Early Success with HVAD LATERAL trial Medtronic

Early Success with HVAD LATERAL Trial

Clinical Trial of Medtronic Heart Pump HVAD Delivers Positive Results with Less-Invasive Implant Procedure

 

Medtronic plc announce results of the ENDURANCE Supplemental trial in a late-breaking clinical trial session of the 2017 International Society for Heart and Lung Transplantation (ISHLT) Scientific Meeting in San Diego. The study evaluated the company’s HVAD(TM) System as a destination (long-term) therapy for patients needing heart pumps (left ventricular assist devices, or LVAD) who received improved blood pressure management. The HVAD System is not approved in the United States for destination therapy.

While the trial did not meet its primary endpoint (all neurologic events at 12 months), secondary results showed that 76.4 percent of patients receiving the HVAD System were alive on the originally implanted device and free of disabling stroke, compared to 66.9 percent of patients in the control arm (non-inferiority p-value < 0.0001; superiority p-value = 0.0354). This prespecified secondary endpoint analysis showed the HVAD System was superior to the control group (absolute difference 9.2 percent), as evaluated by the composite endpoint used in most clinical trials of LVAD therapies.

“In the ENDURANCE trial, we were concerned about the higher rate of stroke in the HVAD group compared to the control. In the ENDURANCE Supplemental trial, that gap closed and the stroke rates are comparable: there was no statistically significant difference between the HVAD and HeartMate II(TM). We believe the narrowing of those rates was most likely due to blood pressure management,” said Carmelo Milano, M.D., co-principal investigator, and surgical director of cardiac transplantation and left ventricular assist device programs for the Division of Cardiothoracic Surgery at Duke University Medical Center in Durham, N.C.

Device exchange was not included in the primary endpoint, but transient ischemic attacks were: 14.7 percent of patients who received the HVAD System experienced a neurologic event within 12 months of implantation, compared to 12.1 percent of patients in the control arm (p =0.14). Post-hoc analysis revealed a rate of disabling stroke or death of 18.8 percent at 12 months among patients receiving the HVAD System, compared to 21.6 percent of patients receiving the control device.

Additional post-hoc analyses comparing data from the ENDURANCE Supplemental trial to data from the original ENDURANCE Destination Therapy trial show:

  • The pre-specified blood pressure management protocol in the ENDURANCE Supplemental trial was effective in reducing the mean arterial blood pressure (MAP) by a clinically meaningful amount when compared to HVAD patients from the original ENDURANCE trial (as well as when compared to the control group in ENDURANCE Supplemental).
  • A 24.7 percent reduction of overall stroke and transient ischemic attack (TIA) incidence – and a 50 percent reduction in hemorrhagic strokes – in patients receiving support from the HVAD System.

“We are pleased with the overall results of the ENDURANCE Supplemental trial, particularly the reduced rates of disabling stroke and the promising effects of optimal blood pressure management,” said David Steinhaus, M.D., vice president and general manager of the Heart Failure business at Medtronic. “We hope to be able to offer this therapy to the very sick population of patients in the U.S. who are ineligible for a heart transplant and rely upon mechanical circulatory support as long-term destination therapy.”

ENDURANCE Supplemental Destination Therapy Trial Design

The ENDURANCE Supplemental clinical trial was a prospective, randomized, controlled, multicenter evaluation of the incidence of neurologic events in patients receiving the HVAD System as destination therapy who received optimal blood pressure management. Between October 2013 and August 2015, 465 patients were randomly selected to receive either the HVAD System or, as part of a control group, any alternative LVAD approved by the U.S. Food and Drug Administration (FDA) for destination therapy, in a two-to-one ratio. The HVAD pump was implanted in 308 patients ineligible for a heart transplant, while 157 patients received the control device for the same destination therapy indication.

This trial was a follow-up to the ENDURANCE Destination Therapy trial that implanted 445 patients between 2010-2012 who received either the HVAD System or any alternative LVAD approved by FDA for destination therapy in a two-to-one ratio. The ENDURANCE trial met its primary endpoint, demonstrating non-inferiority of the HVAD System to the control device; results were recently published in The New England Journal of Medicine.

