Pumping Marvellous

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.

Free Prescriptions for Heart Failure patients and associated conditions like Cardiomyopathy

Responsible department: Department of Health

Managing a long term condition like Heart Failure and it’s associated conditions including cardiomyopathy is tough enough without the financial strain of paying for prescriptions as well.Remember medication is for life and there are over 1,000,000 people in the UK diagnosed with Heart Failure. Pumping Marvellous the Heart Failure charity is asking for people to support the e-petition which is long overdue. People can’t understand why someone taking thyroxin or who has diabetes is exempt from paying for prescriptions when Heart Failure patients do. Pumping Marvellous is asking the government to overhaul the prescription system and include Heart Failure and it’s associated conditions within the free prescription bracket.

Click here for link to e-petition 

Can Cocoa help Heart Failure Patients?

So is Dark Chocolate good for Heart Failure patients – interesting article for Dark Chocolate lovers.

Patients with advanced heart failure showed improvement after three months of consuming epicatechin-enriched cocoa, U.S. researchers said. Dr. Francisco J. Villarreal of University of California, San Diego, said epicatechin is a flavonoid found in dark chocolate. The researchers examined five profoundly ill patients with major damage to skeletal muscle mitochondria, structures responsible for most of the energy produced in cells. These “fuel cells” are dysfunctional as a result of heart failure, leading to abnormalities in skeletal muscle, Villarreal said.

Patients with heart failure experience abnormalities in both the heart and skeletal muscle that can result in impaired functional capacity. They often complain of shortness of breath, lack of energy and have difficulty walking even short distances. Trial participants consumed dark chocolate bars and a beverage with a total epicatechin content of approximately 100 milligram per day for three months. Biopsies of skeletal muscle were conducted before and after treatment.

After three months, the researchers looked at changes in mitochondria volume and the abundance of cristae, are internal compartments of mitochondria necessary for efficient function of the mitochondria. “The cristae had been severely damaged and decreased in quantity in these patients,” Villarreal said in a statement. “After three months, we saw recovery — cristae numbers back toward normal levels, and increases in several molecular indicators involved in new mitochondria production.”

The findings were published in the journal Clinical and Translational Science.

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)

Guest Blog – Atrail Fibrillation Association

Diagnosing & Treating AF (part 2 of 3 guest blogs about AF)

When the monitor is returned the clinician can download the information and assess it. The heart rhythm can be diagnosed with certainty and possible underlying heart problems may often be detected.

Following the ECG, and if you are diagnosed as having Atrial Fibrillation, you may need to have an echocardiogram (a scan) which can assess the structure and overall function of the heart. This test is painless and without any risk to a patient. The results from this test will tell the physician about heart muscle disease (thickening or thinning), the size of the main pumping chambers, and the state of the heart valves, any of which might have aggravated the heart rhythm abnormality.

A variety of blood tests may be needed, depending on the individual’s medical history. In almost all cases, the activity of the thyroid gland will be measured through a blood sample, because over activity may provoke AF.

Free, medically approved and endorsed patient information can be ordered or down loaded from Atrial Fibrillation Association

If a patient has suffered chest pain, a marker of heart muscle damage (troponin) is often measured. If a patient is taking any other medication or has underlying heart disease or has any other medical problems, suitable tests will also be carried out.

Once Atrial Fibrillation has been diagnosed, there are a number of treatments available. The mainstay of treatment of AF is with drug therapies. Other non-drug therapies such as pacemakers and ablation therapies are reserved for certain subsets of AF patients. The drugs used to restore the normal heart rhythm are known as anti-arrhythmic drugs. They work by blocking specific channels in the cardiac cell. Anti-arrhythmic drugs comprise different drug classes and have different modes of action. Moreover, someclasses and even certain drugs within a class are effective for particular rhythm disturbances. Some drugs, aim for Rhythm Control, that is, to restore and maintain normal rhythm but can have troublesome side-effects.

