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Variation in Mortality Rates for Heart Failure Patients

Another reason for Pumping Marvellous to exist and flourish, especially for those without support.

A major new audit of heart failure patients in England and Wales has uncovered wide variations in mortality rates.

The National Heart Failure Audit analysed 21,294 medical records for patients admitted to hospital for heart failure between April 2009 and March 2010. It found that, overall, about 32 per cent of heart failure patients died within a year of hospital admission.

The report underlined the value of cardiologists and specialist heart failure services, as mortality rates fell to 23 per cent for patients with access to these. It also showed that in-patient mortality is 12 per cent for heart failure patients on a non-cardiac ward, compared to just six per cent for those on dedicated cardiac wards.

Clinical lead Dr Theresa McDonagh, chair of the British Society for Heart Failure, said: ‘This audit shows that patients admitted to hospital with heart failure have an unacceptably high death rate.

‘Outcomes for these patients can be significantly improved by having specialist cardiology input to their care, administration of appropriate evidence-based doses of key drugs and follow-up by specialist services.’

The audit, which is run jointly by the NHS Information Centre and the British Society for Heart Failure, also revealed that many patients do not get the recommended dose of drugs such as ACE inhibitors and beta blockers.

Just 60 per cent of patients for whom dosing information was available were prescribed beta blockers – which can reduce mortality by around a third – and two-thirds received less than half of the recommended dose.

And of those patients for whom information was available on ACE inhibitors – which can halve mortality during the first year after discharge – half received less than 50 per cent of the target dose.

Dr Mike Knapton, associate medical director of the British Heart Foundation, said that treatment for heart failure should be given the same priority as that for heart attacks.

‘But while there have been huge improvements in the management of heart attack patients, the same cannot be said for people with heart failure,’ he claimed.

‘There are more than 700,000 people living with heart failure in the UK and this number is set to increase, so it’s vital we address this issue.’

Without sounding arrogant we could have told you so on each statement made within the commentary above.

Interesting post on Alcohol

I was in Lloyds Pharmacy this afternoon picking up my bucket load of drugs and I picked up a really useful device and instantly thought of Pumping Marvellous readers.

I am sure Lloyds will love me for this but it is a little invention produced by the East Lancs PCT, now I am sure this has been out for a long time but I was really impressed with it.

Now I don’t really drink alcohol so I am probably not the best person to comment on this but here goes.

It is a black wheel looking thing which tells you the units per drink and the calories per drink. There are a set of measures so if you can’t get your hands on one of these then here goes –

Regular Cider 5%ABV – 1 pint (568ml) – 2.8 units and 250 calories
Strong Cider 7.5%ABV – 275ml bottle – 2.1 units and 99 calories
Guinness 4.1%ABV – 1 pint (568ml) – 2.4 units and 210 calories
Port 20%ABV – 50ml glass – 1 unit and 78 calories
Sherry 17.5%ABV – 50ml glass – 0.9 units an 77 calories
Alcopop/Ready to Drink 5%ABV- 275ml bottle – 1.4 units and 200 calories
Standard Beer/Bitter 3.6%ABV – 1 pint (568ml) – 2 units and 182 calories
Standard Lager 4%ABV – 1 pint (568ml) – 2.3 units and 200 calories
Premium Beer / Lager 5%ABV – 330ml bottle – 1.7 units and 142 calories
Premium Beer / Lager 5%ABV – 1 pint (568ml) – 2.8 units and 244 calories
Super Strength Lager 9%ABV – 440ml can – 4 units and 250 calories
Whiskey/Bourbon/Brandy 40%ABV – 35ml measure – 1.4 units and 78 calories
Gin/Vodka/Rum 37.5%ABV – 35ml measure – 1.3 units and 72 calories
Wine/Champagne 12%ABV – 750ml bottle – 9 units and 555 calories
Wine/Champagne 12%ABV – 125ml glass – 2.1 units and 133 calories

Hopefully this will make you think twice about consuming alcohol.