LVAD therapy is an effective treatment for indicated patients. The HVAD System is indicated for use as a bridge to cardiac transplantation in patients who are at risk of death from refractory end-stage left ventricular heart failure. Medtronic has submitted its PMA application to the FDA for a destination (long-term) therapy indication for the HVAD System based on the ENDURANCE and ENDURANCE Supplemental trial datasets.

Good communication helps improve outcomes for heart patients - credit AHA

Good communication helps improve outcomes for heart patients

Patients who said they communicated effectively with their healthcare providers were more likely to report the use of prescribed statin drugs and aspirin

Patients with hardened arteries who reported good communication with their healthcare providers were less likely to use the emergency room and more likely to comply with their treatment plans, according to a new study presented at the American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions 2017.

Researcher interviews of 6,810 adults with atherosclerosis, found:

  • Patients who said they communicated effectively with their providers were 52 percent more likely to report the use of prescribed cholesterol-lowering statin drugs and 26 percent more likely to report taking aspirin.
  • Patients with good provider communication were 41 percent less likely to go to the emergency room.
  • In comparison, those who reported poor communication with their healthcare providers were twice as likely to report poorer outcomes and spent $1,243 more in healthcare costs.

Participants were asked questions such as “How often did your healthcare providers show respect for what you had to say?” and “How often did healthcare providers spend enough time with you?”

“A patient’s beliefs about their illness, their perception of the health care system, the extent to which a physician fulfils the patient’s requests and other obstacles can make it a challenge for patients and providers to connect,” said lead study author Victor M. Okunrintemi, M.D., M.P.H., a researcher at Baptist Health South Florida in Miami.

He said “One cannot say for sure how communication exactly influences health outcomes. However, optimal communication between patients and their healthcare providers may yield better understanding of the medical condition, build trust and confidence, motivate patients and promote adherence to medication which could improve patients’ health status while reducing the need for unnecessary health resource utilization which can lower health care expenditures.”

Generation NOW – How Do Health Systems Cope?

Generation NOW – How Do Health Systems Cope?

Generation Now – The Patient Revolution

 

As life races forward and humans play catch up with the ever increasing pace of “on demand” satisfaction to life’s queries. If you want an answer now, no problem, Google will satisfy the answer you need and throw alternatives into the mix.

Due to increased accessibility to knowledge, “on demand” has become embedded into the psyche, it is a cultural movement.

So how does an already under pressure NHS or any other health system manage the insatiable appetite for answers now by its customers?

Patient activation, patient engagement and patients agreeing to take on the responsibility of managing their own health is a hot topic in health conversations. Believe it or not this hasn’t always been the case, but the pressure of a tsunami of long-term conditions means that the professionals we all look to for help to resolve our aches and pains haven’t got all the answers.

Looking at the other end of the spectrum what does the patient’s point of view look like? I have some insights my team and I would like to share with you to give you a look into how people satisfy their “on demand” lifestyle.

Now before I start, it is important to highlight that not all patients are “Generation Now” patients. Generation now patients tend to be of working age and are those patients that are willing to believe in self-management, try new ways of managing their condition and generally taking control of their condition. They need little reason or motivation to be patient innovators. They don’t silo themselves as innovators, they just do it because they are looking for solutions themselves to challenges they have managing their conditions.

My team and I run the UK’s Heart Failure Charity the Pumping Marvellous Foundation which was born in a recession and has grown in the “Apple Era” It is a “Generation Now” patient group. In the space we operate in we need to invent, innovate and deliver solutions everyday in different ways to our beneficiaries that keeps pace with their insatiable appetite for “on demand” attention. The time of developing offline, real-world support groups is diminishing.

Many people want to be part of a community where they find commonality, similarity and sustenance in peer-to-peer support, relating to their need. The difference now is they want to access this when they want to, not when the next scheduled meeting is due to take place and answers plated up quickly not having to wait in a queue for the information.

We have developed a powerful, heart-failure-focused, peer-to-peer patients’ platform where people and their carers get lightning fast answers to their problems, not just from one patient but a multitude of patients altruistically volunteering their experiences to help others all within a safe and highly moderated environment. It has been known for patients to just observe and watch the discussions for many months if not years and then suddenly pop up, ask a question, get bombarded with friendly information and retreat to the audience not to be seen until they need help again. The vast majority of patients and carers in our groups do just that, they dip in and dip out as and when they need help or when they are in crisis. The reason why this works is that the individual believes in the community but they are disconnected enough to not feel lectured to but connected enough to ask the question and get their answer.

