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Kwok CS, Tafuro J, Wong CW, Bennett S, Zachariah D, Barker D, Morley-Davies A, Satchithananda D, Gunning M, Borovac JA. What Are the Causes of Death among Patients Admitted to a Contemporary Tertiary-Level Cardiology Department? An Analysis of 10 Years of Morbidity and Mortality Meetings. Pathophysiology 2023; 30:467-479. [PMID: 37873854 PMCID: PMC10594450 DOI: 10.3390/pathophysiology30040034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/24/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
Despite the efforts to deliver the best evidence-based care, in-hospital death is an inevitable event among some patients hospitalized in cardiology departments. We conducted a retrospective evaluation of mortality events from inpatient admissions to the cardiology department between 2010 and 2019. Data were collected from morbidity and mortality meeting presentations that evaluated comorbidities, medical history, treatments, and causes of death for the overall cohort and according to age group and sex. There were 1182 registered deaths. The most common causes of death among patients were acute myocardial infarction (AMI, 53.0%), heart failure (HF, 11.7%), cardiac arrest (CA, 6.6%), HF with complication/defined cardiomyopathy (6.3%), and sepsis (4.4%). We observed a decline in deaths from AMI from 61.9% in 2010 to 46.7% in 2019, while there was a clear increase in deaths from HF (11.1% in 2010 to 25.9% in 2019). Compared to patients ≥65 years, younger patients were more likely to have died from CA (15.7% vs. 4.3%, p < 0.001) and other cardiac reasons (3.0% vs. 0.4%, p < 0.001). The majority of deaths were due to AMI, HF, and CA. We observed a significant declining trend in the proportion of deaths due to AMI in recent years, with an increase in deaths due to HF.
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Affiliation(s)
- Chun Shing Kwok
- Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK; (C.S.K.); (J.T.); (C.W.W.); (D.Z.); (D.B.); (A.M.-D.); (D.S.); (M.G.)
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham B5 5JU, UK
| | - Jacopo Tafuro
- Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK; (C.S.K.); (J.T.); (C.W.W.); (D.Z.); (D.B.); (A.M.-D.); (D.S.); (M.G.)
| | - Chun Wai Wong
- Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK; (C.S.K.); (J.T.); (C.W.W.); (D.Z.); (D.B.); (A.M.-D.); (D.S.); (M.G.)
| | - Sadie Bennett
- Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK; (C.S.K.); (J.T.); (C.W.W.); (D.Z.); (D.B.); (A.M.-D.); (D.S.); (M.G.)
| | - Donah Zachariah
- Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK; (C.S.K.); (J.T.); (C.W.W.); (D.Z.); (D.B.); (A.M.-D.); (D.S.); (M.G.)
| | - Diane Barker
- Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK; (C.S.K.); (J.T.); (C.W.W.); (D.Z.); (D.B.); (A.M.-D.); (D.S.); (M.G.)
| | - Adrian Morley-Davies
- Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK; (C.S.K.); (J.T.); (C.W.W.); (D.Z.); (D.B.); (A.M.-D.); (D.S.); (M.G.)
| | - Duwarakan Satchithananda
- Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK; (C.S.K.); (J.T.); (C.W.W.); (D.Z.); (D.B.); (A.M.-D.); (D.S.); (M.G.)
| | - Mark Gunning
- Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK; (C.S.K.); (J.T.); (C.W.W.); (D.Z.); (D.B.); (A.M.-D.); (D.S.); (M.G.)
| | - Josip A. Borovac
- Division of Interventional Cardiology, Cardiovascular Diseases Department, University Hospital of Split, 21000 Split, Croatia
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Britton I, Bradbury C, Srinivas S, Balasubramaniam R, Dale M, Morley-Davies A, Bednall R. CTC service heterogeneity and design of a workforce calculator. Clin Radiol 2023:S0009-9260(23)00144-7. [PMID: 37188552 DOI: 10.1016/j.crad.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 12/14/2022] [Accepted: 03/31/2023] [Indexed: 05/17/2023]
Abstract
AIM To determine the level of heterogeneity in delivery of computed tomography (CT) colonography services and develop a workforce calculator that accommodates the variation identified. MATERIALS AND METHODS A national survey, based on the "WHO workforce indicators of staffing need", established activity standards for essential tasks in delivery of the service. From these data a workforce calculator was designed to guide the required staffing and equipment resource by service size. RESULTS Activity standards were established as mode responses >70%. Service homogeneity was greater in areas where professional standards and guidance were available. The mean service size was 1,101. Did not attend (DNA) rates were lower where direct booking was available (p<0.0001). Service sizes were larger where radiographer reporting was embedded in reporting paradigms (p<0.024). CONCLUSION The survey identified benefits of radiographer-led direct booking and reporting. The workforce calculator derived from the survey provides a framework to guide the resourcing of expansion while maintaining standards.
