Pumping Marvellous

DNAplays a part in immune system reaction to Heart Failure

British Heart Foundation (Photo credit: Wikipedia)

DNA from a person’s own heart can play a significant part in heart failure by wrongly activating the immune response. A study co-funded by the British Heart Foundation and carried out by researchers in the UK and Japan found that in some people with this DNA the immune response is triggered during heart failure. This causes inflammation which makes the heart muscles less effective and reduces the ability to pump blood around the body.
The study, published by the journal Nature, found that the immune system is triggered by the release of DNA from the energy-generating structures in heart cells called mitochondria. Mitochondria evolved billions of years from bacteria and now share a similar DNA footprint, often causing a mistaken response from the immune system which recognises it as bacteria. “This intriguing discovery is an important breakthrough in our understanding of why, during heart failure, the immune system becomes activated without the presence of any obvious external threat,” Dr Shannon Amoils, research advisor at the BHF said.

A sudden drop in blood pressure caused by moving from lying down to standing has been linked to a higher risk of heart failure, a condition where the organ does not pump with sufficient force. There are around 750,000 sufferers of heart failure in Britain and symptoms can include swollen ankles, breathlessness and fatigue. Reachers at the University of North Carolina found a link between people who feel light headed when they stand up, known orthostatic hypotension and heart failure, especially those aged between 45 and 55 years compared with older people. The results were published in the journal Hypertension. Blood pressure was taken from 12,363 healthy adults when lying down and shortly after standing up and patients were followed up for an average of 17 years.

In that time around 11% of people who developed heart failure, had orthostatic hypotension compared with 4% who did not have the problem.

It was calculated that people with orthostatic hypotension were 54% more likely to develop heart failure than those without. Once other factors that can cause heart failure, including high blood pressure, were accounted for, the increased risk was around one third.

Dr Christine DeLong Jones, lead author said: “Orthostatic hypotension   appears to be related to the development of heart failure along with other conditions known to cause heart failure.

“Hypertension, diabetes and coronary heart disease are already known to   contribute to a person’s risk of developing heart failure. Orthostatic blood pressure measurement may supplement what is already known about the risk for heart failure and requires no additional equipment, just a standard blood   pressure cuff.”

Sleep Apnea

Not only will treating sleep apnea improve sleep, it may also resolve future heart failure by reversing structural and functional heart impairments associated with the sleep disorder, according to a new study. Researchers discovered that moderate to severe obstructive sleep apnea patients had significantly larger left ventricles and worse filling and emptying parameters, effects similar to hypertension, compared to people without the sleep condition.

Dr. Gregory Lip of the University of Birmingham, England, and his team found that some of the heart changes associated with sleep disorder included increased mass, thickening of the heart wall and reduced pumping ability. However, after six months of continuous positive airway pressure treatment, heart irregularities seen in sleep apnea patients improved or returned to “near-normal measurements,” the scientists reported in study published in the journal Circulation: Heart Failure.

“This may imply that obstructive sleep apnea could be crucial in development of left ventricular diastolic dysfunction, which may lead to heart failure and increased mortality if left untreated,” Lip and his team concluded. The study compared 40 patients with moderate to severe obstructive sleep apnea to 40 people with high blood pressure and 40 healthy people.

Using 2D and 3D echocardiograms and Doppler imaging of heart muscle tissue, before and after 26 weeks of sleep apnea treatment, researchers found that before treatment the abnormal heart structure and function changes seen in sleep apnea patients resembled typical changed associated with people with chronic high blood pressure, even though sleep patients only had moderately elevated blood pressure.

While previous studies have suggested that obstructive sleep apnea contributes to the worsening of structural and performance changes in the left ventricle and can lead to heart failure, the latest study, which had better defined and controlled patient groups and used more advanced echocardiograms and Doppler imaging, confirmed past findings.

Researchers noted that there were some limitations to the study and that apnea patients typically have a higher body mass index, and a larger randomized trial should clarify the findings.

Experts estimate that more than 18 million Americans have some form of sleep apnea, according to estimates from The National Sleep Foundation of the USA.

“Obstructive sleep apnea patients may have cardiac abnormalities that often are undetected, but will improve with continuous positive airway pressure,” Lip said in a statement released on Tuesday. “Patients also need to understand that obstructive sleep apnea is not a benign disorder, but that their risk of heart problems can be easily treated with continuous positive airway pressure.”

Researchers recommend doctors to ask patients or partners of patients with hypertension and those with abnormal echocardiograms about snoring and other signs of sleep apnea.

