• NICE- Atrial Fibrillation Guidelines
    Expert Opinion by: Dr Steve Furniss, Consultant Cardiologist, East Sussex Healthcare Trust
  • Outcomes of mitral surgery after transcatheter edge-to-edge mitral repair – Analysis from Society of Thoracic Surgeons database
    By Chikwe J, O’Gara P, Fremes S et al Transcatheter edge-to-edge (TEER) mitral repair may be complicated by residual or recurrent mitral regurgitation. An increasing need for surgical reintervention has been reported, but operative outcomes are ill defined. This study evaluated national outcomes of mitral surgery after TEER. The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database was used to identify 524 adults who underwent mitral surgery after TEER between July 2014 and June 2020. Emergencies, previous mitral surgery, or open implantation of transcatheter…
  • Diagnostic pathways in myocardial infarction with non-obstructive coronary artery disease (MINOCA)
    By Giovanni Occhipinti, Chiara Bucciarelli-Ducci & Davide Capodanno When acute myocardial injury is found in a clinical setting suggestive of myocardial ischaemia, the event is labelled as acute myocardial infarction, and the absence of coronary stenosis angiographically 50% or greater leads to the working diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA). The initial diagnosis of MINOCA can be confirmed or ruled out based on the results of subsequent investigations. This review appraises strengths and limitations of invasive and non-invasive investigations for this condition.…
  • Real-world performance and accuracy of stress echocardiography: the EVAREST observational multi-centre study
    By Saadia Aslam The EVAREST (prospective, observational) study provides UK-wide data to evaluate real-world performance and accuracy of stress echocardiography in patients with obstructive coronary artery disease. Participants undergoing stress echocardiography for CAD were recruited from 31 hospitals. They were followed up through health records which underwent expert adjudication. Cardiac outcome was defined as anatomically or functionally significant stenosis on angiography, revascularization, medical management of ischaemia, acute coronary syndrome, or cardiac-related death within 6 months. A total of 5131 patients (55% male) participated with a…
  • Digital solutions to identify worsening heart failure: TRIAGEHF PLUS
    By Ahmed El-Medany Presented by: Dr Fozia Ahmed, Consultant Cardiologist, Manchester Heart Centre The Digital Innovation in Cardiology session at BCS 2021 was a fascinating and inspiring insight into the technology available in various areas of Cardiology and covered exciting digital prospects for the future. Dr. Ahmed discussed TRIAGEHF PLUS, a risk-based digital heart failure (HF) care pathway, designed to help optimise the care of HF patients with implanted devices. There are currently around 920,000 individuals with HF in the UK, with approximately 200,000 new…
  • Efpeglenatide, a novel GLP-1 receptor agonist, reduces cardiovascular events and progression of chronic renal failure in type 2 diabetes
    By Ahmed El-Medany Weekly subcutaneous injections of efpeglenatide, a novel exendin-based GLP1-RA, have been shown to reduce the risk of major adverse cardiovascular events (MACE) by and chronic kidney disease progression by, compared with placebo, for high-risk adults with type 2 diabetes. In a randomised, placebo-controlled trial by Gerstein et al (2021), a total of 4,076 participants were enrolled, and randomly assigned in a 1:1:1 ratio to receive weekly injections of efpeglanatide at 4mg, 6mg, or placebo. During a median follow-up of 1.81 years, an…
  • Myocarditis recognised rare adverse association with COVID-19 vaccine
    By Ahmed El-Medany In a case series of 23 male patients, by Montgomery et al (2021), myocarditis was identified within 4 days of administration of a COVID-19 vaccine. 20 out of 23 of these patients received a diagnosis of myocarditis following their second dose of mRNA COVID-19 vaccine. It is important to note that these episodes occurred against a backdrop of 2.8 million delivered doses of mRNA COVID-19 vaccine in the United States. Furthermore, a case series by Rosner et al (2021) in Circulation, as…
  • The ECHOES cardiovascular digital twin: the brain assist device needed to make sense of data overload?