 – Nick Hartshorne Evans – CEO The Pumping Marvellous Foundation

Insomnia associated with increased risk of heart failure, heart attack and stroke

Insomnia associated with increased risk of heart failure

Insomnia symptoms associated with increased risk of incidence or death from heart disease, including heart failure, heart attack and stroke, according to research published in the European Journal of Preventive Cardiology.

Research finds link between insomnia and increased risk of heart attack, stroke

“Sleep is important for biological recovery and takes around a third of our lifetime, but in modern society more and more people complain of insomnia,” said first author Qiao He, a Master’s degree student at China Medical University, Shenyang, China. “For example, it is reported that approximately one-third of the general population in Germany has suffered from insomnia symptoms.”

“Researchers have found associations between insomnia and poor health outcomes,” continued Miss He. “But the links between insomnia and heart disease or stroke have been inconsistent.”

The current meta-analysis assessed the association between insomnia symptoms and incidence or death from cardiovascular disease (acute myocardial infarction, coronary heart disease, heart failure), stroke, or a combination of events. Insomnia symptoms included difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening, and non-restorative sleep.

The authors analysed 15 prospective cohort studies with a total of 160 867 participants. During a median follow-up of three to 29.6 years, there were 11 702 adverse events.

There were significant associations between difficulty initiating sleep, difficulty maintaining sleep, and non-restorative sleep and the risk of heart disease and stroke, with increased relative risks of 1.27, 1.11, and 1.18, respectively, compared to those not experiencing these insomnia symptoms. There was no association between early-morning awakening and adverse events.

Miss He said: “We found that difficulty initiating sleep, difficulty maintaining sleep, or non-restorative sleep were associated with 27%, 11%, and 18% higher risks of cardiovascular and stroke events, respectively.”

“The underlying mechanisms for these links are not completely understood,” continued Miss He. “Previous studies have shown that insomnia may change metabolism and endocrine function, increase sympathetic activation, raise blood pressure, and elevate levels of proinflammatory and inflammatory cytokines – all of which are risk factors for cardiovascular disease and stroke.”

Women with insomnia symptoms had a slightly higher risk of cardiovascular and stroke events than men, especially for non-restorative sleep, but the difference between sexes did not reach statistical significance.

Miss He said: “We cannot conclude that insomnia is more dangerous for women, given the limitations of meta-analyses and the lack of a statistically significant difference between sexes. However, we do know that women are more prone to insomnia because of differences in genetics, sex hormones, stress, and reaction to stress. It may therefore be prudent to pay more attention to women’s sleep health.”

Miss He concluded: “Sleep disorders are common in the general population and sleep health should be included in clinical risk assessment. Health education is needed to increase public awareness of insomnia symptoms and the potential risks, so that people with sleep problems are encouraged to seek help.”

Link to full research paper – He Q, et al. The association between insomnia symptoms and risk of cardio-cerebral vascular events: A meta-analysis of prospective cohort studies:  http://journals.sagepub.com/doi/full/10.1177/2047487317702043

Importance of Heart Failure Awareness

In response to heart failure in the headlines this week PumpingMarvellous CEO Nick Hartshorne Evans highlights the importance of Heart Failure Awareness

Heart Failure rears its ugly head again with the coroner’s report on the tragic death of George Michael released on Tuesday. It has been reported by the senior coroner that George Michael’s death was due to dilated cardiomyopathy, myocarditis and a fatty liver.

 

Naturally, it is inappropriate to speculate on the reasons why George Michael had dilated cardiomyopathy (DCM), myocarditis and a fatty liver, however it is appropriate to talk about the reasons why heart failure occurs.

 

Heart failure is a syndrome, which has a cause. It is an umbrella term that is used to describe the syndrome. Heart failure indicates that a heart is failing to pump as efficiently as it should or heart failure can also mean that the heart is failing to relax and fill correctly. Both ways the heart is prevented from supplying the blood and nutrients that the body needs to function.

