Pumping Marvellous

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.

Misdiagnosis of Heart Failure 

The most-frequent diagnostic errors are for common conditions seen by primary care doctors, including ailments such as pneumonia and heart failure that can lead to severe harm if not treated appropriately, a study found in the US.

The misdiagnoses occurred most often during the doctor’s examination, including trouble getting a complete history from the patient, performing the physical exam and ordering tests, according to research published today in JAMA Internal Medicine. Other common misdiagnoses were for kidney failure, urinary tract infection and cancer.

The findings show that doctors miss or wrongly diagnose a wide range of conditions that can be harmful to patients’ health, said lead study author Hardeep Singh. To reduce the number of misdiagnoses, more needs to be done by doctors and hospitals to engage the patient in their own health care and to improve their access to physicians, he said.

“If we do it together with patients, providers and health care systems, we will have a much deeper impact of understanding and improving this problem,” Singh, chief of health policy and quality program at the Health Services Research and Development Center at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, said in a telephone interview with Bloomberg.

Is Spironolcatone being questioned? 

A drug often used to treat chronic heart failure may not ease symptoms in people with one form of the disease, a new study suggests.

Spironolactone failed to improve symptoms or quality of life among 422 patients with diastolic heart failure — a form of the disease that affects about half of all people with heart failure.

The drug did, however, benefit the structure and function of patients’ hearts. And experts said it’s too early to know what to make of the results, which appear in the Feb. 27 issue of the Journal of the American Medical Association.

“It would be premature to say this is not beneficial,” said Dr. Sanjiv Shah, a cardiologist at Northwestern University Feinberg School of Medicine, in Chicago, who was not involved in the study.

Shah is involved in an ongoing study of spironolactone’s effects in people with diastolic heart failure. And that trial is focusing on the big questions: Can the drug prevent or delay hospitalizations, or prolong people’s lives?

Spironolactone is in a class of drugs called aldosterone receptor antagonists. They cause the kidneys to eliminate excess water and sodium from the body, so they can lower blood pressure and get rid of fluid build-up in some people with heart failure.

Studies have shown that spironolactone can extend the lives of some heart failure patients — namely, those with a low “ejection fraction.

The problem is that heart failure is a “syndrome”  - or a collection of signs and symptoms – rather than a disease. So a treatment that works for some patients may not work as well for others.

In systolic heart failure, the heart’s left ventricle (the main pumping chamber) cannot contract strongly enough, and many people with this form of heart failure have a reduced ejection fraction.

In the diastolic form, the left ventricle doesn’t relax enough between contractions, which means it cannot fill up with as much blood as it should. But the heart’s ejection fraction is actually normal.

Diastolic heart failure is trickier to diagnose, and doctors know less about how to best treat it, said Dr. John Cleland, a cardiologist at Hull York Medical School in Kingston-upon-Hull who co-wrote an editorial published with the study.

He agreed that it’s too soon to draw conclusions from the current findings, and that doctors will know more when Shah’s study results are in.

What is a BNP test? 

BNP ( brain natriuretic peptide ) is a hormone secreted by cardiac cells in response to increased pressure within the heart.

BNP helps to regulate the body’s salt and fluid content, and reduces blood pressure.  In patients who have heart failure, BNP levels tend to become greatly elevated during episodes of worsening shortness of breath.

Measuring BNP levels in the blood through a blood test can help doctors to determine whether a patient’s shortness of breath is due to heart failure, or to some other cause. If the elevated figure is above 400 then NICE guidelines say that the patient should have an echocardiogram within three weeks which is the gold standard of diagnosis for heart failure in the UK.

We feel the BNP test is one of the most under utilised tools in primary care and would if used more assist clinicians with the early symptons and treatment of Heart Failure.

BNP tests can also be used to monitor the severity of heart failure once diagnosed.

The chief utility of BNP measurement is that it can be helpful in diagnosing whether or not heart failure is the cause of a patient’s dyspnea.

Once heart failure has been diagnosed, some doctors believe that following repeated measurements of BNP can help guide their therapy (for instance, by helping them decide whether they have given enough diuretic medication). But clinical trials have failed to demonstrate that treatment guided by serial BNP measurements is useful in improving the outcome of therapy, so most doctors use BNP blood tests only if they need help with the diagnosis.

Ventricular re-modelling at its most exciting! 

Ventrix, Inc. announced today that its VentriGel^™cardiac repair scaffold safely and effectively mitigated left ventricular remodeling and improved cardiac function in pigs after myocardial infarction, or a heart attack. The findings, made during pre-clinical studies, were published today in the journal Science Translational Medicine. Based on these and other results, Ventrix will initiate a clinical trial for VentriGel later this year.

“These results give us strong validation that VentriGel has the potential to prevent the development of congestive heart failure in patients who are recovering from heart attack,” said Adam Kinsey, Ph.D., CEO of Ventrix. “We will continue to develop VentriGel for this indication, for which there is a very acute need and large market potential.”