    By Ahmed El-Medany Presented by Prof Tim Chico, Honorary Consultant Cardiologist and Professor of Cardiovascular medicine, University of Sheffield. The Digital Innovation in Cardiology session at BCS 2021 was a fascinating and inspiring insight into the technology available in various areas of Cardiology and covered exciting digital prospects for the future. Prof Chico ended the session by talking about an exciting project looking at streamlining and simplifying the abundance of data presented to us in our day-to-day clinical work. ‘ECHOES is built on the premise…
  • Artificial Intelligence, precision phenotyping and risk prediction in cardiomyopathy
    By Ahmed El-Medany Presented by Prof O’Regan, MRC Investigator and Consultant Radiologist, Imperial College London The Digital Innovation in Cardiology session at BCS 2021 was a fascinating and inspiring insight into the technology available in various areas of Cardiology and covered exciting digital prospects for the future. Prof O’Regan discussed Artificial Intelligence’s (AI) role in cardiovascular imaging; particularly when integrating imaging and non-imaging data, understanding new mechanisms of heart disease, and early diagnosis and risk prediction. The speaker demonstrated some excellent examples of 3D segmentation…
  • Women in Cardiology: Building a Healthy Culture
    Highlights from the BCS 2021 Virtual Conference By Saadia Aslam Speakers: Dr Derek and Emma Harrington: Cardiology through my daughter’s eyesDr Rebecca Dobson: Back to the futureDr Dipti Itchaporia: Leading a team and maintaining clinician well-being  An excellent and insightful session which highlighted the potential causes of lack of recruitment of women to the field of cardiology, the current initiatives that are being undertaken by the BCS Women in Cardiology group and finally, how to lead a team whilst ensuring clinician well-being. The first talk highlighted…
  • Prevalence of coronary artery disease and coronary microvascular dysfunction is high in in patients with HFpEF
    Taken directly from JAMA Network In a prospective, multi-center cohort study, 106 consecutive participants with preserved ejection fraction were evaluated with coronary angiography, invasive coronary physiologic and vasoreactivity testing, and cardiac magnetic resonance imaging. A total of 51% of the study participants had obstructive epicardial coronary artery disease, 66% had endothelium-independent coronary microvascular dysfunction, and 24% had endothelium-dependent coronary microvascular dysfunction. The findings of this study suggest that obstructive epicardial coronary artery disease and coronary microvascular dysfunction are common and often unrecognised in hospitalised patients…
  • Pregnancy during cardiology training: a call to action
    By Saadia Aslam In the UK, 28% of cardiology trainees and 13% of cardiology consultants are women. A recent article published in the “Heart” highlights the issues and concerns faced by the pregnant cardiologist such as: the impact of fertility treatment, pregnancy symptoms, radiation exposure during pregnancy, shift work, securing maternity leave and childcare. The pregnant cardiologist may feel isolated and unsupported due to the limited number of female cardiologists in the field. Furthermore, education of radiation exposure is consistent and resources are lacking. These…
  • Prevalence of LA thrombus despite guideline directed anticoagulation – results from a meta-analysis
    Taken directly from the American College of Cardiology A summary by Sarah Kohnstamm, MD, FACC Quick Takes This meta-analysis set out to answer the prevalence of LA thrombus in patients with atrial fibrillation or flutter on guideline-directed anticoagulation. It further identified higher-risk populations in whom the diagnostic yield of a pre-procedure TEE would be beneficial. The overall prevalence of LA thrombus in patients with atrial fibrillation or flutter, receiving a minimum of 3 weeks of uninterrupted anticoagulation, was approximately 3%. The prevalence of LA thrombus was…
  • Can artificial intelligence guide novice operators to obtain echocardiographic scans with limited diagnostic utility?
    By A. Narang et al In this prospective, multi-centre diagnostic study by Narang et al, a cohort of 8 nurses without prior ultrasonography experience used artificial intelligence guidance to scan 30 patients each with a 10-view echocardiographic protocol (240 total patients). Five expert echocardiographers blindly reviewed these scans and felt they were of diagnostic quality for left ventricular size and function in 98.8% of patients, right ventricular size in 92.5%, and presence of pericardial effusion in 98.8%. Artificial intelligence can extend the reach of echocardiography…
  • Impact of wearable devices on clinical outcomes and health care utilisation in AF patients
    Summary taken directly from the American College of Cardiology  Quick Takes Patients with AF who use wearable devices for detection of AF are more than twice as likely to undergo an ablation procedure as comparable patients who do not use a wearable device. There is no evidence that use of wearable devices improves heart rate control in patients with AF. Younger patients are overall more likely to use wearable devices than older patients. Read more:https://www.acc.org/latest-in-cardiology/journal-scans/2021/06/02/18/10/wearable-devices-and-health-care-useFull article: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2780408 Reference: Wang L, Nielsen K, Goldberg J, Brown JR, Rumsfeld…