 

There is always a reason for heart failure but sometimes this cannot be identified. Reasons for heart failure in approximately 75% of cases is caused by
  • A heart attack where the heart has been previously damaged due to a poor supply of blood to it caused predominantly by blocked arteries
  • Un-treated, un-diagnosed high blood pressure, hypertension

 

The two above conditions means you are at a higher risk of a diagnosis of heart failure

 

There are other reasons why heart failure may occur and these could be any of the following or a combination of

 

  • Viral myocarditis – where a virus has effected the heart
  • Abnormal heart rhythm like Atrial Fibrillation (AF)
  • A genetic condition like some cardiomyopathy
  • Excessive alcohol and recreational drug use
  • Some types of chemotherapy
  • Damaged heart valves

 

Left untreated or not treated appropriately heart failure has a worse prognosis than most forms of common cancer excluding lung cancer and costs the NHS up to £2 billion per year.

 

It is therefore important we continue to spread awareness of what heart failure is and what are the common symptoms.

 

Most Common Symptoms

 

  • Breathlessness
  • Severe tiredness
  • Swelling of the feet, ankles, legs and stomach

 

“Anyone, Anywhere, Anytime – Heart Failure may be affecting you…”

 

If you are experiencing a combination of these symptoms contact your GP.

 

 – Nick Hartshorne Evans – CEO The Pumping Marvellous Foundation

New Clues to Causes of Heart Failure

New Clues to Causes of Heart Failure

Penn Study Finds New Clues to Causes of Heart Failure

Signaling proteins in cells lining the heart are crucial heart for attack recovery – new clues to causes of heart failure

Of the more than 700,000 Americans who suffer a heart attack each year, about a quarter go on to develop heart failure. Scientists don’t fully understand how one condition leads to the other, but researchers in the Perelman School of Medicine at the University of Pennsylvania have now discovered a significant clue—which ultimately could lead new therapies for preventing the condition.

Heart failure can develop after a heart attack due to a long-term damage response by the immune system that transforms much of the heart muscle into stiff, fibrous, scar-like tissue. In a study published today in the Journal of Clinical Investigation, researchers report that a set of signaling proteins produced in the epicardium, a layer of special cells that lines the heart muscle, appears to play a key role in keeping this wayward damage-response process in check.

“These findings highlight the importance of the heart’s interaction with the immune system in the post-heart-attack response,” said co-senior author Rajan Jain, MD, an assistant professor of Cardiovascular Medicine. “They hint at the possibility of developing designer therapies aimed at modulating specific aspects of immune system in the future as part of treating patients who have had a heart attack. ”

Prior work from Epstein and colleagues at Penn has shown that in the epicardium, a cascade of protein-to-protein interactions known as the Hippo signaling pathway occurs early in life and is important for normal heart development. Other research has suggested that two key components of the Hippo pathway, the signaling proteins YAP and TAZ, also promote the regeneration of heart muscle after experimental heart-attack-like damage in newborn mice.

In this study, researchers examined the role of epicardial YAP and TAZ after heart attack in the adult heart, which, compared to the fetal or newborn heart, is much less able to regenerate itself following injury. After an experimentally induced heart attack, normal adult mice, as expected, showed a small amount of fibrous change in the heart, limited to the area where a coronary artery were blocked and heart muscle had been deprived of oxygen. By contrast, in adult mice whose YAP and TAZ genes had been deleted from their epicardial cells just before the heart attack, there were signs of widespread inflammation and fibrosis in the heart muscle.

“The hearts of these mice were essentially encased in fibrotic cells,” Jain said. “We found that this extreme fibrotic response was accompanied by a decline in heart function resembling what is seen in human heart failure, as well as rapid weight loss and a much higher death rate.”

Researchers found evidence that the Hippo-pathway proteins normally trigger the increased production of the immune protein interferon gamma. The latter summons regulatory T cells – “T-regs” – which generally calm immune responses, and have been shown in prior research to reduce heart-muscle inflammation after a heart attack. In the YAP-less, TAZ-less mice, a heart attack failed to induce the usual rise in interferon gamma production and recruitment of T-regs, allowing inflammation and fibrosis to run rampant.

New Clues to Causes of Heart Failure

“We are hoping to harness the immune system, just as we are doing at Penn to fight cancer, in order to improve the balance between scar formation and regeneration after a heart attack,” said co-senior author Jonathan A. Epstein, MD, executive vice dean and chief science officer at Penn Medicine. “The more we look, the more we discover that the immune system is regulating how we heal from injury in every way – acting like the conductor of a complex cellular orchestra.”