Your Daily Allowance

In the UK the department of health recommends that an adult man does not drink more than 3-4 units of alcohol and an adult woman 2-3 units of alcohol as a maximum in any one day.

Managing Heart Failure in extreme Heat

I am currently going through my first summer after being diagnosed with Heart Failure in January 2010. Writing this I am thinking maybe I should write this next year when I am an expert but the subject is always at the top of my mind so nothing like the present but I thought I would need some help so the following is an excerpt from the British Heart Foundations website.

“Extremely hot weather can cause dehydration and heat exhaustion. Heat and humidity can
interfere with the body’s natural cooling process. If you have a heart problem, extreme
heat may place an extra burden on your heart and circulation.

Excessive sweating in hot weather increases the loss of fluid from your body. This reduces
the total blood volume. This will increase the workload of your heart and the demand for
oxygen, which can lead to angina if you have coronary heart disease. Losing too much
body fluid will also increase your internal body temperature, which could be life-threatening if left untreated.

If you are in hot and humid weather, it is very important to wear light, comfortable clothing. Managing your fluids is a very difficult process as you are trying to balance excess perspiration as well as the diuretic action of your drugs. If you feel as though you need to increase your fluids have a chat with your clinician. However if you need to take more fluid on board then sip the fluid or have a look at some of my tips, sweets, frozen grapes and water spray. Try to avoid caffeine-based drinks because these act as a
diuretic. (That means that they increase the amount of fluid you get rid of through your kidneys.)

Symptoms of heat exhaustion include heavy sweating, cold clammy skin, dizziness,
muscle cramps, shallow or fast breathing, nausea and vomiting. If you have any of these
symptoms, get medical attention immediately.

It’s a good idea to consult your doctor if you have any concerns about extremes of
temperature or have plans to travel to a country with either a hot or cold climate.

Health spas, saunas, jacuzzis and steam rooms

If you have a heart condition or have high blood pressure, it is generally advisable not to
use spa facilities – including baths, saunas, jacuzzis or steam rooms. In particular, don’t
use facilities that involve a sudden change of temperature – for example, having a hot
sauna and then plunging into a cold bath. If you particularly want to use any of these
facilities, ask your doctor about it first. Depending on what heart condition you have, your
doctor can give you advice on which types of facilities you should avoid.

Diuretics

Diuretics used to be known as water pills because they stop fluid collecting in your body and make you urinate more often. These are one of the most common treatments in heart disease. However, there have been only a few large studies into how effective they are in heart failure.

Researchers have combined the findings from smaller studies and concluded that diuretics extend life and improve symptoms of heart failure. Clinicians recommend them for people with heart failure who have signs of fluid retention, such as swollen ankles or breathlessness due to fluid in the lungs. Doctors will vary the dose of diuretic depending on your symptoms.

There are many different types of diuretic, but some of the most widely used for heart failure are bendroflumethiazide, chlorthalidone and furosemide.

Don’t drink at all or drink within safe limits

For most people, a glass of wine or a pint of normal-strength beer a day does no harm (and may even do some good) but drinking above that level increases blood pressure, which can lead to heart failure.
Alcohol is measured in units therefore a pint of typical strength bitter (about 4% alcohol) contains two to three units, and a glass of wine can contain anything from 1.5 to more than three units, depending on the strength of the wine and size of the glass. Men who regularly drink more than three to four units of alcohol a day, and women who regularly drink more than two to three units a day are likely to be damaging their health. Heavy drinking over a number of years can damage heart muscle, and lead directly to heart failure, as well as having many other harmful effects on your health. It also causes weight gain because of the calories in alcohol.
Binge drinking is particularly likely to increase blood pressure and increase the risk of heart failure. The alcohol intake that amounts to binge drinking may well be lower than you think, and reflects the levels of heavy drinking in a single night that start to seriously affect health. For a man, binge drinking is more than eight units in a night (about three pints of beer with 5% alcohol), while for a woman, it is about six units in a night (three standard or two large glasses of wine).