  • Reversal agents for DOACs – a recent meta-analysis
    By Saadia Aslam Major bleeding that requires hospitalisation occurs in 2% to 3.5% of patients that take DOACs. Some of these patients may require reversal agents to control bleeding. Recent work from Gómez-Outes et al evaluated clinical outcomes associated with the use of 4-factor prothrombin complex concentrates, idarucizumab, or andexanet in this setting.This evaluation included 60 studies in 4,735 patients with severe DOAC-related bleeding who were treated with 4-factor prothrombin complex concentrates (n = 2,688), idarucizumab (n = 1,111), or andexanet (n = 936). Mortality…
  • British Society of CMR survey reveals high levels of regional variation and poor equity in access to CMR
    By Ahmed El-Medany Cardiovascular magnetic resonance (CMR) is widely available and established in the United Kingdom (UK) with high scan volumes by international standards. The British Society for CMR periodically surveyed all UK CMR units, starting in 2008. An electronic survey was sent to the service leads of all CMR units in the UK in 2019, requesting data from 2017 and 2018. Responses were then analysed and interpreted by region alongside population statistics.The survey response rate was 100% from 82 units across the nation. 11,967…
  • Cardiologist Burnout to Clinical Wellness: A mountain to climb but a roadmap to follow
    By Guy Lloyd In one of the standout session during BCS 2021, the enormous problem of cardiologist burnout, its causes and consequences as well as potential strategies to address the issue were discussed. In the concluding remarks it was noted that none of the panellists (which included the Presidents of the British Cardiovascular Society (BCS) and Irish Cardiac Society (ICS), the current and past presidents of to American College of Cardiology (ACC) and the Director of Health and Wellbeing for the RCPI) could imagine such…
  • In VICTORIA, elevated baseline troponin associated with cardiovascular mortality and heart failure hospitilisation
    By Ahmed El-Medany Elevated baseline high-sensitivity cardiac troponin T was associated with increased risk for CV death and heart failure (HF) hospitalisation in patients from the VICTORIA trial, according to a presentation at the American College of Cardiology Scientific Session. The VICTORIA trial (Armstrong et al, 2020) assessed the effect of vericiguat (a novel oral soluble guanylate cyclase stimulator) in recently hospitalised patients with heart failure and reduced ejection fraction. Among the 4,614 participants from VICTORIA for whom baseline cardiac troponin T levels were available,…
  • Intensive lipid therapy in preventive cardiology: a summary of the latest ESC/EAS recommendations
    By Ahmed El-Medany Guidelines for the management of dyslipidaemia from the ESC and the EAS were updated in late 2019. With the advent of combination therapy using ezetimibe and/or proprotein convertase subtilisin/kexin type 9 inhibitors in addition to statins, the routine attainment of extremely low LDL-C levels in the clinic has become a reality. This helpful and thorough review by Packard et al discusses the evidence that led to the most aggressive goals yet for LDL-C lowering, and explores a case-based interpretation of the practicality…
  • Can the consent process be improved using animation?
    Video update: 8 June 2021. Article originally published 7 May 2021. Patient understanding of angiography and angioplasty is often incomplete at the time of consent. Language barriers and time constraints are significant obstacles, particularly in the urgent setting.  Multi-language animations explaining angiography and angioplasty were introduced at nine district hospitals for patients with acute coronary syndrome before urgent transfer to a cardiac centre for their procedure.  Reported understanding of the reason for transfer, the procedure, its benefits and risks in 100 consecutive patients were recorded…
  • HOLIDAY Monitors: Alcohol Consumption Significantly Increases Risk of AFib Episode
    Taken directly from the American College of Cardiology One glass of wine, beer or other alcoholic beverage may significantly increase the risk of an atrial fibrillation (AFib) episode within the next four hours, according to results of the HOLIDAY Monitors study presented May 17 during ACC.21. The study, led by Gregory M. Marcus, MD, FACC, looked at alcohol consumption and AFib episodes in 100 patients with paroxysmal or intermittent AFib who consumed at least one alcoholic beverage per month. All participants wore an electrocardiogram (ECG)…
  • Are ethnicity-specific BMI cutoffs now needed for type 2 diabetes risk in England?
    By Saadia Aslam A study by Caleyachetty et al has prospectively identified ethnicity-specific BMI cutoffs for obesity based on the risk of type 2 diabetes that are risk-equivalent to the BMI cutoff for obesity among White populations (≥30 kg/m2). Research in context: (directly taken from the paper) Evidence before this study WHO and the National Institute for Health and Care Excellence (NICE) in England both recommend a BMI cutoff of 27·5 kg/m2 to trigger action to reduce the risk of obesity-related conditions, such as type…
  • When detecting heart murmurs, has Artificial Intelligence surpassed the Consultant Cardiologist?