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Affiliation(s)
- I Britton
- Imaging Department, University Hospital of North Midlands, Stoke-on-Trent, UK.
| | - C Bradbury
- Imaging Department, University Hospital of North Midlands, Stoke-on-Trent, UK
| | - S Srinivas
- Imaging Department, University Hospital of North Midlands, Stoke-on-Trent, UK
| | - R Balasubramaniam
- Imaging Department, University Hospital of North Midlands, Stoke-on-Trent, UK
| | - M Dale
- Imaging Department, University Hospital of North Midlands, Stoke-on-Trent, UK
| | - A Morley-Davies
- Cardiology Department, University Hospital of North Midlands, Stoke-on-Trent, UK
| | - R Bednall
- Quality Improvement Academy, University Hospital of North Midlands, Stoke-on-Trent, UK
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Bourke J, Turner C, Bradlow W, Chikermane A, Coats C, Fenton M, Ilina M, Johnson A, Kapetanakis S, Kuhwald L, Morley-Davies A, Quinlivan R, Savvatis K, Schiava M, Yousef Z, Guglieri M. Cardiac care of children with dystrophinopathy and females carrying DMD-gene variations. Open Heart 2022; 9:e001977. [PMID: 36252992 PMCID: PMC9577913 DOI: 10.1136/openhrt-2022-001977] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 09/26/2022] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE We provide succinct, evidence-based and/or consensus-based best practice guidance for the cardiac care of children living with Duchenne muscular dystrophy (DMD) as well as recommendations for screening and management of female carriers of mutations in the DMD-gene. METHODS Initiated by an expert working group of UK-based cardiologists, neuromuscular clinicians and DMD-patient representatives, draft guidelines were created based on published evidence, current practice and expert opinion. After wider consultation with UK-cardiologists, consensus was reached on these best-practice recommendations for cardiac care in DMD. RESULTS The resulting recommendations are presented in the form of a succinct care pathway flow chart with brief justification. The guidance signposts evidence on which they are based and acknowledges where there have been differences in opinion. Guidelines for cardiac care of patients with more advanced cardiac dystrophinopathy at any age have also been considered, based on the previous published work of Quinlivan et al and are presented here in a similar format. The recommendations have been endorsed by the British Cardiovascular Society. CONCLUSION These guidelines provide succinct, reasoned recommendations for all those managing paediatric patients with early or advanced stages of cardiomyopathy as well as females with cardiac dystrophinopathy. The hope is that this will result in more uniform delivery of high standards of care for children with cardiac dystrophinopathy, so improving heart health into adulthood through timely earlier interventions across the UK.