Hi Nick

I was reading this with interest, and just thought that maybe carrying a spray type bottle with water in might let you just moisten your mouth and tongue without consuming large volumes?

You could even freeze the water or juice if you plan to carry it around all day, then as it melts during the day it will still be cold and refreshing.

This is a great tip from one of my friends in the East Lancs Primary Care Trust – it could help you stop smoking but it also manages your fluid intake. I think it is a real tasty tip!

“Hi Nick,
A tip that I give to people who are trying to quit smoking without weight gain is to suck on frozen grapes. Lots of them love it, its low in sugar and calories, it’s sweet and tasty and will contribute a little to your ’5-a-day’. Just as good for the management of fluid intake and a healthy alternative to ice-lollies and boiled sweets.”

Angela

Yes it’s another drugs post but we think you should be aware of the drugs you should not be taking unless you are being directed by your Doctor or Heart Failure Nurse.

We believe this information is really important because you need to know what you can take and what you can’t and the reasons why.

Many types of drugs can aggravate heart failure by raising blood pressure and heart rate, creating irregular heartbeat or causing fluid buildup.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

These include aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn), which are given to relieve pain and inflammation. Even short-term use can increase blood pressure and interfere with blood-pressure-lowering drugs. Many over-the-counter cough and cold medicines contain NSAIDs. The same warning goes for COX-2 inhibitors such as celecoxib (Celebrex).

Thiazolidinediones

Rosiglitazone and pioglitazone are two examples of this class of diabetes drugs, which can result in dangerous levels of fluid retention in patients with moderate-to-severe heart failure.

Contraceptives

Both of these can raise blood pressure. Pregnancy, in and of itself, can also result in hypertension (high blood pressure).

Stimulants

Psychotropic drugs used to treat attention deficit hyperactivity disorder (ADHD) fall into the stimulant category, including Adderall (an amphetamine) and methylpenidate (Ritalin, Concerta). These medications often elevate blood pressure and increase heart rate. Many so-called diet pills are also stimulants.

Chemotherapy
Anthracyclines, including the commonly used doxorubicin (Adriamycin), are among the most effective chemotherapy medicines, but they can damage heart muscle. Giving these medications over a longer duration at a lower dosage can make them safer for many patients.

Antidepressants
Treating depression can be vitally important in patients with heart disease, but when you have heart failure this treatment must be undertaken carefully. Elevated blood pressure can result from taking noradrenaline reuptake inhibitors including venlafaxine (Effexor). Increased heart rate can be caused by tricyclics, which include amitriptyline (Elavil). Higher blood pressure and irregular heartbeat can be a consequence of mixing monoamine oxidase inhibitors, which include phenelzine (Nardil), with certain cheeses, wines and pickles.

Illegal Drugs
Cocaine and methamphetamine can cause a sudden rise in blood pressure and heart rate. Cocaine can also constrict the heart’s pumping chamber.

As you may or may not know if you have Heart Failure it is very important to manage your fluid intake. Generally 2 litres of water is the recommended intake but as the summer kicks in and the heat starts effecting your desire for more fluid stop right there. I am just about to go through my first summer with Heart Failure and believe me it is a challenge to keep the fluid intake to 2 litres per day. I dragged my family or they dragged me around New York at the start of June where the temeratures were 85 – 90 degrees and this was a test of my ability to manage my fluid intake. In the heat you also need to be aware that you will probably be on some form of diuretic which is taking fluid out as well but also with the added increased perspiration due to the heat.

So my little emergency kit consists of the following to help me deal with the heat. I have an emergency kit in each of the cars, in the office and in the house. When I went to New York I had a travelling kit as well – luckily I got through customs without being attacked by a Spaniel:-

Stay in the shade
Boiled sweets are great – old school style – my favourite sweetie website
Lolly ices
Fresh Strawberries

Obviously these sweets are full of sugar so go easy on them and if you are diabetic you can get some great sweets from here.