As medical management and surgical tools have advanced, more and more patients are surviving heart attacks. However, damage to the heart during myocardial infarction can lead to a growth of dense scar tissue which cannot contribute to the pumping function of the heart. Over time, the heart wall will thin causing heart failure. Currently, the only successful treatments for end-stage heart failure are heart transplantation or left ventricular assist devices.

In the study, the VentriGel scaffold was injected into pigs two weeks following heart attack via a minimally-invasive catheter. Three months after injection, more cardiac muscle and less scar tissue was found in the VentriGel-treated group compared to controls that did not receive VentriGel. This led to significant improvements in contractility and cardiac function and prevented heart failure in treated animals.  Ejection fraction, one measure of cardiac function, was significantly greater after delivery of VentriGel.

VentriGel is a biomaterial scaffold designed specifically for the repair of damaged myocardium (heart muscle). It is injected via catheter in a minimally-invasive procedure that does not require surgery or general anesthesia.

Heart Skips a beat with the new Pumping Marvellous Toolkit

The BHF have got staying alive and now Pumping Marvellous have got “heart skips a beat” by Olly Murs. We would like to thank everybody for their hardwork and dedication in making this video such a success and we really hope it energises people who have been newly diagnosed with heart failure to have some attitude, belief and success in managing their heart failure symptoms. Also remember this video is also good for carers / caregivers and families to learn about how to help.

This video accompanies the Patient Heart Failure toolkit that has been developed by Pumping Marvellous for the NHS in England and Wales to support self management.

Heart Failure Toolkit Launch

We have confirmed that Pumping Marvellous will be handing over it’s first Heart Failure toolkits to the NHS on 14th February 2013 on the cardiology wards at the Royal Blackburn. the HEart Failure toolkit has 42 components and is a complete self care patient management system. We believe that this is the most comprehensive discharge and educational coaching tool for heart failure patients. If you have any questions about our toolkit or would like to have the toolkit for your trust then please email us.

Pumping Marvellous Heart Failure Toolkit

Fish oils and Atrial Fibrillation 

Fish oil supplements

It is important you read this report in context that the information only pertains to preventing AF in patients who have had an AF diagnosis with fish oils. There are lots of other benefits to individuals who take omega-3 fish oils.

Fish oil supplements did not prevent atrial fibrillation in patients who have already experienced episodes, a new clinical trial has found.

The study, published in the Journal of the American College of Cardiology.

“The results for atrial fibrillation are important negative findings, answering key clinical and research questions,” said Dr. Dariush Mozaffarian, an omega-3 expert at the Harvard School of Public Health, who was not involved in the study.

The new research, combined with other trials, “indicates that short-term fish oil use is unlikely to prevent recurrent atrial fibrillation,” he said.

Atrial fibrillation, in which the heart’s upper chambers beat out of step with those below. The condition is linked to strokes and heart failure.

Although doctors prescribe certain medications to treat the condition, none to date has proven particularly effective. As a result, most drug treatment focuses on preventing strokes by administering blood thinners to dissolve clots caused by the fibrillation.

Some evidence suggests that omega-3 fatty acids, found in oily fish like sardines and tuna, might reduce the risk of atrial fibrillation, although exactly how they would produce their effect is not clear.

A study published earlier this year in Circulation, for example, found that people with the most omega-3s in their blood had a 30% lower chance of developing an irregular heart beat than those with the lowest concentrations of the substances.

That 30% difference would work out to eight fewer cases of atrial fibrillation per 100 people – which would be a meaningful benefit if it could be enjoyed by those with fibrillation or at risk for it, just by consuming more omega 3s.

But the latest study suggests that it probably can’t. The trial included 586 men and women with a history of atrial fibrillation who were given a gram a day of fish oil or dummy capsules for a year. Participants also were allowed to take other drugs to control their heart rhythms, as prescribed by their doctors.

At the end of the study period, about 24% of the people who took fish oil, and 20% of those who did not, had experienced a recurrence of atrial fibrillation – a difference so small, statistically, it was likely due to chance.

The findings on atrial fibrillation echo results from a study led by Mozaffarian published in November, of patients recovering from heart surgery.

Even so, Dr. Alejandro Macchia, a cardiologist at the GESICA Foundation in Buenos Aires, who led the current study and collaborated with Mozaffarian on the previous one, said fish oil may still prove beneficial for heart health, at least in some patients.

Ivabradine (Procorolan) for Heart Failure

The National Institute for Health and Clinical Excellence (NICE) is issuing final draft guidance recommending ivabradine (Procoralan) as a treatment option for some people with chronic heart failure.

Treatment for heart failure is designed to help improve life expectancy, quality of life and to avoid hospital admissions. We feel this decision is long overdue and is great news for some patients.

Ivabradine evidence

The heart-rate-lowering drug ivabradine significantly reduced the risk of cardiovascular death and hospital admissions for worsening heart failure when added to standard treatment in patients, according to a UK, US and European study in 2010.