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

Celebration over a service that should be standard

After reading this commentary below from this is Bath we are surprised and concerned with the slant of this article as it seems as though there has been some ground breaking progress made with the availability of the BNP test when the BNP test (Brain natriuretic peptide) should be made available across all areas of the UK. We are however pleased that this seems to be an initiative made by GP’s. Taking a neutral stance but is this the sort of spin we should expect from the “New NHS?” We also hope that the implementers below realise that if the reading is above 400 then this should mean an automatic referral for an Echo-cardiogram within 2-3 weeks of the results via NICE guidelines which will ultimately put strain on the Hospital Services. Lets hope they have planned well. Although you do wonder who wrote this as ECG doesn’t mean an Echo-Cardiogram??!

Article - published by “this is Bath” (visit the publication at this is bath)

–GP’s who are taking the reins of the NHS in Bath have revamped heart treatment to save patients from undergoing unnecessary hospital scans. The new venture will see patients with symptoms of heart failure being offered a blood test at their GP surgery instead of being automatically referred to the Royal United Hospital.

Blood will be analysed for an enzyme which is only present if the muscles of the wall of the heart are put under significant strain. Patients get their results within 48 hours, and only if the blood test is positive are they now referred to the RUH for an echo-cardiogram (ECG).

This will save people from an unnecessary hospital scan and an anxious wait, and is likely to save the NHS locally up to £60,000 a year through better use of resources. RUH clinical lead in cardiology Dr Jacob Easaw and Dr Ruth Grabham from Newbridge Surgery worked closely together to create the new service.

Dr Grabham is the clinical director of the new clinical commissioning group, which will take over local health and care planning from the NHS B&NES primary care trust when it is abolished in April next year. She said: “We want to use this opportunity of clinically-led commissioning to improve services for patients.

“This new pathway for diagnosing heart failure will significantly reduce anxiety for a lot of patients. Now, a simple blood test could rule out the problem in a matter of days. A blood test is also much cheaper than a hospital outpatient appointment, so this new service shows it is possible to change services, improve patient experience and save money all at the same time.” Dr Easaw said: “This partnership will lead to improved early diagnosis of heart failure, and this means as cardiac specialists we can focus more of our attention and resources on those patients who need our skills the most.

“We will see high-risk patients earlier than in the past which means treatment can be more effective. It also avoids unnecessary scans and worries for those people who the blood test shows do not have heart failure.”

The change is the first significant local effect of the shake-up about to take place in the running of the NHS. Although many bodies representing clinicians across the NHS are deeply concerned about the Government’s Health Bill, the new commissioning group says getting GPs more involved in prioritising care makes sense.– (finish)

Pumping Marvellous at the BBC

Nick and Shakil two of the trustees at Pumping Marvellous talk to Talat on the BBC, broadcasting out to Radio Manchester and Radio Lancashire.

Here is the iPlayer link for the interview

Heart Failure is discussed live on air at the BBC

We have been saying for a long time that our patients are feeding back to us that their short term memory has been affected since being diagnosed with Heart Failure. We are pleased to see that research has proved their assumptions to be correct.

Heart failure is associated with a decline in mental processes and a loss of grey matter in the brain, new research has found. Scientists at the University of Western Australia say the changes could make it harder for people with heart failure to remember their medication and follow the instructions correctly.
The researchers performed cognitive tests and MRI scans on 35 patients with heart failure, 56 patients with ischaemic heart disease and 64 healthy volunteers. They found that people with heart failure tended to have worse immediate and long-term memory and reaction speeds than healthy people.Heart failure patients also showed changes in areas of the brain that play a role in cognitive and emotional processing.
Professor Osvaldo Almeida said: ‘What we found in this study is that both ischaemic heart disease and heart failure are associated with a loss of cells in certain brain regions that are important for the modulation of emotions and mental activity. ‘Such a loss is more pronounced in people with heart failure, but can also be seen in people with ischaemic heart disease without heart failure.’
The findings are published in the European Heart Journal and could have important implications, as figures from the British Heart Foundation suggest there are more than 27,000 new cases of heart failure each year in the UK.

Lancashire Patient Heart Failure Christmas Conference 2011

Heart Failure Conference Speakers

Just like to say a big thank you for all the fine work you did with your presentations. I was ever so pleased that we managed to get two great tangible outcomes apart from the great education opportunities all the patients and carers received.

The outcomes were as follows -

Shakil from Carers Contact has engaged with carers on the day and will create a Heart Failure Carer support group just for Carers. This is excellent however we realise without referrals this won’t work and therefore I ask everybody once we hear back from Shakil on the next steps that we support both Shakil and the carers as from what I saw there is definitely a real need – brilliant outcome and you can rely on Pumping Marvellous support.