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Affiliation(s)
- John Bourke
- Department of Cardiology, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
- John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Cathy Turner
- John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - William Bradlow
- Department of Paediatric Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ashish Chikermane
- Department of Cardiology, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Caroline Coats
- Department of Cardiology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Matthew Fenton
- Department of Paediatric Cardiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Maria Ilina
- Scottish Paediatric Cardiac Services, Royal Hospital for Children, Glasgow, UK
| | | | - Stam Kapetanakis
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Adrian Morley-Davies
- Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Ros Quinlivan
- Department of Neuromuscular Disease, National Hospital for Neurology and Neurosurgery, London, UK
- Institute of Neurology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Konstantinos Savvatis
- Institute of Neurology, University College London Hospitals NHS Foundation Trust, London, UK
- Barts Heart Centre, Saint Bartholomew's Hospital Barts Heart Centre, London, UK
| | - Marianela Schiava
- John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Zaheer Yousef
- Department of Cardiology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle upon Tyne, UK
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Panchal G, Kwok CS, Morley-Davies A, Zachariah D, Phan T. A comparison of clinical outcomes following atrial fibrillation ablation for heart failure patients with preserved or reduced left ventricular function: A systematic review and meta-analysis. Indian Pacing Electrophysiol J 2021; 22:18-23. [PMID: 34624479 PMCID: PMC8811280 DOI: 10.1016/j.ipej.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/28/2021] [Accepted: 09/16/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This review aims to determine if patients who undergo atrial fibrillation (AF) ablation with heart failure with preserved ejection fraction (HFpEF) do better, or worse or the same compared to patients with heart failure with reduced ejection fraction (HFrEF). METHODS A search of MEDLINE and EMBASE was performed using the search terms: "atrial fibrillation", "ablation" and terms related to HFpEF and HFrEF in order to identify studies that evaluated one or more of i) AF recurrence, ii) periprocedural complications and iii) adverse outcomes at follow up for patients with HFpEF and HFrEF who underwent AF ablation. Data was extracted from included studies and statistically pooled to evaluate adverse events and AF recurrence. RESULTS 5 studies were included in this review and the sample size of the studies ranged from 91 to 521 patients with heart failure. There was no significant difference in the pooled rate for no AF or symptom recurrence after AF ablation comparing patients with HFpEF vs HFrEF (RR 1.07 95%CI 0.86-1.33, p = 0.15). The most common complications were access site complications/haematoma/bleeding which occurred in similar proportion in each group; HFpEF (3.1%) and HFrEF (3.1%). In terms of repeat ablations, two studies were pooled to yield a rate of 78/455 (17.1%) for HFpEF vs 24/279 (8.6%) for HFrEF (p = 0.001. CONCLUSIONS Heart failure patients with preserved or reduced ejection fraction have similar risk of AF or symptom recurrence after AF ablation but two studies suggest that patients with HFpEF are more likely to have repeat ablations.
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Affiliation(s)
- Gaurav Panchal
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Chun Shing Kwok
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK; School of Medicine, Keele University, Stoke-on-Trent, UK.
| | | | - Donah Zachariah
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Thanh Phan
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
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Bradbury C, Britton I, Morley-Davies A, Balasubramaniam R. What is the impact of CT colonography interpretation by advanced practitioner radiographers on delivery of the 28 day colorectal cancer target? Radiography (Lond) 2021; 27:1130-1134. [PMID: 34176721 DOI: 10.1016/j.radi.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION CT Colonography (CTC) is an indicated test to assess the colon and rectum for evidence of polyps and neoplasms. The advanced practitioner radiographer (APR) is increasingly involved with the entirety of the radiology pathway including procedural modification, preliminary clinical evaluation (PCE) and multi-disciplinary team (MDT) meeting notification of high risk colonic pathologies. METHODS A retrospective audit of the Radiology Information System (RIS) was undertaken at a large secondary care centre, 12 months of data of 119 consecutive patients who had undergone CTC with summary coded reports of high risk pathology were included for analysis. Analysis of accuracy of procedural modification, PCE and impact of hypothesised earlier full radiological staging data being available for MDT discussions were measured and evaluated. RESULTS For high risk C4b studies, just 16.67% of colonic pathology was observed during the CTC study, rising to 79% during radiographer PCE. For likely colonic neoplasm C5a studies 86% of colonic pathology was observed during the CTC study, rising to 93% during radiographer PCE. Where subsequent CT chest staging was deemed necessary following CTC by the referring team, patients had a median wait of 34 days for completion CT chest scan staging. CONCLUSION This study supports the integration of the advanced practitioner radiographer into the entire radiological processes of a CTC, with time advantages apparent for both diagnostics, but also the decision to treat. IMPLICATIONS FOR PRACTICE Appropriately trained radiographers are able to support CTC services to ensure delivery of an effective two-week wait diagnostic service with direct MDT liaison.
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Affiliation(s)
- C Bradbury
- Imaging Department, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom.
| | - I Britton
- Imaging Department, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom.
| | - A Morley-Davies
- Imaging Department, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom.
| | - R Balasubramaniam
- Imaging Department, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom.