In a further experiment, the researchers applied a hydrogel laced with interferon gamma to the hearts of some of these mutant mice just after their heart attacks. As hoped, the artificial restoration of interferon gamma led to higher T-reg levels in the heart and much more moderate inflammation and fibrosis.

The findings show that epicardial YAP and TAZ are important not only for the normal development of young hearts but also for a healthier repair process in damaged adult hearts.

Jain, Epstein and their colleagues now plan further experiments to map out the fibrosis-causing immune response in more detail—a project that could reveal multiple targets for future drug interventions to prevent heart failure in heart attack patients. The team also plans to develop mice in which the YAP and TAZ genes are not deleted but are instead overexpressed. “The hope is that higher levels of these proteins will lead to a scar-free healing of the heart after a heart attack,” Jain said.

Additional Penn authors on this study include co-first authors Vimal Ramjee and Deqiang Li, both of the Epstein Laboratory at the time of the study; Lauren J. Manderfield, Feiyan Liu, Kurt A. Engleka, Haig Aghajanian, Christopher B. Rodell, Wen Lu, Vivienne Ho, Tao Wang, Li Li, Anamika Singh, Dasan M. Cibi, and Jason A. Burdick. Co-senior author Manvendra K. Singh, formerly of Penn Medicine and now at Duke-NUS Medical School, also contributed to this research.

The research was supported by the American Heart Association, the Burroughs Wellcome Fund, the Singapore National Research Foundation, the Cotswold Foundation, the WW Smith Endowed Chair, and the National Institutes of Health (U01 HL100405).

Carers UK and the Pumping Marvellous Foundation team up in world’s first cross global study on carers of people with heart failure

Carers UK and the Pumping Marvellous Foundation team up in world’s first cross global study on carers of people with heart failure

Carers UK and the Pumping Marvellous Foundation team up in world’s first cross global study on carers of people with heart failure

3 February 2017

National carers and patients organisations – Carers UK and Pumping Marvellous Foundation are part of a ground-breaking four nation research study to look at the challenges faced by carers of people with heart failure.  The research, which is being coordinated by the International Alliance of Carer Organisations (IACO) will cover Australia, Canada, the United States as well as carers in the UK.

 

The work is the first multi-national study on carers who are supporting a relative or friend with heart failure and seeks to learn more of the impact of caring for a heart failure patient on the carer such as the physical, emotional/psychological, and social impacts.

 

A carer is someone who cares, unpaid for a relative or close friend with an illness or disability and can be a spouse, partner, parent, another family member or close friend.  Heart failure is a clinical syndrome in which the heart fails to pump efficiently or it fails to relax and fill efficiently.  Symptoms include breathing difficulties, gathering of fluid in the lower limbs or stomach and extreme lethargy and tiredness.

 

Emily Holzhausen, Director of Policy and Public Affairs at Carers UK, said “We are delighted to be part of this international study and to be working with the Pumping Marvellous Foundation to see what common issues carers face in the UK and in different countries around the globe.  We will use the research findings to look at what better support families need in their caring role, here in the UK as well as internationally.”

 

Nick Hartshorne-Evans, CEO and founder of the Pumping Marvellous Foundation, said “This is truly an important international study to assess the impact of caring for a person managing their heart failure. Working with Carers UK we will be able to assess the needs of carers of heart failure patients in the UK as well as attaining a cross country perspective. These will be truly valuable insights.”

 

We are calling upon carers of someone with heart failure to complete the confidential questionnaire so that we are able to take this valuable work forward.

 

Carers in those 4 nations interested in participating in the 15 minute questionnaire, can access it at http://www.internationalcarers.org/research-study-on-carers-of-persons-with-heart-failure/.  Results are likely to be available in October 2017.

 

The survey is being promoted during Heart Awareness Month throughout the whole of February 2017.

 

IACO is a global coalition of 14 member nations committed to building a global understanding and respect for the vital role of family carers. Recognised as an official Non Governmental Organisation by the United Nations, each IACO member country is represented by a nationally-renowned carer organisation. The coalition meets annually to share best practices, identify global issues, and advocate for family carers.