    A study by Chorba et al investigate Deep learning approaches in detect heart murmurs and clinically significant valvular heart disease, using recording from digital stethoscopes. A deep neural network was trained using 34 hours of previously recorded and annotated heart sounds. 962 participants were then enrolled, and recording collected at 4 primary auscultation locations. Digital algorithm sensitivity was analysed by comparing results to patient echocardiograms and annotations by 3 expert Cardiologists. Sensitivity and specificity of the algorithm for detecting murmurs was 76.3% and 91.4%, respectively.…
  • COVID-19 and Cardiology ARCP outcomes: a summary for trainers and trainees
    By Ahmed El-Medany Disruption to training due to the COVID-19 pandemic has led to difficulties for some trainees in acquiring the competencies required to progress, or complete, their training. However, where the acquisition of competencies has been delayed due to COVID-19 and there are no serious concerns about the trainee, one of the two new ARCP outcomes, Outcome 10.1 or Outcome 10.2 have been suggested by the Statutory Education Bodies (SEBs) of the 4 Nations. The aim of introducing these new ARCP outcomes has been…
  • The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030
    By Dr Rebecca Dobson, BCS Women in Cardiology Lead and Consultant Cardiologist at the Liverpool Heart and Chest Hospital A bold and ambitious statement from an international team of experts and leaders makes welcome reading in the Lancet this week. In the first-ever global report on cardiovascular disease in women, the Commission aims to reduce the global burden of cardiovascular disease in women by 2030. Cardiovascular disease is the leading cause of death in women, which despite a global decline in prevalence, is on the…
  • Getting the best from the Heart Team: Guidance for the structure and function of cardiac multidisciplinary meetings
    Today the British Cardiovascular Society, together with the Association for Cardiothoracic Anaesthesia and Critical Care, the British Cardiovascular Intervention Society, the British Heart Valve Society and the Society for Cardiothoracic Surgery published a guidance document on the structure and function of cardiac multidisciplinary meetings (MDMs). The purpose of Getting the best from the Heart Team: Guidance for the structure and function of cardiac multidisciplinary meetings is to update the existing joint British Societies recommendations published in 2015 to reflect changes in practice. The documents aim is…
  • MITRAL Trial Valve-in-Valve Arm 1-Year Outcomes
    Summary taken directly from the American College of CardiologyWritten by: Debabrata Mukherjee, MD, FACC Quick Takes Transseptal MViV in selected patients at high surgical risk was associated with a 100% technical success rate, a low complication rate, and a low mortality rate (3.3%) at 1 year. Based on these preliminary data, transseptal MViV may be considered for selected high-risk patients with degenerated mitral bioprosthesis who have favorable anatomy. Additional prospective randomized controlled studies are needed to validate these results and to assess the durability of…
  • NICE publishes updated clinical guideline on the diagnosis and management of atrial fibrillation
    Key changes: Bleeding risk scoreNew NICE guideline recommends using the ORBIT bleeding risk score but equally recognises that existing bleeding risk scores may still be used as they are embedded in clinical pathways and electronic systems.  AnticoagulationDOACs are preferred in patients with atrial fibrillation and a CHA2DS2‑VASc score of 2 or above. Apixaban, dabigatran, edoxaban and rivaroxaban are all recommended as options. However if these are contra-indicated or not tolerated then vitamin K antagonist (VKA) should be offered. However, if patients are established on treatment with…
  • Air pollution tied to hypertension in children and adolescents
    By Ahmed El-Medany A meta-analysis by Huang et al has suggests exposure to short- and long-term air pollution in childhood and adolescence increases the likelihood of hypertension later in life.14 studies (351,766 participants) were analysed, with a mean age of 5.4-12.7 years. studies were divided into groups by composition of air pollutants (NO2, particulate matter (PM) with diameter ≤10 μm or ≤2.5 μm) and length of exposure. The beta regression coefficients (β) and their 95% confidence intervals (Cis) were calculated to evaluate the strength of…
  • STEMI after TAVR associated with poorer outcomes.
    By Ahmed El-Medany Longer door-to-balloon times and higher percutaneous coronary intervention (PCI) failure rate were observed in a multicentre study by Faroux et al. 118 patients presenting with STEMI following transcutaneous aortic valve replacement (TAVR) were analysed and compared to 439 ‘non-TAVR’ STEMI patients. Results suggested that median door-to-balloon time was 40 minutes in the TAVR group (IQR, 25-57) and 30 minutes in the non-TAVR group (IQR, 25-30; P = .003). A door-to-balloon time of 60 minutes or more occurred in 20.8% of the TAVR…
  • Greater adverse outcomes in patients presenting with COVID-19 and STEMI
    Outcomes from the North American COVID-19 STEMI registry The goal of the NACMI (North American COVID-19 and STEMI) registry is to describe demographic characteristics, management strategies, and outcomes of COVID-19 patients with STEMI. MethodsA prospective, ongoing observational registry was created under the guidance of 3 cardiology societies.  Group 1: STEMI patients with confirmed COVID+Group 2: suspected COVID-19 infectionGroup 3: Control group that was age- and sex-matched STEMI patients (matched to COVID+ patients in a 2:1 ratio) treated in the pre-COVID era (2015 to 2019)  The…
  • Conference update from Society for Cardiovascular Angiography and Interventions (SCAI) 2021 Scientific Sessions
    The National Cardiogenic Shock Initiative is a single-arm, prospective, multi-center study assessing outcomes associated with early mechanical circulatory support (MCS) in patients presenting with acute myocardial infarction and cardiogenic shock (AMICS) treated with percutaneous coronary intervention (PCI).