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Lachlan T, He H, Sharma K, Khan J, Rajappan K, Morley-Davies A, Patwala A, Randeva H, Osman F. MAGNETO cardiography parameters to predict future Sudden Cardiac Death (MAGNETO-SCD) or ventricular events from implantable cardioverter defibrillators: study protocol, design and rationale. BMJ Open 2020; 10:e038804. [PMID: 33040013 PMCID: PMC7552867 DOI: 10.1136/bmjopen-2020-038804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Predicting sudden cardiac death (SCD) is challenging as current risk predictors have significant limitations. Evaluating magnetocardiogram (MCG) parameters could be of great value and we plan to assess the capability of a new mobile unshielded MCG device in predicting SCD and ventricular arrhythmias (VA) in patients undergoing implantable cardioverter defibrillator (ICD) implantation. METHODS AND ANALYSIS A prospective multicentre (University Hospitals Coventry and Warwickshire (UHCW) National Health Service (NHS) Trust/University Hospital North Midlands NHS Trust, UK) observational study evaluating the VitalScan MCG (Creavo Medical Technologies, UK) to predict future VA risk; 270 patients meeting criteria for primary or secondary prevention ICDs (ischaemic or non-ischaemic aetiology) are being recruited. The first patient was recruited September 2019 and the study will be completed at final participant follow-up. The primary endpoint is appropriate ICD therapy for VA, secondary endpoint is SCD. Previous trials using MCG identified late QRS signals/QRS fragmentation as potential indicators of SCD in small samples using large shielded expensive MCG devices that were difficult to use clinically. It is hoped the MAGNETO-SCD trial will show this new MCG device can provide real world risk stratification for SCD/VA risk. The trial has recruited 25 patients (13 with secondary prevention indication) from a single site (UHCW) with recruitment starting at the second site in March 2020. ETHICS AND DISSEMINATION Research Ethics Committee, Yorkshire and Humber Sheffield Research Ethics Committee UK (Ref: 19/YH/0143) and Health Research Authority (IRAS reference 254466, EDGE ID: 123146) approval received on 17/07/2019. The Medicines and Healthcare products Regulatory Agency approval received 11/07/2019. Results will be disseminated via a peer-reviewed publication and presentation at international conferences. TRIAL REGISTRATION NUMBERS ClinicalTrials.gov Registry (NCT04352816) and EU Clinical Trials Registry (EudraCT2019-002994-78).
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Affiliation(s)
- Thomas Lachlan
- Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Hejie He
- Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Kavi Sharma
- Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jamal Khan
- Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Kim Rajappan
- Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Adrian Morley-Davies
- Cardiology, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | - Ashish Patwala
- Cardiology, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | - Harpal Randeva
- Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Faizel Osman
- Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
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Cosbey L, Naneishvili T, Morley-Davies A, Jones H. Survival into sixth decade after a Potts palliation for Tetralogy of Fallot, complicated by shunt-infective endocarditis and massive pulmonary embolism. BMJ Case Rep 2019; 12:12/4/e229421. [PMID: 31023738 DOI: 10.1136/bcr-2019-229421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Lucy Cosbey
- Radiology Department, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Tamara Naneishvili
- Cardiology Department, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | | | - Hefin Jones
- Radiology Department, Royal Stoke University Hospital, Stoke-on-Trent, UK
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Ooues G, Clift P, Bowater S, Arif S, Epstein A, Prasad N, Adamson D, Cummings M, Spencer C, Woodmansey P, Borley J, Ingram T, Morley-Davies A, Roberts W, Qureshi N, Hawkesford S, Pope N, Anthony J, Gaffey T, Thorne S, Hudsmith L. Patient experience within the adult congenital heart disease outreach network: a questionnaire-based study. J Congenit Heart Dis 2018. [DOI: 10.1186/s40949-018-0020-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Broughton C, Curry S, McGibbon K, Beynon R, Morley-Davies A, Phan T. 67Does non-specialist care mean under treatment with antiarrhythmic drugs and poor DC cardioversion outcome for persistent atrial fibrillation - a single centre study. Europace 2017. [DOI: 10.1093/europace/eux283.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kwok CS, Rashid M, Beynon R, Barker D, Patwala A, Morley-Davies A, Satchithananda D, Nolan J, Myint PK, Buchan I, Loke YK, Mamas MA. Prolonged PR interval, first-degree heart block and adverse cardiovascular outcomes: a systematic review and meta-analysis. Heart 2016; 102:672-80. [DOI: 10.1136/heartjnl-2015-308956] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/08/2016] [Indexed: 11/04/2022] Open