 

The research study is funded by Novartis Pharma AG.
For More Information

For information about IACO, please visit www.internationalcarers.org.  For more information about the study in the UK, please contact Emily Holzhausen, Director of Policy at Carers UK: Emily.holzhausen@carersuk.org or

Nick Hartshorne-Evans, Executive Director at Pumping Marvellous Foundation: nick@pumpingmarvellous.org

 

Notes:

Along with Carers UK and the Pumping Marvellous foundation in the UK, the study partners include:   the National Alliance of Care-giving and WomenHeart in the USA, Carers Canada, Carers Australia and Heart Support Australia.

 

The research is being led by Dr Anna Strömberg, Professor of Nursing Science, Linköping University and Research Co-coordinator and Heart Failure Nurse Specialist, Department of Cardiology, Linköping University Hospital.

 

The survey is confidential.

Sudden death warning over faulty gene British Heart Foundation

Sudden death warning over faulty gene

Faulty Gene. Hundreds of thousands at risk of sudden death from silent heart conditions

 

Number of people living with a deadly faulty gene legacy grossly underestimated

 

Around 620,000 people in the UK are carrying a faulty gene that puts them at high risk of developing coronary heart disease or sudden death, according to new estimates from the British Heart Foundation (BHF).

Worryingly, the majority of people affected by the faulty gene are undiagnosed and unaware that they may be at risk of a deadly heart attack or cardiac arrest.

The figure is almost 100,000 higher than previous estimates due to better understanding of the prevalence of inherited heart conditions.

The UK’s leading heart research charity warns the overall figure could be much higher due to underdiagnoses and undiscovered faulty genes which can increase a person’s risk of these potentially fatal conditions.

Inherited heart conditions can affect people of any age and each child of someone with an inherited heart condition can have a 50 per cent chance of inheriting it. For many families, the first sign there’s a problem is when someone dies suddenly with no obvious cause or explanation.

Each week in the UK around 12 seemingly healthy people aged 35 or under are victims of sudden cardiac death with no explanation, largely due to these devastating conditions (2).

BHF-funded research has helped to discover many of the faulty genes that cause inherited heart conditions, which has led to the development of structured genetic testing services for those at highest risk for some of these conditions. However, more research is urgently needed to better detect and treat these conditions to stop the devastation brought to loved ones, who could also be at risk themselves.

Former England cricketer, James Taylor is backing the BHF’s campaign after being forced to retire at the age of 26 after being diagnosed with arrhythmogenic right ventricular cardiomyopathy (ARVC) in April last year.

ARVC is an inherited heart condition that causes heart muscle to be replaced by fibrous tissue and fat so the ventricle becomes thin and stretched, meaning the heart does not pump blood around your body properly and there is an increased risk of sudden cardiac arrest.

Professor Sir Nilesh Samani, Medical Director at the British Heart Foundation, said: “The reality is that there are hundreds of thousands of people across the UK who are unaware that they could be at risk of sudden death.

“If undetected and untreated, inherited heart conditions, can be deadly and they continue to devastate families, often by taking away loved ones without warning.

“Thanks to the public’s kind support BHF-funded researchers have discovered some of the genes responsible for these frightening conditions but there is still much to do.

“We urgently need to fund more research to better understand these heart conditions, make more discoveries, develop new treatments and save more lives.”

Speaking of his involvement, James Taylor said: “It is safe to say that being diagnosed with ARVC was the toughest and scariest week of my life.  I never would have thought it would happen to me, I was 26 years old and playing cricket for England but my condition meant that I was at risk of sudden death from a cardiac arrest.

“I was lucky as my condition was detected early and despite having to give up my career, with medication I can lead a relatively normal life. But it could have been an incredibly different story.

“Please help the BHF fund even more life saving research and together, we can fight back against these conditions that rip families apart.”

The BHF has launched a new television campaign to raise awareness of the sudden devastation caused by heart disease. In the advert, a bridesmaid suffers a cardiac arrest due to an inherited heart condition on her sister’s wedding day.

Watch the television advert tonight during No Offence on Channel 4.

For more information and advice about inherited heart conditions and to support the BHF to fund more research to end the devastation of heart disease visit www.bhf.org.uk/unexpected

Digital Health and Heart Failure

Professor Martin Cowie explains digital health and heart failure care

Digital health (sometimes referred ot as eHealth) is quietly transforming the health care landscape, but what is it and what does it mean for people living with heart failure now and how what could it look like for the future hf patient and cardiology?