  • Techniques to Decrease PPM Implantation Rates Post-TAVR
    Kris Kumar, DO; Firas E. Zahr, MD, FACC; Harsh Golwala, MDExpert Analysis (from the ACC) Quick Takes: Decreasing the degree that the transcatheter heart valve (THV) is within the left ventricular outflow tract (LVOT) can help diminish forces on the conduction apparatus and atrioventricular node, leading to lower rates of conduction abnormalities and permanent pacemaker (PPM) implantation. Understanding the anatomical considerations as well as the angiographic projections necessary to achieve a reduction in parallax and valve deployment aligned with the radiolucent line in the right anterior oblique-caudal…
  • Warfarin and DOACs show similar safety and efficacy in left ventricular thrombus
    By Ahmed El-Medany A meta-analysis by Xuan et al, evaluated the safety and efficacy of direct oral anticoagulants (DOACs) versus warfarin in patients with left ventricular thrombus (LVT). A total of 6 studies (837 patients; mean age 60.2 ± 1.6 years; 77.2% male) were included. There was no significant difference found with regards to thromboembolic events (relative risk [RR] 1.69, 95% confidence interval [CI] 0.94–3.06, P 0.08, heterogeneity (I2) 12.7%), rate of resolution of thrombus (RR 1.08, 95% CI 0.96–1.21, P 0.21, I2 4.8%), and…
  • Pharmacist-led hypertension care in Black barbershops – a cost-effective way to improve blood pressure control and reduce health inequities?
    By Ahmed El-Medany In the Los Angeles Barbershop Blood Pressure Study (LABBPS), pharmacist-led hypertension care in Black-owned barbershops significantly improved blood pressure (BP) control in non-Hispanic Black men with poorly controlled hypertension at baseline. In this analysis, Bryant et al conducted a 10-year event simulation that predicted BP, medication-related adverse events, fatal and nonfatal CVD events, and non-CVD death among study participants. The researchers estimated program costs, health care costs, and quality-adjusted life-years (QALYs). Simulation analysis showed that the barbershop intervention was highly cost-effective, with…
  • Depression associated with increased risk of heart failure events and sudden cardiac death in hypertrophic cardiomyopathy
    Hu et al sought to investigate the impact of depression on clinical outcomes in individuals with hypertrophic cardiomyopathy (HCM)
  • Inflammatory biomarkers linked with heart failure hospitalisation in atrial fibrillation
    By Ahmed El-Medany Among atrial fibrillation (AF) patients, inflammatory markers strongly predict heart failure (HF) hospitilisation. Benz et al analysed 3,784 individuals with AF (median follow-up 4 years). High-sensitivity c-reactive protein (hs-CRP) and interleukin-6 (IL-6) were measured at baseline. The authors state, ‘We calculated an inflammation score ranging from 0 to 4 (1 point for each biomarker between the 50th and 75th percentile, 2 points for each biomarker above the 75th percentile)’. After multivariable adjustment, both biomarkers were significantly associated with risk of HF hospitalisation…
  • Atrial fibrillation increases beat-to-beat variability of cerebral microcirculatory perfusion – a potential target for reducing long-term cognitive decline?
