Pumping Marvellous

Heart Failure Nurses Conference

On Wednesday 8th of May, Pumping Marvellous hosted a conference with the East Lancashire Hospital Trusts Heart Failure Nursing Team where over 80 Nurses attended and learn’t about the innovative approach to heart failure patient management. Pumping Marvellous founder Nick Hartshorne-Evans represented the patient voice and gave his story of what happened to him and the resulting after effects of a diagnosis of heart failure.

Both the nursing team and the charity have received great feedback and we will be doing this on a regular basis. This just highlights the needs and requirement of parity in care for patients and their carers.

Heart Failure Nurses Conference with 80 attendees

Pharmacists and their useful role in managing Heart Failure 

A review shows that pharmacists play a very useful role in managing heart failure. Their involvement reduces the risk of hospitalisation which both improves patient quality of life and reduces the public health burden of heart failure.

Medications for heart failure include angiotensin-converting enzyme (ACE) inhibitors and beta-blockers. The problem is that these are under-used. A multi-disciplinary approach, including input from a pharmacist, could perhaps improve outcomes for the patient with heart failure. Researchers at the University of Alberta, Edmonton, Canada, have looked back at research on heart failure that has involved input from a pharmacist.

The researchers found 12 studies covering over 2,000 patients with heart failure where care given by a pharmacist was compared with usual care. In seven studies, the pharmacist was the key person, helping with medication, education, adherence, and communication with the physician. In other studies, the pharmacist was part of a team looking after the patient with heart failure. The team analyzed whether involvement of the pharmacist reduced mortality and hospitalisation for both all causes and for heart failure.

There was no overall reduction in mortality with pharmacist intervention. But there was a significant reduction in hospitalisation rates, by around one third, both overall and for heart failure if the pharmacist was involved.

Heart failure is one of the leading causes of hospitalisation. These hospitalisations are, the researchers say, too often attributed to problems with medication. Therefore, more input from the pharmacist, who is the one who knows most about medication, might be expected to decrease the risk of hospitalisation.

It is also not clear from the current study what kind of pharmacist intervention makes the most difference when it comes to looking after patients with heart failure. But the finding that their work can reduce hospitalizations by one third underlines the key role medication plays in managing heart failure. Therefore, a pharmacist should always be involved in caring for the patient with heart failure.

Gene Therapy for UK Heart Failure Patients 

British Heart Foundation (Photo credit: Wikipedia)

Patients with severe heart failure are to be treated with gene therapy for the first time in Britain.Earlier clinical trials have suggested the treatment could reverse damaging changes inside cardiac cells that weaken the muscle and reduce the ability of the heart to pump blood.

The condition affects up to 1,000,000  people in the UK.

Doctors backed by the British Heart Foundation will give 100 patients an infusion of a harmless virus that has been genetically engineered to carry an extra gene, called SERCA2a.

The virus infects cardiac cells. Once inside, the gene becomes activated and makes a protein crucial to normal beating of the heart.

Dr Alexander Lyon, consultant cardiologist at The Royal Brompton Hospital, is leading the Cupid 2 trial. He said: “When the heart muscle is injured it activates a series of compensatory changes, but over time fatigue sets in which results in the natural version of this gene switching off. ”When the gene is repaired it produces more of the functional protein and the problem is reversed.”

The first patients will be given the treatment in the next three to six weeks at hospitals in London and Glasgow.

They will be tracked and compared to another group of study volunteers who will receive a dummy treatment.

A previous pilot study in the United States found the treatment dramatically reduced emergency hospitalisations and deaths.

The 39 patients given the gene are still in a stable condition after three years.

Professor Sian Harding, head of the British Heart Foundation’s Centre for Regenerative Medicine at Imperial College London, whose team developed the therapy, said: “It’s been a painstaking, 20-year process to find the right gene and make a treatment that works. ”But we’re thrilled to be working with cardiologists to set up human trials that could help people living with heart failure.”

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.

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.

Heart Failure + Depression = Bad Chemistry 

Now we all know how important it is to not get depressed about your condition so certainly to us this is not surprising however this is a strong step in the right direction to demonstrate the importance of being positive.

Depression could make heart failure even more fatal, a new study suggests.

Researchers from the Mayo Clinic in the US found that people with heart failure who are moderately to severely depressed have a 4x higher risk of death, compared with people with heart failure who are not depressed. They also have a 2x higher risk of being hospitalised or having to go to accident and emergency.

The study shows just how important it is to pay attention to patients’ mental health, as “depression is a key driver of healthcare use in heart failure,” study researcher Alanna M. Chamberlain, Ph.D., M.P.H., an assistant professor of epidemiology at the Mayo Clinic, said in a statement. The new study is published in the journal Circulation: Heart Failure.

The findings are based on 402 people with heart failure, with an average age of 73, who were from three Minnesota counties in the US. The study participants completed a survey with nine questions some time between 2007 and 2010 that analyzed their depression status. Then, the participants were followed for about a year and a half.

Researchers found an association between having depression and risk of being hospitalized or dying in the followup period. The risks went up with severity of depression. For example, according to the survey, people with mild depression were 60% more likely to die, and 35% more likely to have to visit the emergency room than those without depression. They were also 16% more likely to be hospitalised.

However, researchers did note a caveat to the findings. “We measured depression with a one-time questionnaire so we cannot account for changes in depression symptoms over time,” Chamberlain said in the statement. “Further research is warranted to develop more effective clinical approaches for management of depression in heart failure patients.”

Similarly, another new study published in the Journal of the American Heart Association shows that anxiety and depression raise risk of death among people with heart disease. Specifically, anxiety doubles risk of death from any cause among heart disease patients, and patients with both anxiety and depression have a tripled risk of dying. That finding, from Duke University researchers, is based on data from 934 people with an average age of 62.

Multi-Functional Epelerone / Inspra

Eplerenone appears to reduce the risk of cardiovascular mortality and heart failure after a heart attack by more than one-third, according to research presented at the American College of Cardiology‘s 62nd Annual Scientific Session.

The REMINDER (Reduction of heart failure morbidity in patients with acute ST-elevation myocardial infarction) trial was a randomized, double-blind trial of 1,012 patients who had a heart attack caused by a complete blockage of one of the heart’s arteries. Patients had no signs or history of heart failure. They were given either eplerenone or placebo in addition to standard therapy. Overall, patients taking eplerenone were 38%  less likely to have poor outcomes than those given a placebo.

Eplerenone counteracts a hormone called aldosterone, which can increase blood pressure.

“This is the first randomized trial to test a mineralocorticoid receptor agonist during the acute phase of heart attack, and the results suggest a clinical benefit,” said Gilles Montalescot, MD, PhD, lead investigator of the study and professor of cardiology and head of the Cardiac Care Unit at Piti–Salp-tri-re Hospital, Paris.

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.