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.
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.
Fish oils and Atrial Fibrillation
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.
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.
Our Heart Failure patient toolkit is the most comprehensive patient self care programme for Heart Failure patients. Where your journey starts at A&E or even your GP through to maybe acute and then into community care, the toolkit is a guide for not only you but also your carer and family as to how to manage your new life and opportunities. Throughout the world we see different methods of engagement with patients from clinicians engaging with patients through a checklist to handing out books to read.
The difference between our toolkit and others is this -
- It is authored and put together by a Heart Failure patients experiences
- Subject matter is from patient and carer inputs from all over the world
- Specialist charities and organisations have written there own sections
- Clinicians from the NHS Trusts have provided the technical data
- Companies specialism in heart failure treatments have lent their hand
- It is geographically transferable
- It is attractive and engaging for patients
- It is digitally available to specialist heart failure nurses along with a suite of APPs for tablets therefore enriching the patient experience and self learning.
Surgeons at Glenfield Hospital in Leicester are launching a trial into the use of an implant to treat heart failure.
Unlike existing devices which help the heart to pump, the new CardioFit, will stimulate nerves in the neck allowing the heart to pump more slowly and therefore cope better. If proven effective it could be used as an alternative to lifelong drugs and heart pumps in patients with heart failure.
Lead investigator in the trial, Dr André Ng, a senior lecturer in cardiology at the University of Leicester and consultant cardiologist at Glenfield Hospital, said: “Our aim with the INOVATE-HF study is to assess CardioFit’s safety as well as its potential to improve heart function in patients with heart failure, thereby improving their quality of life and survival.
If the hypothesis is proven in the study results, this could transform heart failure treatment and would support the use of the innovative therapy over and above tablets for standard heart failure treatment.”
The CardioFit system stimulates the “parasympathetic” nervous system, via the vagus nerve in the right side of the neck, to reduce stress on the heart. “This is a potentially ground-breaking treatment for patients with heart failure” “My University of Leicester research group has been studying the relationship between vagus nerve stimulation and heart function for almost 15 years. It is really exciting that there is finally an innovative form of treatment available that will allow us to investigate its potential use in heart failure,” Dr Ng said.
The system has already been tried in 32 patients in Germany, Italy, The Netherlands and Serbia where the results have been promising.
It was found that the heart was more flexible and able to cope with speeding up and slowing down as needed, resting heart rate was lowered and the force of the heart’s pumping action was improved. Patients who have already received the devices said they had a better quality of life and they performed better on hill walking tests.
Professor Huon Gray, Interim National Clinical Director for Cardiovascular Disease said: “We know that heart failure can have a devastating effect on people’s lives, so any potential advance in its treatment is to be welcomed.
Eplerenone / Inspra approved for Heart Failure in Scotland
Patients with chronic heart failure are to be offered a new drug which reduces their risk of being hospitalised by almost 40%.
The Scottish Medicines Consortium has approved a new drug, Inspra, for use in adults with the illness after evidence showed it reduced the risk of hospitalisation and death.
Around one in 100 people in Scotland has chronic heart failure. The new drug, also known as Eplerenone, was found to reduce the risk of cardiovascular death or heart failure hospitalisation by 37%.
John McMurray, Professor of Medical Cardiology at Glasgow University, said: “We must continue to do what we can to reduce deaths from cardiovascular disease and, importantly, do what we can to reduce the daily impact of the disease on those patients with established illness through optimal management.
“By ensuring patients receive the most effective treatments we can keep them out of hospital which is great for patients and can also help relieve the pressure on healthcare budgets.”
Heart failure occurs when the efficiency of the heart is impaired, resulting in it becoming unable to pump a sufficient amount of blood to meet the demands of the body.
Common causes of heart failure include damage to the heart caused by a heart attack, ischaemic heart disease and high blood pressure.
Heart Failure Toolkit update
Lancashire Telegraph – written by Catherine Pye
The Hapton-based charity Pumping Marvellous applied for £22,000 from NHS North West to produce 1,500 tool kits — parcels of information on how to live with the condition after discharge — and hope to launch them at the end of September.