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Kulshrestha R, Morley-Davies A, Willis T. Implantable cardioverter defibrillator for cardiac resynchronisation therapy in Duchenne muscular dystrophy: A case study. Neuromuscul Disord 2015. [DOI: 10.1016/j.nmd.2015.06.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sinnecker D, Dirschinger RJ, Barthel P, Müller A, Morley-Davies A, Hapfelmeier A, Dommasch M, Huster KM, Hasenfuss G, Laugwitz KL, Malik M, Schmidt G. Postextrasystolic blood pressure potentiation predicts poor outcome of cardiac patients. J Am Heart Assoc 2014; 3:e000857. [PMID: 24895163 PMCID: PMC4309081 DOI: 10.1161/jaha.114.000857] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Postextrasystolic blood pressure potentiation (PESP), the pulse wave augmentation after an extrasystolic beat, is typically enhanced in heart failure (HF) patients. This study prospectively tested the association of PESP and mortality in cardiac patients. Methods and Results Consecutive patients (n=941; mean age, 61 years; 19% female) presenting with acute myocardial infarction were enrolled between May 2000 and March 2005 and followed up until August 2010. The main study outcome was 5‐year all‐cause mortality. Patients underwent noninvasive 30‐minute recordings of ECG and continuous blood pressure. PESP presence was based on the ratio between the first postectopic pulse wave amplitude and the mean of the subsequent 9 pulse wave amplitudes. A ratio above 1 was prospectively defined as PESP present. Ventricular premature complexes (VPCs) suitable for PESP quantification were present in recordings of 220 patients. PESP was present in 62 of these patients. Patients without suitable VPCs were classified as PESP absent. During the follow‐up, 72 patients died. Among the 220 patients in whom PESP was measurable, 27 died. Under univariable analysis, PESP was a significant predictor of death (P<0.001) as were GRACE score (P<0.001), left ventricular ejection fraction (LVEF) (P<0.001), and the number of recorded VPCs (P<0.001). Under multivariable analysis, PESP (P<0.001), GRACE score (P<0.001), and LVEF (P=0.001) were independently associated with outcome. The combination of PESP presence and LVEF ≤35% identified a subgroup of patients with a particularly high mortality of 46.7%. Separate validation reproduced the finding in an unrelated population of 146 HF patients. Conclusions PESP, which likely reflects abnormalities of myocardial calcium cycling, predicts the mortality risk in postinfarction patients. Clinical Trial Registration URL: ClinicalTrials.gov. Unique identifier: NCT00196274.
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Affiliation(s)
- Daniel Sinnecker
- Medizinische Klinik und Deutsches Herzzentrum, München der Technischen Universität München, Munich, Germany (D.S., R.J.D., P.B., A., M.D., K.M.H., K.L.L., G.S.)
| | - Ralf J Dirschinger
- Medizinische Klinik und Deutsches Herzzentrum, München der Technischen Universität München, Munich, Germany (D.S., R.J.D., P.B., A., M.D., K.M.H., K.L.L., G.S.)
| | - Petra Barthel
- Medizinische Klinik und Deutsches Herzzentrum, München der Technischen Universität München, Munich, Germany (D.S., R.J.D., P.B., A., M.D., K.M.H., K.L.L., G.S.)
| | - Alexander Müller
- Medizinische Klinik und Deutsches Herzzentrum, München der Technischen Universität München, Munich, Germany (D.S., R.J.D., P.B., A., M.D., K.M.H., K.L.L., G.S.)
| | - Adrian Morley-Davies
- Department of Cardiology, University Hospital of North Staffordshire, NHS Trust, City General Hospital, Staffordshire, UK (A.M.D.)
| | - Alexander Hapfelmeier
- Institut für Medizinische Statistik und Epidemiologie der Technischen, Universität München, Munich, Germany (A.H.)
| | - Michael Dommasch
- Medizinische Klinik und Deutsches Herzzentrum, München der Technischen Universität München, Munich, Germany (D.S., R.J.D., P.B., A., M.D., K.M.H., K.L.L., G.S.)
| | - Katharina M Huster
- Medizinische Klinik und Deutsches Herzzentrum, München der Technischen Universität München, Munich, Germany (D.S., R.J.D., P.B., A., M.D., K.M.H., K.L.L., G.S.)
