Latest News

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

The Advent of the ARNI - new developments in the treatment of heart failure

May 30, 2017

The tern ‘heart failure’ is unhelpful and worrying but has become accepted terminology for a number of symptoms and signs associated with heart muscle that is weakened by a number of disease processes. The condition is important because it is associated with a poor quality of life and sometimes an early death. Great strides have been made in the treatment of this condition over the last 20 years but a new drug combination has taken this one step further. Sacubitril/valsartan is an Angiotensin Receptor Neprilysin Inhibitor combo that has been shown to reduce death and hopsitilisation from ‘heart failure’ by 20% or 4.7% in absolute terms. It has recently been given NICE approval and will almost certainly become a core feature of heart failure treatment in the future. (NEJM 2014: 371: 993-1004 Paradigm-HF. McMurray JJ et al)

Read article »

Cardiac Resynchronisation in women - is the defibrillator necessary?

May 30, 2017

Cardiac resynchronisation or biventricular pacing has been shown to improve quality of life and survival in patients with an LV ejection fraction of less that 35% and a prolonged QRS duration, preferably with a LBBB pattern. The addition of a defibrillator to the biventricular pacing does reduce the incidence of sudden death in this population but it is not entirely clear exactly who benefits from this device with its implications for driving and potential negative impact on quality of life with inappropriate shock delivery. More recent analysis, not in the form of RCTs however, have suggested that the benefits of the defibrillator may only be apparent in ischaemic cardiomyopathy and possibly only in men. The jury is still out but there is no doubt that targeting these therapies more appropriately to those who benefit most has to be a good thing. Heart 2017: 103;753

Read article »

Exercise type and dieting in obese older adults

May 30, 2017

Obesity causes frailty in older adults but there are concerns that weight loss may lead to loss of bone and muscle mass thus leading to more frailty. In a recent study, obese older adults were assigned to an aerobic exercise programme, a resistance exercise programme and a combined programme for 6 months. Physical performance increased more in the combined group than either of the other two groups although all groups did better than the control group. Body weight also decreased by 9% in the exercise groups compared to control. So, it just goes to show that it is never too late to start exercising and that exercise should be part of any weight loss management plan. NEJM 2017:376; 1943-55

Read article »

iFR is probably as good as FFR

May 30, 2017

Please excuse the technical nature of this blog. There has been a healthy debate over the last 10-20 years about the value of coronary artery stenting in lesions of intermediate severity, particularly in stable angina. The FAME trials suggested that there was no prognostic benefit to stenting lesions that had a fractional flow reserve (FFR) of >0.8. Despite this, the number of patients undergoing FFR assessment has not increased as much as expected, because the assessment takes time and is uncomfortable for patients. iFR, a new technique that is quick to do and does not require the administration of adenosine, has a number of theoretical attractions. In two papers in the New England Journal of Medicine, an iFR >0.89 has been shown to be non-inferior to an FFR >0.8 in terms of one year cardiovascular outcomes. It will now almost certainly become the assessment of choice in those lesions of intermediate severity. NEJM 2017:376;1813-1835

Read article »

Exercise and Cognitive function

May 30, 2017

A recent meta-analysis of 39 studies looking at the effect of exercise on brain function has concluded that moderate and high intensity exercise for >45mins at a time leads to a significant improvement in executive function, memory and working memory in adults older than 50 years of age. So exercise is not only good for physical health, it also seems protect your mental health. Mens sana in corpore sano Meta-analyses are not the purest form of scientific evidence but the results published in the British Journal of Sports Medicine do suggest a very consistent effect. Tai Chi was also found to be effective but yoga not so - read into that what you will! http://dx.doi.org/10.1136/bjsports-2016-096587

Read article »