Nick Hartsthorne-Evans, 42, set up Pumping Marvellous after he suffered heart failure, aged 39, from picking up a virus. He said: “Hospitals do their best to give leaflets that are clinically correct, but is that what the patient needs, to read about how morbid it is?
“What they give you satisfies your needs for about six months. It’s not a life-long thing.
“What we’re doing is based on the ‘bounty bag’ that new mums get after giving birth. It will give patients all the information they need throughout their lives on how to manage the condition. “There will be information in there for the employer, about smoking cessation and alcohol management, information for carers, and how make sure someone is getting benefits they’re entitled to.
“For the cost of each tool kit — about £15 — it will have a great impact on reducing hospital admissions and will make people less symptomatic
After an 18 month trial period, Nick hopes to be able to secure more funding to roll the scheme out regionally and then nationally.
Is Telehealth really the solution?
There is currently a lot of reporting in the press on “Telehealth” trials and how it could save the NHS £billions by remotely monitoring a patients condition. I suppose what they are intimating is it’s like having a nurse at the other end of the phone 24hrs a day 7 days a week. We do agree that this approach is a good addition to services for people with long term conditions that need managing however what a machine can’t help you with is the emotional isolation from information that a human can give. The output is black and white.
It is all well a good that these systems can save valuable resource in the long term however our opinion is that if clinicians become over reliant then patients will inevitably make mistakes, not be consistent how they use the telehealth system, a bit like forgetting to take your prescribed medicines and therefore you get to a “what’s the point in having it” as misinformation is worse than no information sometimes. You will also have the spectre of “Big Brother” looking over your shoulder. Many patients are brusied and battered with the torrent of information that they recieve and a lot of the time if this information is not delivered correctly it can be seen as “Big Brother” telling you what to do. The system is great for producing Health Data.
There is a place for “Telehealth” in the pathway to self management but it is only one element and should be treated as an information provider not as a golden solution. Unfortunatley the obsession with this system has led to yet another justification that it’s all about saving money.
Seaweed Juice may save Heart Attack patients?
An Australian grandmother had a liquid derived from seaweed injected into her heart, in a world-first procedure poised to dramatically boost heart attack survival rates. Pauline Fulton underwent the treatment in a Melbourne hospital two weeks ago, two days after she suffered a major heart attack. Dr. William van Gaal, a cardiologist who performed the procedure, said it could revolutionize treatment for heart attack patients and save lives.
But it was hoped the liquid, bio-absorbable cardiac matrix, would prevent the heart enlarging, and heart failure developing.
In the 30-minute procedure, van Gaal injected 0.13 fluid ounces of the “liquid device” into the blocked artery, which was absorbed by the damaged heart muscle.
It then formed a gel that acted as a scaffold to support the heart muscle as it recovered and prevented the organ becoming bigger, he said. After six weeks, the liquid device, which had no side-effects, would dissolve and be excreted from the body through the kidneys.
Standard treatment was to give patients tablets to prevent their heart enlarging, but they were not always effective, van Gaal said.
Fulton, 64, became the first of 300 patients who will have the experimental treatment in a worldwide study.
It could be routine treatment within three years, van Gaal said.
Medtronic Device for Heart Failure gets approval in the US
Medical device maker Medtronic said on Tuesday that the U.S. Food and Drug Administration had approved its implantable heart defibrillator with resynchronization therapy for a wider group of patients.
The FDA approved the device, known as CRT-D, for heart failure patients with mild symptoms. This treatment potentially can improve survival, reduce hospitalisations and prevent the disease from getting worse, Medtronic said. The latest approval could increase the number of patients eligible to get the device by 620,000 worldwide, including nearly 200,000 in the United States, the company said.
Heart failure affects more than 22 million people worldwide, including around 1 million in the UK and more than 5.8 million in the United States. Previously the defibrillators, which help the heart’s lower chambers beat in a more synchronized way, were only approved by the FDA to treat certain patients with moderate-to-severe heart failure.
While certain mildly-symptomatic heart failure patients could already receive an implantable defibrillator to protect them from sudden cardiac arrest, they are still vulnerable to a further weakening of their heart. CRT-D therapy works by sending electrical impulses to the heart muscles, improving the blood-pumping capability