| | - Gerd Hasenfuss
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany (G.H.)
| | - Karl-Ludwig Laugwitz
- Medizinische Klinik und Deutsches Herzzentrum, München der Technischen Universität München, Munich, Germany (D.S., R.J.D., P.B., A., M.D., K.M.H., K.L.L., G.S.) DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany (K.L.L., G.S.)
| | - Marek Malik
- St. Paul's Cardiac Electrophysiology, University of London and Imperial College, London, UK (M.M.)
| | - Georg Schmidt
- Medizinische Klinik und Deutsches Herzzentrum, München der Technischen Universität München, Munich, Germany (D.S., R.J.D., P.B., A., M.D., K.M.H., K.L.L., G.S.) DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany (K.L.L., G.S.)
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Broughton C, Murray A, Morley-Davies A, Satchithananda DK, Hookey C. Experience of tolvaptan on patients with end stage heart failure. BMJ Support Palliat Care 2012. [DOI: 10.1136/bmjspcare-2012-000196.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Osman F, Krishnamoorthy S, Nadir A, Mullin P, Morley-Davies A, Creamer J. Safety and cost-effectiveness of same day permanent pacemaker implantation. Am J Cardiol 2010; 106:383-5. [PMID: 20643250 DOI: 10.1016/j.amjcard.2010.03.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 03/17/2010] [Accepted: 03/17/2010] [Indexed: 10/19/2022]
Abstract
An overnight stay after permanent pacemaker implantation has major cost implications for healthcare systems. Same day pacing could be effective in alleviating this. We evaluated our elective same day pacing practice to determine safety and cost-effectiveness. A total of 780 patients were scheduled for elective new permanent pacemaker implantation as a same day procedure at the University Hospital, North Staffordshire, from April 2001 to December 2006. The mean age +/- SEM of the cohort was 73.8 +/- 0.4 years (464 men and 316 women). Single-chamber devices were implanted in 272 (27 atrial and 245 ventricular) and dual chamber in 508 patients. Vascular access was by the subclavian vein in 431 patients and the cephalic vein in 349. Preimplant intravenous antibiotics were administered to 28% and perioperative antibiotics to the remainder; all patients received oral antibiotics after implantation. Of the 780 patients, 41 (5.3%) required an in-hospital stay after implantation because of hematoma formation in 12, pneumothorax in 3, social reasons for 7, observation at the physicians request but no complication for 13, angina in 3, arrhythmia in 1, and warfarin therapy in 2. Immediate complications (<24 hours) occurred in 6 patients and early complications (>24 hours to 6 weeks) developed in 17. Of the 780 patients, 94 had died at mean follow-up of 2.4 +/- 0.1 years; none were related to pacemaker implantation. An overnight stay at our hospital costs pound203.60 ( approximately US$305). From November 2005 to November 2006, 109 patients underwent same day implantation, resulting in a cost saving of pound22,192.40 ( approximately US$34,500). In conclusion, same day permanent pacemaker implantation was feasible, safe, and cost-effective. It was associated with a low prevalence of complications and only a few patients required an overnight stay.
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16
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Osman F, Ratib K, Krishnamoorthy S, Nadir A, Creamer J, Morley-Davies A. Temporary pacing wire in the coronary sinus: a novel treatment of acute heart failure? Europace 2008; 10:877-9. [PMID: 18420649 DOI: 10.1093/europace/eun102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Treatment of acute heart failure relies initially on medical therapy. Patients can be considered for cardiac resynchronization therapy once they are able to lie flat for several hours. However, placement of a temporary pacing wire (TPW) into the coronary sinus may allow the patient to receive resynchronization therapy in the acute phase. We report a case of a patient who had a dramatic improvement of symptoms and blood pressure after a TPW was placed in the coronary sinus.
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Affiliation(s)
- Faizel Osman
- Department of Cardiology, University Hospital of North Staffordshire NHS Trust, City General Hospital, Newcastle Road, Stoke-on-Trent, Staffordshire ST4 6QG, UK.
