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Welcome to Private Heart Specialists latest news. Here you'll find news and updates related to the industry and updates.

What is the best treatment for acute ischaemic stroke?

May 30, 2017

It has been twenty years since the first demonstration that mechanical therapy with balloons and stents is better than clot-busting drugs in patients with ST-elevation heart attacks. It has taken a lot longer for the same to occur with acute stroke despite the pathology being very similar ie blockage of an artery by a blood clot. A recent two year follow-up analysis presented in the New England Journal of Medicine shows that clot retrieval using a stent led to better functional outcomes than treatment with clot-busting drugs provided it could be done in a timely fashion. NHS England have now said that they will phase in this treatment but the scale of investment in both diagnostics and staff training will need to be huge. Given the lack of investment in the NHS since 2010 we should not expect this to be rolled out nationally anytime soon. NEJM 2017:376;1341-1349

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Blood pressure - can we go too low?

May 30, 2017

A recent analysis in the Lancet of two hypertension trials (ONTARGET and TRANSCEND) which finished recruiting in 2008 have confirmed the benefits of lowering blood pressure (BP) to below 140mmHg but also suggest that if BP is lowered to

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Biodegradable polymer drug-eluting stents - not yet the time

May 30, 2017

Drug-eluting stents are the commonest interventional treatment for coronary disease. There has been some concern that the polymer used to elute the drug may be responsible for some of the negative consequences of having these stents in-situ. These include late stent thrombosis and neo-intimal proliferation. A biodegradable polymer therefore has some theoretical advantages. In the Lancet this week, the BIO-RESORT trial is published comparing two stents with biodegradable polymers with a well known stent with a durable polymer. Essentially, there was no difference between the 3 arms in any of the end-points at one year. All the stents performed very well with thrombosis occurring in 0.3% and target-vessel failure rates of around 5%. It may be that longer follow-up will separate the groups but it is not possible to say yet whether biodegradable polymers are the answer to late complications of stent implantation. Lancet 2016;388:2607

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Atrial Fibrillation (AF) and stroke

May 30, 2017

AF is the most common heart arrhythmia and we, in the West, have a 25% chance of developing it during our lifetime. Interestingly, it may not cause any symptoms. AF does not necessarily signify serious underlying heat disease, which does need to be excluded, but has been estimated to be the cause of 17% of all ischaemic (non-haemorrhagic) stroke. The other contributory causes are high blood pressure, obesity, diabetes, smoking, diet and alcohol. It seems sensible therefore to ask your doctor or nurse just to check your pulse when you go for your usual check-ups.

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Antibiotics and dental treatment

May 30, 2017

For many years, cardiologists believed that giving patients antibiotics prior to dental surgery was a good thing if they were at high risk of developing endocarditis - a potentially fatal infection of the heart. A few years ago, NICE decided that there was not enough evidence to continue with this practice and recommended that antibiotics were no longer required. They have now had a rethink based on the finding that the incidence of endocarditis is increasing and the approaches of a widow of a patient who died from endocarditis. They now say that while antibiotic prophylaxis is not routinely recommended, they concede that there may be groups of patients who are at very high risk who may benefit from this approach. This will please many cardiologists and it seems that sense has prevailed. NICE Clinical Guideline 64

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TAVI - transcutaneous aortic valve implantation update

May 30, 2017

This minimally invasive way of inserting a new aortic valve has until recently only been considered for patients who were deemed not suitable for conventional open-heart surgery because of frailty, lung disease or kidney failure. Technological advances in these valves has meant that cardiologists and cardiac surgeons have been tempted to try these devices in patients who do not have such severe co-morbidities. In the PARTNER-2 study (NEJM 2016: 374;1609-20) there were some indications that TAVI was actually superior to conventional aortic valve replacement particularly in regard to stroke risk It is likely therefore that TAVI will become increasingly used as the treatment of choice for aortic stenosis in the not too distant future. Arise Sir TAVI!

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Air pollution and heart disease

May 30, 2017

It has long been recognised that there is an association with air quality and heart attacks but it has always been difficult to quantify because of the many confounding factors. A study in the Lancet 2016: 388: 696 by Kaufman et al has looked at the rate of progression of coronary calcification living in different metropolitan areas in the USA. They found that those areas with the highest concentrations of particulate matter had a 38% faster rate of calcium deposition in coronary arteries than those with the lowest. This association is analogous to tobacco smoke which has a similar mix of fine particles. More reason to get onto your MPs and campaign to make London a cleaner place to live.

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New cholesterol lowering drugs - the PCSK-9 inhibitors

May 30, 2017

The National Institute for Health and Clinical Excellence (NICE) has recently approved the use of two more unpronounceable drugs, both of which can lower cholesterol levels in the blood. These drugs, evolocumab and alirocumab interfere with the body’s natural systems for cholesterol metabolism and are known as PCSK 9 inhibitors. They are expensive and have to be given by subcutaneous injection every 2-4 weeks but are very effective at lowering cholesterol levels in patients who cannot tolerate statins or who do not reach target levels on optimal conventional therapy. What we do not yet know is whether this reduction in cholesterol using PCSK-9 inhibitors will also reduce heart attacks and strokes in the same way that conventional treatments do - trials are underway!

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A new license for an old drug used for blackouts - Midodrine

May 30, 2017

Transient loss of consciousness is a very common problem and accounts for up to 5% if Emergency Department attendances. Its dramatic presentation is understandably concerning for both patients and relatives and can have an impact on both driving and work. It may herald significant cardiac or neurological disease but in the majority of cases is a benign condition that needs managing. Once significant heart or brain disease is excluded, the mainstay of management is fluid/salt intake and exercise. For the minority of patients who do not respond to these measures then drugs that either elevate the blood pressure or constrict the blood vessels can be used. Midodrine is one such drug which used to have be prescribed on a named-patient basis only but is now licensed for use in reflex syncope in both the USA and UK. We now need to understand how effective it is relative to all the other measures used. (Br J Cardiol 2016; 23:73-77 )

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Statins and blood pressure lowering in those at intermediate risk of cardiovascular disease (CVD)

May 30, 2017

The HOPE-3 study was published in the New England Journal of Medicine on May 26th 2016 (NEJM 2016: 374;2009). This study took more than 12,700 men (>55y) and women (>60y) with one or more risk factor for CVD and followed them up for 5.6 years. They treated some with statins, some with blood pressure drugs and some with both and compared all the groups with those who received a placebo. The headline results were that those receiving statins lowered their risk of CVD whereas those receiving the BP lowering medications did not. As with all trials of this nature, the truth is much more complex than the headlines would suggest but the study undoubtedly shows that the benefit of controlling the risk factors for CVD is directly proportional to the starting risk of the individual i.e the greater the starting risk the greater the absolute benefit of treatment. What I am always at pains to point out is that the absolute benefits of lifestyle modification in terms of smoking cessation, weight loss and exercise are as great as any pharmacological therapy.

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Blood pressure - can we go too low?

May 30, 2017
A recent analysis in the Lancet of two hypertension trials (ONTARGET and TRANSCEND) which finished recruiting in 2008 have confirmed the ben…

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