila Bano – Click here to listen  go to 4mins 40secs for the start

BBC Radio Lancashire – Presenter – Graham Liver - Reporter Rahila Bano – Click here to listen go to 1hour 47mins 20secs for the start

Healthy food for your Heart

Heart Repair Shop

Stem cells grown from patients’ own cardiac tissue can heal damage once thought to be permanent after a heart attack, according to a study that suggests the experimental approach may one day help stave off heart failure.

In a trial of 25 heart-attack patients, 17 who got the stem cell treatment showed a 50 percent reduction in cardiac scar tissue compared with no improvement for the eight who received standard care. The results, from the first of three sets of clinical trials generally needed for regulatory approval, were published today in the medical journal Lancet.

“The findings in this paper are encouraging,” Deepak Srivastava, director of the San Francisco-based Gladstone Institute of Cardiovascular Disease, said in an interview. “There’s a dire need for new therapies for people with heart failure”

The study, by researchers from Cedars-Sinai Heart Institute in Los Angeles and Johns Hopkins University in Baltimore, tested the approach in patients who recently suffered a heart attack, with the goal that repairing the damage might help stave off failure. While patients getting the stem cells showed no more improvement in heart function than those who didn’t get the experimental therapy, the theory is that new tissue regenerated by the stem cells can strengthen the heart, said Eduardo Marban, the study’s lead author.

“What our trial was designed to do is to reverse the injury once it’s happened,” said Marban, director of Cedars- Sinai Heart Institute. “The quantitative outcome that we had in this paper is to shift patients from a high-risk group to a low- risk group.”

Minimally Invasive

The stem cells were implanted within five weeks after patients suffering heart attacks. Doctors removed heart tissue, about the size of half a raisin, using a minimally invasive procedure that involved a thin needle threaded through the veins. After cultivating the stem cells from the tissue, doctors reinserted them using a second minimally invasive procedure. Patients got 12.5 million cells to 25 million cells.

A year after the procedure, six patients in the stem cell group had serious side effects, including a heart attack, chest pain, a coronary bypass, implantation of a defibrillator, and two other events unrelated to the heart. One of patient’s side effects were possibly linked to the treatment, the study found.

While the main goal of the trial was to examine the safety of the procedure, the decrease in scar tissue in those treated merits a larger study that focuses on broader clinical outcomes, researchers said in the paper.

Heart Regeneration

“If we can regenerate the whole heart, then the patient would be completely normal,” Marban said. “We haven’t fulfilled that yet, but we’ve gotten rid of half of the injury, and that’s a good start.”

While the study resulted in patients having an increase in muscle mass and a shrinkage of scar size, the amount of blood flowing out of the heart, or the ejection fraction, wasn’t different between the control group and stem-cell therapy group. The measurement is important because poor blood flow deprives the body of oxygen and nutrients it needs to function properly, Srivastava said.

“The patients don’t have a functional benefit in this study,” said Srivastava, who wasn’t not involved in the trial. The technology is being developed by closely held Capricor Inc., which will further test it in 200 patients for the second of three trials typically required for regulatory approval.

Image via Wikipedia

Viagra Makes the Heart Relax

The impotency drug causes too-rigid heart chamber walls to become more elastic. The research explains how Viagra might benefit patients with diastolic heart failure. People with the condition have abnormally inflexible ventricles, the heart’s major pumping chambers, that do not fill sufficiently with blood. This leads to blood ”backing up” in the lungs and breathing difficulties. Scientists found that Viagra activates an enzyme that causes a protein in heart muscle cells to relax.

The effect was seen in dogs with diastolic heart failure within minutes of the drug being administered. Study leader Professor Wolfgang Linke, from the Ruhr Universitat Bochum (RUB)   in Germany, said: ”We have developed a therapy in an animal model that, for the first time, also raises hopes for the successful treatment of patients.” Viagra has a similar effect on blood vessels, which is why it was originally developed as a treatment for high blood pressure and heart disease. The drug’s active ingredient, sildenafil, inhibits an enzyme involved in the   mechanism that regulates blood flow. However, the enzyme is slightly different in different parts of the body.

The British scientists behind Viagra found to their initial disappointment that it was not a great help to patients with high blood pressure. But it   had a miraculous effect on men with erectile dysfunctin. Proffessor Linke’s team found that it worked on the same enzyme in heart cells. This had the effect of causing a cardiac muscle protein called titin to become more elastic. ”The titin molecules are similar to rubber bands,” said the professor.   ”They contribute decisively to the stiffness of cardiac walls.”

The research is published today in the journal Circulation. Almost half of emergency patients admitted to hospital with heart failure have   a diastolic condition. Diastolic heart failure affects the ”diastole” half of the cardiac cycle, when the heart’s chambers have finished contracting and are re-filling with blood. Various medical conditions can cause the ventricles to become ”stiff”. They include high blood pressure, blocked arteries, and cardiomyopathy heart disorders. Sildenafil is already being tested on heart failure patients taking part in the Relax trial in the US.

Proffessor Linke added: “Of all the patients aged over 60 who are in hospital because of a weak heart, half suffer from diastolic heart failure. Although we know that the decreased distensibility of the cardiac walls is the cause, the disease cannot be treated properly with today’s medicines. If, for the first time, the drug is found to have a positive effect on heart failure, we would already have a molecular mechanism on hand to explain the   effect.”