Another type of drug such as beta-blockers aim for Rate Control. This means slowing the irregular heart rate without attempting to restore the normal heart rhythm. Rate control is not inferior to rhythm control and is an attractive alternative in patients with a high risk of AF recurrence. In less active patients, other rate control drugs, such as digoxin can be used. Combinations of digoxin and beta blockers or calcium antagonists may be required to achieve effective rate control. Amiodarone is often used for rate control in AF when its rhythm control efficacy has been exhausted. However, given its significant side effect profile, it is not routinely used for rate control.

Unfortunately, there is no “one size fits all” answer to the management of AF. Multiple drugs may be tried and adjusted until one is found that achieves the desired goal of optimal rate or rhythm control with minimal side effects.

Recently several new drugs have been approved for use with AF. One, Pradaxa, also known as Dabigatran, prevents blood clots which cause stroke, which is a risk for people with AF. There are also surgical interventions for AF such as Catheter Ablation and Cardioversion. Cardioversion is suitable for those recently diagnosed while Ablation is reserved for those with intrusive symptoms that impact significantly on quality of life, are refractory to treatment with medication or where medical therapy is contraindicated because of other conditions or intolerance.

Heart Failure and Holidays – Don’t forget your Pills

As a Heart Failure Patient you will take regular medication therefore make sure you have a list of all your medicines and dosages, get your clinician to complete this for you.If you need a doctors note to fly then get the list and dosages included in this Make sure you have twice the amount of tablets you actually need just in case of another ash cloud event. We would suggest that you split your medication between your hand luggage and hold luggage for obvious reasons.

Just a little tip. With the letter highlighting all the medication and dosage information, photocopy or scan it down to A5 size, fold it 3 times and put it in your wallet as this generally accompanies you everywhere. You can never be too safe! therefore if you need it when you are out on a boogie you will have it to hand if it is needed.

Flying with Heart Failure

It’s the holiday season and before we go on talking through this frequently asked question the information in this post is purely opinion and you must always discuss with your clinician. In fact the stipulation of many travel insurance companies means that you must be certified to fly usually by a consultant. Irrespective whether you need certification we would recommend you speak to your consultant. In our opinion we feel it is crucial. Anyway here goes -

Over one billion people travel by air each year.The information in this post refers to considerations regarding fitness to fly as a passenger. This is not about assessing your ability to fly but it includes the measures which are taken into consideration when assessing your ability to fly.

The information given is general and not exhaustive; individual patients may need to have several conditions taken into account and different airlines have varied policies. The sources of advice used are only guidelines and clinical judgement should always be used in their interpretation.

Some airlines require medical certificates confirming that a patient is currently stable and fit to fly. Most have medical advisors who provide advice and ‘clear’ passengers as fit to fly. They may ask for a medical information form (MEDIF). The British Medical Association (BMA) advises doctors ‘to word statements on a person’s fitness to fly carefully, indicating the information on which the advice is based, rather than positively certifying a person’s fitness’. For example:

• ‘I know of no obvious reason why this person should not fly’; OR
• ‘There is nothing in the medical record to indicate that flying is risky for this patient’.

This ensures that the doctor is not guaranteeing in any way that this patient can travel without any problem but rather saying that, on the available evidence, there is nothing to indicate a greater risk for this person than for others. However, the doctor is partly dependent on what the patient chooses to disclose to them about past health problems.

The main factors to take into account are whether air travel could adversely affect a pre-existing medical condition and whether or not a patient’s condition could adversely affect the comfort and safety of the other passengers, or the operation of the flight. Regardless of a doctor’s opinion on this latter question, the ultimate sanction to refuse travel lies with the airline and captain of the flight. If they consider there is a risk to the aircraft or its passengers, they may refuse to carry a particular passenger.