    By Ahmed El-Medany This pioneering in vivo study by Saglietto et al investigated beat-to-beat microcirculatory perfusion during atrial fibrillation (AF) by using near-infrared spectroscopy to non-invasively monitor cerebral haemodynamics. A proxy of microcirculatory cerebral perfusion was compared before and after restoration of AF to sinus rhythm following DC cardioversion (DCCV). DCCV was successful in restoring SR in 51 (96%) of 53 enrolled participants. A significant decrease of both hypoperfusive and hyperperfusive/hypertensive microcirculatory events was observed after restoration to sinus rhythm (P < 0.001 and P = 0.041, respectively). As…
  • Clinical Outcomes When a Stroke Thrombectomy Program Is Started in an Experienced Cardiology Cath Lab
    By Saadia Aslam Mechanical thrombectomy has proven to be the best treatment option for ischemic stroke patients, but it is not widely available. When a catheter-based thrombectomy program was initiated in an experienced cardiac cath lab in close cooperation between cardiologists, neurologists, and radiologists, outcomes were comparable to those of neuroradiology centers. The desired clinical results were achieved from the onset of the program, without any signs of a learning curve effect. These findings support the potential role of interventional cardiac cath labs in the…
  • Medical therapy comparable to intervention in spontaneous coronary artery dissection (SCAD)
    By Ahmed El-Medany A meta-analysis by Krittanawong et al found no significant difference to long-term risk of death, recurrent myocardial infarction (MI) and SCAD, and repeat revascularisation. The researchers stated that high-risk patients, including those with hemodynamic instability, persistent and worsening signs of myocardial ischemia, and shock or malignant ventricular arrythmias, may benefit from invasive therapy in cases in which no other options were available.In the study population of 1,369 patients, with a mean age of 49 years, 82% were women, 860 were treated with…
  • Physical activity reduces cardiovascular risk and all-cause mortality if performed during leisure time, not working hours
    By Ahmed El-Medany The contemporary Copenhagen General Population Study recently published their findings in the European Heart Journal. This large study, which was established in 2003-2014, tested the hypothesis that leisure time physical activity correlated with reduced major adverse cardiovascular events (MACE) and all-cause mortality risk, while occupational physical activity related to increased risks. Holtermann et al studied 104,046 individuals over a median 10-year follow-up. Higher self-reported leisure time physical activity was found to be associated with reduced MACE and all-cause mortality risk, while higher…
  • DOACs vs. warfarin in valvular atrial fibrillation
    By Ahmed El-Medany A retrospective cohort study by Dawwas et al reports that DOACs, compared with warfarin, were associated with lower risks for ischemic stroke or systemic embolism, and major bleeding events, in patients with valvular AF. Among 56,336 patients with valvular AF matched on propensity score, use of DOACs was associated with lower risk for ischemic stroke or systemic embolism (hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.59-0.70) and major bleeding events (HR, 0.67; 95% CI, 0.63-0.72). The results for the effectiveness and…
  • Lamotrigine may be associated with increased risk of cardiac arrhythmias, FDA warns
    By Saadia Aslam An FDA review of study findings showed a potential increased risk of cardiac arrhythmias in patients with pre-existing cardiac disease who are taking lamotrigine. FDA reviewed in vitro studies of lamotrigine after receiving reports of abnormal electrocardiographic findings, chest pain, loss of consciousness and cardiac arrest. This information was first added to the lamotrigine prescribing information and Medication Guides in October 2020, which has been updated. Patients have been advised to not stop taking their medications without a medical review first. However, if they experience any palpitations, dyspnoea or…
  • Beyond Diabetes: The Impact of Empagliflozin in Heart Failure with Reduced Ejection Fraction
    (Taken from Expert Analysis- ACC) This secondary analysis from the EMPEROR-Reduced trial shows that use of empagliflozin reduces the risk of CV death or HF hospitalization, as well as worsening renal function, across the glycemic spectrum in those with HF with reduced ejection fraction. This study, in addition to a previous one with dapagliflozin, confirms a benefit of SLGT2is in patients with HF with reduced ejection fraction regardless of diabetes status. Table 1: Effect of SGLTis in DAPA-HF and EMPEROR-Reduced is consistent in those with…
  • Recreational substances associated with a higher likelihood of premature atherosclerotic cardiovascular disease
    By Saadia Aslam Despite an upsurge in the incidence of atherosclerotic cardiovascular diseases (ASCVD) among young adults, the attributable risk of recreational substance use among young patients has been incompletely evaluated. In a cross-sectional analysis using the 2014–2015 nationwide Veterans Affairs Healthcare database and the Veterans with premature AtheroscLerosis (VITAL) registry, patients were categorised as having premature, extremely premature or non-premature ASCVD. Premature ASCVD was defined as having first ASCVD event at age <55 years for men and <65 years for women. Extremely premature was…