NOACs in patients undergoing AF ablation

May 30, 2017

We all now know that the ‘new’ oral anticoagulants are as good if not better than warfarin in patients with non-valvular AF at stroke prevention. What we did not know until now was whether these drugs were as good in the context of AF ablation. Dabigatran, a direct thrombin inhibitor, was compared to warfarin in 635 patients undergoing AF ablation. Dabigatran was associated with significantly fewer bleeding events (1.6% vs 6.9%) without any increase in stroke or other thromboembolic events. Further evidence that the indications for warfarin therapy are becoming ever narrower. NEJM 2017;376:1627-1636 New GMC confidentiality guidelines for doctors came into effect April 25th 2017 These guidelines are particularly pertinent for driving restrictions ‘If you become aware that a patient is continuing to drive when they may not be fit to do so, you should make every reasonable effort to persuade them to stop. If you do not manage to persuade the patient to stop driving, or you discover that they are continuing to drive against your advice, you should consider whether the patient’s refusal to stop driving leaves others exposed to a risk of death or serious harm. If you believe that it does, you should contact the DVLA or DVA promptly and disclose any relevant medical information, in confidence, to the medical adviser.’ A subtle but interesting change in the balance of social responsibility vs patient confidentiality..... www.GMC-uk.org

Read article »

Early warning signs of heart attacks 'being missed'

Mar 06, 2017

Treatment of heart attacks is one of the success stories of the last ten years with death rates falling by 50%. Nevertheless, heart disease remains the commonest cause of death in the western world and focus is now shifting away from treatment strategies onto earlier identification of symptoms. In a recent Lancet study looking at all heart attack deaths between 2006 and 2010, the researchers found that 16% of people had been admitted to hospital in the 28 days prior to their death suggesting that some warning symptoms had been misinterpreted. This is not surprising when you realise how variable the presenting symptoms can be but does mean that both the medical profession and patients could do better. Most people think of the symptoms of a heart attack as severe crushing central chest pain but in females and the elderly in particular, only a minority will experience these classical features. The pain may actually be quite mild and very similar to minor indigestion, it may occur in the throat or be experienced as an ache in the arms and may not even be registered at all. In the latter cases, patients just report feeling generally unwell, nauseated, anxious, a non-specific abdominal discomfort or sweaty. In all cases however, significant symptoms tend to build up over a period of minutes and will last longer than 15 minutes and up to a few hours. Fleeting symptoms or those that last days are very rarely an indication of important heart disease. Given these findings, it is very difficult to give definitive advice but if you feel unwell with any of the symptoms listed above and there is no other explanation for them, then it is sensible to seek medical attention. (Http://dx.doi.org/10.1016/S2468-2667(17)30032-4)

Read article »

Smoking and Lung Function

Jan 10, 2017

A new study finds that smokers with preserved lung function have similar symptoms and complications as those who have proven Chronic Obstructive Pulmonary Disease or COPD. It appears that little has changed since King James I, 412 years ago, wrote that smoking was “ a custome loathsome to the eye, hatefull to the Nose, harmefull to the braine, dangerous to the Lungs, and in the blacke stinking fume thereof, neerest resembling the horrible Stigian smoke of the pit that is bottomlesse” NEJM 2016

Read article »

Suboptimal care after heart attacks

Jan 10, 2017

This week, much of the media focused on a study that demonstrated how lives were being lost because the patients of England and Wales were receiving sub-optimal care after having had a heart attack. The figure quoted was 33,000 lives could have been saved if patients had recommended treatments including dietary advice, smoking advice and cardiac rehabilitation as well as some drug treatments and further investigations. To put this in context, this study covered 10 years (2003-2013) when deaths from heart attacks were approximately 150,000 per year. In other words, approximately 2% of all the heart attack deaths may have been preventable, a figure which is still too high but unlikely to have made the headlines if it had been billed as such. The study does, however, emphasise how important drug treatments and lifestyle changes are after a heart attack and why I wish the media would drop it’s campaign of statin hatred - if you’ve had a heart attack these drugs are hugely important in preventing you having a further one.

Read article »

Out of hospital cardiac arrest

Jan 10, 2017

A new study published in the New England Journal of Medicine this week (NEJM 2016;374:1711) has shown that the administration of anti-arrhythmic drugs on scene in the context of a cardiac arrest out-of-hospital do not make any difference to the survival or functional outcomes of patients. In a way this is good news in that all our focus should be on proper cardio-pulmonary resuscitation techniques and rapid defibrillation if required. This means more training for members of the public in how to recognise cardiac arrest and how to initiate CPR as well as increasing the availability of defibrillators in public spaces. As Vinnie Jones demonstrated in the ad campaign, we all need to be able to sing along to the Bee Gees ‘Staying Alive’.

Read article »

iCal feed   get RSS feed

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 n…

PHS on Twitter

Sign up to our newsletter

Name Email