The ‘Systolic Heart Failure treatment with the ivabradine Trial’, known as SHIFT, looked at whether lowering heart rate with ivabradine reduces cardiovascular death and admission to hospital.

The patients studied had worsening heart failure, chronic heart failure, systolic dysfunction and a high heart rate over 70 beats per minute (bpm) or higher.

6,505 patients from 37 countries were studied over around 23 months. Around half were randomly given ivabradine twice daily in addition to standard heart failure treatments. The other half had a dummy placebo treatment added instead.

Treatment with ivabradine significantly reduced the risk of major heart failure by 18% compared to the dummy treatment. 16% of patients taking ivabradine were admitted to hospital with worsening heart failure compared to 21% in the placebo group. 3% of patients in the group taking ivabradine died from heart failure compared to 5% taking the placebo.

Ivabradine brought about an average reduction in heart rate of 15 bpm.

Who would get the new treatment?

The new guidance covers ivabradine for people with classes of chronic heart failure called NYHA class II to IV and other restrictions. The new guidance says ivabradine is cost effective when used in combination with standard therapy, including beta-blockers, angiotensin-converting enzyme (ACE) inhibitors and aldosterone antagonists, or when beta-blockers are not appropriate.

The decision to use ivabradine would be taken by a heart failure specialist. The treatment would cost the NHS around £42 per patient a month.

For this cost compared to a hospital admission makes economic sense. Be aware if you have AF then ivabradine will not be prescribed.

Scheme of atrial fibrillation (top) and sinus rhythm (bottom). The purple arrow indicates a P wave, which is lost in atrial fibrillation. (Photo credit: Wikipedia)

Heart arrhythmia AF and alcohol

New research has been published in the Canadian Medical Association Journal.

People with heart disease who drink, even moderately, may have a slightly  increased risk of a common heart rhythm problem, a new study suggests. The study is not the first to link moderate drinking to the heart arrhythmia,  known as atrial fibrillation (AF). But it’s still not clear that the habit,  itself, is the problem.

Doctors have long known that a drinking binge can trigger an episode of AF,  in which the heart’s upper chambers begin to quiver instead of  contracting normally. In general, it’s thought that having one or two drinks per day is protective  against coronary heart disease – where cholesterol-containing “plaque” builds up  in the arteries. But modest drinking hasn’t been linked to a decreased risk of AF – and the  new findings suggest that when people already have heart issues, moderate  drinking is actually tied to more AF cases.

The study included  more than 30,000 older adults who either had clogged arteries, a history of  stroke or diabetes complications such as kidney disease. Most had coronary heart  disease.

Over about five years, people who drank occasionally or not at all developed  AF at a rate of about 1.5% each year. For moderate drinkers, the rate was  1.75 and for heavy drinkers, it was 2.1%.

The researchers looked at other factors, too – like age, weight and smoking  habits. But moderate drinking was still linked to a 14% increase in the  risk of AF.

“Recommendations about the protective effects of moderate alcohol intake in  patients at high risk of cardiovascular disease may need to be tempered with  these findings,” write the researchers, led by Dr. Yan Liang, of McMaster  University in Hamilton, Ontario. Still, a researcher not involved in the work doubted the link between  moderate drinking and AF.

One problem is separating out the effects of binge drinking, according to Dr.  Kenneth J. Mukamal, of Harvard University and Beth Israel Deaconess Medical  Center in Boston.

Liang and colleagues did do a separate analysis where they excluded people  who reported a history of binge drinking – having more than five drinks at a  time. And the results were similar. But, Mukamal said in an email, the study did not repeatedly measure binge  drinking habits over the five-year follow-up. So it’s impossible to know if  moderate drinkers’ AF episodes were related to binges. “The majority of binge-drinking episodes nationwide occur among otherwise  moderate drinkers,” Mukamal noted. What’s more, he said, the current study included patients who were involved  in two clinical trials testing blood pressure drugs. That’s a narrow group of people. “In large studies of general populations -  much more representative than these clinical trial participants – AF only  appears higher among heavy drinkers,” Mukamal said.

Atrial fibrillation arises from a problem in the heart muscle’s electrical  activity. It’s not immediately life-threatening, and in some cases, an AF  episode is short-lived and goes away on its own. The known risk factors for AF include older age, high blood pressure,  diabetes, obesity and hyperthyroidism.

According to Mukamal, it’s not surprising that moderate drinking seems to  offer no protection against AF. The ways in which alcohol might cut the risk of coronary heart disease -  through better “good” cholesterol levels and less blood clotting – don’t affect  the risk of developing AF.

In general, experts say that if you’re already a moderate drinker (up to one  drink a day for women, and two for men), it’s probably okay to keep it up. But for people with certain chronic health problems, the new results may  question that guidance, the researchers said.

“And binge drinking should be avoided, even if you drink infrequently.”