  • Underrepresentation of black participants in key Cardiology trials
    By Ahmed El-Medany In contrast to their prevalence in the overall disease population, Black individuals were considerably underrepresented in trials that affirmed the United States’ Food and Drug Administration’s (FDA) approval of 24 CVD treatments, researchers reported.A cross-sectional study by Chen and Li evaluated the representation status of Black and White Americans in clinical drug trials by calculating the participation to prevalence ratio (PPR). PPR <0.8 or >1.2 were defined as either underrepresentation or overrepresentation of a particular ethnic group, respectively. Total enrolment across all…
  • ACC and AHA release key data elements and definitions for heart failure
    By Ahmed El-Medany On 23 March, the American College of (ACC) and American Heart Association (AHA) released the 2021 ACC/AHA Key Data Elements and Definitions for Heart Failure in the Journal of the American College of Cardiology. This new document, led by writing committee co-chairs Bozkurt and Hershberger, supersedes the previous 2005 clinical standards, and includes data elements for heart failure (HF) risk factors, cardiovascular history, and non-cardiovascular health determinants, including COVID-19 infection. Other highlights include an updated patient assessment with more detailed elements for…
  • Application of Machine Learning to X-Ray and CT images in the diagnosis of COVID-19
    By Ahmed El-Medany Chest CT scans and X-ray images have been reported to have sensitivity values of 98 and 69%, respectively, with regards to diagnosing SARS-CoV-2 pneumonitis. In this review by Mohammad-Rahimi et al, 105 studies reporting on machine and deep learning methods on CT and X-ray images in COVID-19 were analysed and compared. The accuracy of these methods ranged from 76% to more than 99%, suggesting the applicability of machine and deep learning methods in the clinical diagnosis of COVID-19; albeit with the requirement…
  • Prasugrel and ticagrelor associated with similar efficacy and safety following myocardial infarction
    By Ahmed El-Medany In a large retrospective study by Venetsanos et al, researchers analysed 37,990 patients from the SWEDEHEART registry with myocardial infarction (MI) who underwent percutaneous coronary intervention (PCI) to compare the clinical outcomes of prasugrel (Effient, Daiichi Sankyo/Eli Lilly) and ticagrelor (Brilinta, AstraZeneca). Outcomes of interest included 1-year major adverse cardiac events (MACE – defined as death/MI/stroke), and major bleeding.  Researchers utilised multivariable adjustment, inverse probability of treatment weighting and propensity-score matching to adjust for confounders. No differences were found between prasugrel and…
  • Sexism experienced by consultant cardiologists in the United Kingdom
    Female cardiologists in the UK experience more sexism and sexual harassment than male cardiologists. Sexism impacts the career progression and professional confidence of female cardiologists more, including their confidence when working with patients and colleagues. Future research is urgently needed to test interventions against sexism in cardiology and to protect the welfare of female cardiologists at work. Read the report at Heart
  • Obesity increases risk of cardiovascular complications in pregnant women with heart disease
    By Saadia Aslam Adverse CE during pregnancy were examined in a prospective cohort of women with heart disease. CE were a composite of the following: cardiac death/arrest, arrhythmias, heart failure, myocardial infarction, stroke, aortic dissection, and thromboembolic events. Pre-eclampsia and post-partum haemorrhage were also studied. Outcomes were examined according to body mass index (BMI). To identify additional predictors of CE, a baseline risk score (CARPREG [Canadian Cardiac Disease in Pregnancy Study] II score) for predicting cardiac complications was calculated for all pregnancies and included in…
  • Considerations for prescription of fluoroquinolones in patients developing signs or symptoms of heart valve disease
    Dr Laura Dobson comments on a recent update by MHRA regarding fluoroquinolones.
  • Does night-time aircraft noise trigger mortality? A case-crossover study on 24,886 cardiovascular deaths
    In this Swiss case-crossover study, Saucy et al. investigate the potential acute effects of aircraft noise on mortality and the specific role of different night-time exposure windows. Findings suggest that night-time aircraft noise can trigger acute cardiovascular mortality. The association was similar to that previously observed for long-term aircraft noise exposure.
  • People infected with COVID-19 have a higher risk of dying after a cardiac arrest. A report from the Swedish Registry for Cardiopulmonary Resuscitation
    COVID-19 patients who suffer a cardiac arrest either in or out of hospital are far more likely to die than patients who are not infected with the coronavirus.
  • 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
    The American College of Cardiology (ACC) and the American Heart Association (AHA) ended 2020 by publishing updated guidance on the management of valvular heart disease. This document covered significant ground with regards to transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve repair.