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Osman F, Ward R, Morley-Davies A. Simultaneous spontaneous onset of ventricular tachycardia and termination of atrial fibrillation. Europace 2008; 10:171-2. [DOI: 10.1093/europace/eum294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Abstract
A 69-year-old man with previous myocardial infarction and proximal three-vessel coronary artery disease underwent coronary bypass grafting, with an epicardial lead placed on the lateral left ventricular wall during surgery. A cardiac resynchronization therapy-defibrillator (CRT-D) device was subsequently implanted using active right atrial and right ventricular leads, with the pulse generator placed in a pre-pectoral pocket. Four weeks later, the right atrial lead was failing to sense or capture, and chest X-ray revealed it had pulled out of the myocardium and coiled up behind the device; a diagnosis of Twiddler's syndrome was made. Twiddler's syndrome is unusual in patients with CRT-D devices and may cause symptoms such as inappropriate shocks and hiccups. Placement of the pulse generator in a sub-pectoral position may help prevent it.
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Affiliation(s)
- Faizel Osman
- Department of Cardiology, City General Hospital, University Hospital of North Staffordshire NHS Trust, Newcastle Road, Stoke on Trent ST4 6QG, UK.
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19
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Bauer A, Barthel P, Schneider R, Watanabe MA, Morley-Davies A, Schmidt G. P3-42. Heart Rhythm 2006. [DOI: 10.1016/j.hrthm.2006.02.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Schulte-Frohlinde V, Ashkenazy Y, Goldberger AL, Ivanov PC, Costa M, Morley-Davies A, Stanley HE, Glass L. Complex patterns of abnormal heartbeats. Phys Rev E Stat Nonlin Soft Matter Phys 2002; 66:031901. [PMID: 12366146 DOI: 10.1103/physreve.66.031901] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2002] [Indexed: 11/07/2022]
Abstract
Individuals having frequent abnormal heartbeats interspersed with normal heartbeats may be at an increased risk of sudden cardiac death. However, mechanistic understanding of such cardiac arrhythmias is limited. We present a visual and qualitative method to display statistical properties of abnormal heartbeats. We introduce dynamical "heartprints" which reveal characteristic patterns in long clinical records encompassing approximately 10(5) heartbeats and may provide information about underlying mechanisms. We test if these dynamics can be reproduced by model simulations in which abnormal heartbeats are generated (i) randomly, (ii) at a fixed time interval following a preceding normal heartbeat, or (iii) by an independent oscillator that may or may not interact with the normal heartbeat. We compare the results of these three models and test their limitations to comprehensively simulate the statistical features of selected clinical records. This work introduces methods that can be used to test mathematical models of arrhythmogenesis and to develop a new understanding of underlying electrophysiologic mechanisms of cardiac arrhythmia.
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Affiliation(s)
- Verena Schulte-Frohlinde
- Center for Polymer Studies, Department of Physics, Boston University, Boston, Massachusetts 02215, USA.
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Goodfield NE, Morley-Davies A, Bloomfield P. Strut fracture of the Convexo-Concave Björk-Shiley mitral valve prosthesis. Heart 1995; 73:391. [PMID: 7756078 PMCID: PMC483838 DOI: 10.1136/hrt.73.4.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Abstract
Wegener's granulomatosis is a systemic inflammatory disorder of unknown aetiology. The protean clinical presentations depend on the organ(s) involved and the degree of progression from a local to a systemic arteritis. The development of serological tests (antieutrophil cytoplasmic antibodies) allows easier diagnosis of a disease whose incidence is increasing. This is particularly helpful where the presentation is not classic--for example "overlap syndromes"--or where the disease presents early in a more localised form. This is true of cardiac involvement, which is traditionally believed to be rare, but may not be as uncommon as has hitherto been thought (< or = 44%). This involvement may be subclinical or the principal source of symptoms either in the form of localised disease or as part of a systemic illness. Pericarditis, arteritis, myocarditis, valvulitis, and arrhythmias are all recognised. Wegener's granulomatosis should therefore be considered in the differential diagnosis of any non-specific illness with cardiac involvement. This includes culture negative endocarditis, because Wegener's granulomatosis can produce systemic upset with mass lesions and vasculitis. Echocardiography and particularly transoesophageal echocardiography can easily identify and delineate cardiac and proximal aortic involvement and may also be used to assess response to treatment.
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Affiliation(s)
- N E Goodfield
- Department of Cardiology, Royal Infirmary, Edinburgh
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