I thought David and Jason from Northern Dragons  had a tricky job to engage with the patients and their carers however yet again the approach was brilliant and the outcome was full of engagement and when I get home I had two emails from patients on the day wanting to start the Pumping Marvellous Tai Chi Group with Northern Dragons with their carers as well; as stated Pumping Marvellous will pay half of the initial subscription for the first 4 paid lessons. Normal price is £5 therefore we will contribute £2.50 to a total of £10 per patient to get them going with their first 4 lessons which equates to £10 per patient or carer as I think we need to open this up to carers as well.

Eg – 10 patients and carers start, PM will sponsor these 10 people through the programme with a donation of £100 which will cover 50% of the total cost for the first 4 weeks. This should get them going!!! After taking the lead from Dr Joanne Sanderson surrounding the mental processing of weighing up the cost benefit analysis this will probably work to demonstrate to the patients and carers that there is a good health benefit and it is fun,  remind me after my sessions!! only kidding David and Jason.

A big thanks to Dr Joanne Sanderson for travelling from the Cardiac Centre at Blackpool to raise some big awareness issues surrounding the psychological elements of first hearing that you have heart failure and then the management of it going forward. I think we all listened with vigour so thanks very much for the help with this very specialised subject.

Thanks to Mike from CLAHRC in Manchester and we all hope you got the feedback you were looking for with our “Traffic Light” programme and we hope you will go back and communicate the hard work we are all doing and the innovation we are all showing.

Thanks to Beverly from the Cardiac and Stroke Network of Lancashire and Cumbria for showing support and hopefully we can help you going forward where you need patient input etc etc

I think some of us have found a new conference venue so thanks to Victoria at Ozzy Mills Business and Conference Centre for a flawless performance. Thanks for the twitter work as well you kept my thumbs busy on my iphone.

Let me not forget the kitchen at Soulmatefood, follow them on twitter if you want @Soulmatefood or @Soulmatechef – these are our corporate sponsors who make the most healthy and delicious food  and excellent sugar free mince pies, people were asking where they could buy them?? looks like you should start a mince pie company guys! there were only 10 left! shame really!!

At last but not least Angela Graves Clinical Lead for the Heart Failure Team at the ELHT and Beth Baron, Cardiac Practioner at Burnleys Healthy Lifetsyle team – I don’t need to say anything really as you “know me so well”

Image by CiscoANZ via Flickr

Telehealth is a method of sending vital health data to medics without there commitment of being there with the patient where medication can be changed over the telephone etc etc. What is important is that these advances in sympton control must run along side the specialist nursing care. Managing Heart Failure symptons are not all about data. It is a combination of how you feel and how the data relates to you as an individual however this data acquired by the Telehealth system alerts the specialist nurses to issues and symptons more rapidly.

It has been suggested that Telehealth technologies can reduce mortality, hospital admissions, the number of bed days spent in hospital and the time spent in A&E, according to the initial findings of a study by the Department of Health.

Early indications have shown that, if used properly telehealth – a term for electronic sensors or equipment that monitors vital health signs remotely in a patient’s home, or while on the move – can deliver a 15% reduction in A&E visits and, say the Department of Health, a 45% reduction in deaths of those with long term conditions, such as diabetes or heart failure.

According to the findings, telehealth could reduce emergency admissions by 20%, elective admissions and bed days by 14%, and a reduction in tariff costs of 8%.

The department’s claims are based on the finding its whole system demonstrator programme, which was launched in May 2008 to show  what telehealth and telecare were capable of and provide evidence to support investment decisions.

“The programme was one of the most complex trials ever undertaken by the Department of Health and will continue to provide useful information as the analysis continues, in particular we await the final results for telecare,” the department says.

“But we want to share the telehealth headlines now, to help as many people as possible, as early as possible.”

About 3 million people with long-term health conditions and social care needs could benefit from telehealth or telecare technologies, such as sensors at home which enable people to remain safe and live independently for longer. The department believes the key is to integrate these technologies into the care and services.

“Going forward this evidence gives us confidence that we can transform the way services are delivered and ensure that we use appropriate technology to put people at the centre, and in control,” says the department.

The programme involves 238 GP practices and nearly 6,200 patients across three sites in Newham, Kent and Cornwall. More than 30,000 people with either diabetes, heart failure or chronic obstructive pulmonary disease were included in the telehealth trial.