Professor Martin Cowie, Imperial College and Chair of Pumping Marvellous Clinical Board explains digital health, in a a series of bite-sized, easily digestible videos.

1. What is eHealth/ Digital Health?

“eHealth is a very vague general term for a huge number of different technologies – Generally Digital Health is now a better name for it.”

 

2. eHealth Application and Cardiovascular Medicine

“Remote monitoring has done lots of [heart failure] studies in that area to try and find some system that actually improves outcome for patients – It’s not all plain sailing though.”

 

3. The Challenges of eHealth?

“So I think the challenge is how do you add value to data? It’s not just a question of getting the data, but then how do you make sense of it? How do you then make better decsions both for the patient and the health care professional?”

 

4. What Are the Risks of eHealth?

“It’s quite a challenging equation at the moment for technology.”


5. Most Exciting Prospect of Cardiovascular Medicine?

“It’s about personalisation, it’s about navigation of systems rather than being gatekeepers. It’s a very different world and we have some hint that that may be possible.”

 

6. What Could the Future of Digital Health Look Like for Heart Failure Patients?

“I think longer term, five, ten. fifteen years from now it’d be great for all of us who’ll be living with several medical conditions where we don’t actually have to go to hospital or clinics to get expert advice. We can monitor a lot of these things ourselves.”

 

Source – The European Society of Cardiology

Recovered Heart Function DCM Study

Please Help The Royal Brompton Hosptial Find Dilated Cardiomyopathy Patients With Recovered Heart Function for a Current Study – TRED

Researchers at the Royal Brompton Hospital, and the NHLI (National Heart and Lung Institute) are still working hard on a new BHF-funded dilated cardiomyopathy study. They are currently inviting patients with a previous DCM diagnosis, whose heart function has recovered after a period on medical therapy, to join a trial [TRED] to explore whether the recovered heart function represents a cure and whether it is safe for patients to stop their medications.

Dilated Cardiomyopathy with recovered heart function

Therapy withdrawal in REcovered Dilated cardiomyopathy [TRED]

CLICK HERE TO SEE TRED TRIAL SUMMARY

CLICK HERE TO FIND OUT HOW TO SIGN UP TO THE TRED TRIAL

Has your heart function improved to normal after being diagnosed with dilated cardiomyopathy?
Would you like to stop your medications? Find out more about the new, dilated cardiomyopathy study.

Currently, it is unclear whether patients continue to derive benefit from medications after their heart function has recovered.

In this new dilated cardiomyopathy study, the team plan to withdraw medications gradually in a structured supervised fashion. They will use heart (MRI) scans, exercise tests and blood tests to monitor heart function. If there are any early signs of a reduction in heart function they will re-establish patients on medication immediately.

 

What is the purpose of the new Dilated Cardiomyopathy study TRED?

The aim of the study is to determine whether it is safe and feasible for patients with a prior diagnosis of dilated cardiomyopathy and recovered heart function, to stop their heart failure medications.
Dilated cardiomyopathy (DCM) is the most common disease of the heart muscle and can be caused by many different things including genetic differences, infections and excess alcohol consumption. It is characterised by a reduction in function and increase in size of the heart’s pumping chambers. In 1 in 3 patients, the heart function improves and returns to normal with medications. A question we are often asked by patients is whether they need to continue their medications after their heart function has recovered. Currently there is little research for doctors to base their answer on and no consensus about the best approach. Patients therefore often receive a variety of answers from different doctors.

This study gives participants the opportunity to come off medications in a supervised, monitored fashion, not ordinarily available otherwise. If there is any sign of worsening heart function, patients will be put back on medications at the earliest opportunity, reducing the chances of coming to any harm as a result of stopping medications to the smallest possible level.

 

Find out more: A Randomised-Controlled Pilot Trial of The Feasibility And Safety Of Therapy Withdrawal In
Asymptomatic Patients With A Prior Diagnosis Of Dilated Cardiomyopathy & Recovered Cardiac Function, co-ordinated by Dr Brian Halliday (BHF Clinical Research Fellow)
Royal Brompton Hospital; NHLI, Imperial College, London

CLICK HERE TO FIND OUT HOW TO PARTICIPATE IN THE TRED TRIAL