Modern aircraft are not pressurised to sea level. Cabin altitude equivalent is usually between 5,000 and 8,000 feet which means that there is a reduction in barometric pressure and a reduction in the partial pressure of alveolar oxygen. Sometimes during flight, although not usually for long periods, oxygen saturation levels can fall to around 90%. A healthy individual can usually tolerate this with no problems but it may not be the same for someone with Heart Failure.

Basic considerations when assessing a patient’s fitness-to-fly include:

• The effect of mild hypoxia (deprivation of oxygen) and decreased air pressure in the cabin.
• The effect of immobility.
• The ability to adopt the brace position in emergency landing.
• The timing of regular medication for long-haul/transmeridian travel.
• The ability of the patient to cope mentally and physically with travel to and through the airport to reach the flight and on disembarkation.
• Will the patient’s medical condition adversely affect the comfort or safety of the other passengers and the operation of the aircraft?
• What health insurance cover does the patient have in case of problems?

Cardiovascular contra-indications to commercial airline flight include:

• Unstable angina.
• Decompensated congestive cardiac failure.
• Uncontrolled hypertension.
• Coronary artery bypass graft within 10 days.
• Uncontrolled cardiac arrhythmia.
• Severe symptomatic valvular heart disease.
• Uncomplicated percutaneous coronary interventions (e.g. angioplasty with stent placement) within 5 days – individual assessment is needed after that to ensure fitness and stability.

The decrease in oxygen saturated during air travel may affect those with cardiovascular disease. Indications for in-flight oxygen in cardiovascular disease include:

• Need for oxygen at baseline altitude.
• Heart failure – New York Heart Association’s (NYHA) Class III-IV
• Angina Canadian Cardiovascular Society (CCS) Class III-IV.
• Cyanotic congenital heart disease.
• Primary pulmonary hypertension.
• Other cardiovascular diseases associated with known baseline hypoxia (deprivation of oxygen)

It is unusual for patients to be allowed to take their own oxygen supply and oxygen is usually arranged by the airline who must be aware in advance. A fee is usually charged. This may change in the future and there are ongoing discussions regarding this.

Patients with pacemakers and implantable cardioverter defibrillators can fly once medically stable

Don’t burn your carer out!

This is a very important point and is often overlooked, remember it’s not you with the halo over you, it’s your carer.

Your emotional and psychological health is important and can affect your physical health. Be aware of the signs that point to caregiver “burnout.” Watch for:

• Excessive use of alcohol, medications or sleeping pills
• Appetite changes — either eating too much or too little
• Depression — hopelessness, feelings of alienation, lack of energy to do new things
• Thoughts of death
• Losing control physically or emotionally
• Neglecting or treating roughly the person for whom you are caring
• Trouble falling asleep or staying asleep
• Difficulty concentrating, missing appointments

If you show signs of caregiver burnout, get help. Your healthy body, mind and spirit benefit your loved one as much as they benefit you.

Signs of Heart Failure

By themselves, any one sign of heart failure may not be cause for alarm. But if you have more than one of these symptoms, even if you haven’t been diagnosed with any heart problems, report them to your GP and ask for an evaluation of your heart. If you are still unsure demand a BNP test.

If you have been diagnosed with heart failure, it’s important for you to keep track of symptoms and report any sudden changes to your GP or Heart Failure Nurse.

This table lists the most common signs and symptoms, explains why they occur and describes how to recognise them.

Shortness of breath (also called dyspnea)

Breathlessness during activity (most commonly), at rest, or while sleeping, which may come on suddenly and wake you up. You often have difficulty breathing while lying flat and may need to prop up the upper body and head on two pillows. You often complain of waking up tired or feeling anxious and restless.

Blood “backs up” in the pulmonary veins (the vessels that return blood from the lungs to the heart) because the heart can’t keep up with the supply. This causes fluid to leak into the lungs.

Persistent coughing or wheezing

People who have Heart Failure may experience
Coughing that produces white or pink blood-tinged mucus.

Why it happens
Fluid builds up in the lungs

Buildup of excess fluid in body tissues (Oedema)

People who have Heart Failure may experience
Swelling in the feet, ankles, legs or abdomen or weight gain. You may find that your shoes feel tight.

Why it happens
As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing fluid to build up in the tissues. The kidneys are less able to dispose of sodium and water, also causing fluid retention in the tissues.

Tiredness, fatigue

People who have Heart Failure may experience
A tired feeling all the time and difficulty with everyday activities, such as shopping, climbing stairs, carrying groceries or walking.

Why it happens
The heart can’t pump enough blood to meet the needs of body tissues. The body diverts blood away from less vital organs, particularly muscles in the limbs, and sends it to the heart and brain.

Lack of appetite, nausea

People who have Heart Failure may experience
Feeling of being full or sick to your stomach.

Why it happens
The digestive system receives less blood, causing problems with digestion.

Confusion, impaired thinking

People who have Heart Failure may experience
Memory loss and feelings of disorientation. A carer or relative may notice this first.

Why it happens
Changing levels of certain substances in the blood, such as sodium, can cause confusion.

Increased heart rate

People who have Heart Failure may experience
Heart palpitations, which feel like your heart is racing or throbbing.

Why it happens
To “make up for” the loss in pumping capacity, the heart beats faster.

Dry nasty coughs

As some of you may already know as you are experiencing a dry cough already it is uncomfortable and sometimes can put you in uncompromising situations. There could be numerous reasons for a dry cough but one of the most likely if you are a heart failure patient is the taking of ACE inhibitors. Below you will find some information on potential easing a dry cough.

ACE Inhibitors

ACE inhibitors are a commonly prescribed class of medications for high blood pressure. Most of their generic names end in -il, for example, lisinopril or ramipril (although verapamil is a drug for hypertension that is in a different class). About one in five people who uses these drugs develops a constant cough that simply won’t go away. Persons of Asian or Latin American Hispanic descent are more likely to have a bad reaction to this class of drugs, but a related class of medications call the ACE-receptor blockers does not have this side effect.

What can you do about a chronic cough? Aside from treating the underlying conditions, try these helpful considerations.

• Take a vitamin B supplement that includes vitamin B6. You may not experience greater lung capacity, but you will probably experience less wheezing and coughing.

• Eat a piece of fruit every day and servings of green vegetables several times a week. Studies in the UK of people with asthma, chronic bronchitis, or COPD who never ate fruit or vegetables have consistently noted dramatic improvement after including even one serving of fruit and vegetables a day in the diet.

• Indentify your personal coughing triggers, whether they are tobacco smoke, some frequently eaten food, fumes, dust, or pollen, and make a point of avoiding them.

• If you are allergic to pollen, limit your time outdoors between 5 a.m. and 10 a.m., when most plants pollinate.

• Try yoga. You don’t have to do the asanas (postures) perfectly. The breathing practice that accompanies yoga will help you control cough and breathe more deeply.

And, finally, try eating onions. Onions, as well as whole apples, grapefruit, and grapefruit juice, are great sources of the antioxidant quercetin. This plant chemical is a natural antihistamine, stopping the process of inflammation in the lungs, nose, and throat that keeps air passages constantly irritated.

In a Finnish study involving 10,000 men and women, the flavonoids quercetin, hesperitin, and naringenin, found in apples and oranges, protected against asthma. Other fruits and vegetables, such as grapefruit, cabbage, and various fruit and vegetables were not associated with a decreased risk of asthma. A British study focusing on consumption of apples found that eating 1-1/2 oz (42 g) of apple a day reduced risk of asthma attacks by about one-third. Many people who eat these foods on a regular basis report that their coughing is greatly improved, and in some cases, coughing completely disappears.

It’s worth a go anyway. Remember always discuss supplements and changes in your regular diet to your Doctor or Nurse.