  • NICE report on the impact cardiovascular disease management
    The National Institute for Health and Care Excellence (NICE) has today published a report highlighting progress made by the health and care system in implementing NICE guidance on cardiovascular disease (CVD) management. Alongside the report, Prof Simon Ray, President of the British Cardiovascular Society, provides insights on the key findings about our role in improving outcomes for people with CVD. NHS England’s Long Term Plan suggests that CVD is the main area in which the NHS can save lives over the next 10 years. 6 million people…
  • Leading cardiovascular organisations call for urgent action to reduce air pollution
    “Even before the COVID-19 pandemic, air pollution was an issue of growing concern due to its impact on people’s health, although it was frequently overlooked as a risk factor for cardiovascular disease. COVID-19 has brought a new, deadly factor to the equation, and the time has come for the health community to speak up and take action,”  – Michael Brauer, Chair of the World Heart Federation Air Pollution Expert Group. The World Heart Federation (WHF), American College of Cardiology (ACC), American Heart Association (AHA) and…
  • COVID‐19, myocarditis, and the other side of the bed
    Emer Joyce speaks about the impact COVID-19 has had on the clinical landscape of acute cardiac, intensive care and cardiomyopathy/heart failure services including the wide spectrum of newly proposed inflammatory cardiac syndromes, triggered by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). “If myocarditis is and has always been a chameleon of cardiology, then SARS‐CoV‐2 myocarditis may go on to be its pinnacle.” In the article, Emer shares an interesting perspective as that of both a subspecialist in the field and of her experience as a patient…
  • BSH position statement on the roll out of COVID-19 vaccinations
    Read the BSH position statement on the roll out of COVID-19 vaccinations The BSH has recently released a statement regarding COVID-19 vaccinations. The statement advises: ‘Two COVID-19 vaccines are now being used in the UK. The Pfizer/BioNTech vaccine was rolled out on 8th December 2020 and the AstraZeneca/Oxford University vaccine was rolled out on the 4th January 2021. ‘Both vaccines have been thoroughly tested in clinical trials. Both vaccines have met the strictest standards of safety, quality and effectiveness set out by the independent Medicines…
  • Possible inhibition of ICD therapies by newer generation iPhone 12
    The Heart Rhythm Society recently published information regarding an important public health issue concerning the newer generation iPhone 12 which can potentially inhibit lifesaving therapy in a patient, particularly while carrying the phone in upper pockets. The article advises; “Contemporary studies have shown minimal risk of electromagnetic interference with Implantable Cardioverter Defibrillators (ICD’s) and prior smartphones without magnetic arrays. “Implantable Cardioverter Defibrillators (ICD) have an in-built switch which respond to an externally applied magnetic field. When an external magnet is applied to a defibrillator, high…
  • BCS Review of ESC Clinical Practice Guidelines: 2020
    In 2020, new clinical practice guidelines were published by the European Society of Cardiology. The BCS Clinical Standards Group has reviewed the guidelines and written short summaries with a focus on what is new and any important differences from UK NICE guidance. 2020 ESC Guidelines for:Management of Adult Congenital Heart Disease (ACHD) By Dr Jayant Kakarla These guidelines provide a significant update in the structuring of care, assessment and management of the broad spectrum of pathologies encompassing ACHD. There are no comprehensive national guidelines and…
  • Erythromycin: Caution required due to cardiac risks (QT interval prolongation); drug interaction with rivaroxaban
    Drug Safety Update Published 17 December 2020From: Medicines and Healthcare products Regulatory Agency Erythromycin has been associated with events secondary to QT interval prolongation such as cardiac arrest and ventricular fibrillation. Visit Gov.uk website to learn more about Erythromycin , the and the risks and current advice for healthcare professionals.
  • Current use and safety of novel oral anticoagulants in adults with congenital heart disease: results of a nationwide analysis including more than 44,000 patients
    Dr Amit Bhan examines a study on Novel Oral Anticoagulants recently published in the European Heart Journal.
  • The Expanding Role of Social Media in Cardiovascular Work
    The following two articles explore the roles social media can play in the cardiovascular sector. From research, to peer-to-peer engagement to recruitment. Social media in cardiovascular medicine: a contemporary review https://academic.oup.com/ehjdh/article/1/1/10/5998381 Using social media to recruit study participants for a randomized trial for hypertension https://academic.oup.com/ehjdh/article/1/1/71/6010590
  • PHE publishes updated Cardiovascular Disease Profiles
    Public Health England (PHE) has recently published data analysis on cardiovascular disease and cardiovascular related conditions of heart disease, stroke, diabetes and kidney disease. The profile reports present an overview of data on cardiovascular and cardiovascular related conditions of heart disease, stroke, diabetes and kidney disease. The profiles are for commissioners and health professionals when assessing the impact of cardiovascular disease on their local population and making decisions about services. They include data on mortality, hospital admissions, procedures and disease management. https://www.gov.uk/government/statistics/cardiovascular-disease-profiles-december-2020-update About the profiles The profiles provide…
  • CaReMe Heart Failure in Adults: Diagnosis & Management Algorithm
    CaReMe has today released the Heart Failure Management Algorithm Modified from: Management algorithm for NICE Guideline “Chronic Heart Failure in Adults: diagnosis & management” https://www.nice.org.uk/guidance/ng106 About CaReMe CaReMe is a collaboration between the British Cardiovascular Society, the Renal Association and the Association of British Clinical Diabetologists. The three professional Societies, along with the Primary Care Cardiovascular Society and the Primary Care Diabetes Society have formed the Cardio-Renal-Metabolic (CaReMe) partnership with the aim of improving the management of patients with diabetes, cardiovascular and renal disease. Find out…
  • Rivaroxaban in Patients with Atrial Fibrillation and a Bioprosthetic Mitral Valve
    Important data from Brazil demonstrating the safety and non inferiority of DOAC therapy in biological mitral valves and atrial fibrillation. This study makes a significant contribution to understand the ‘valvular’ AF story.
  • N-of-1 Trial of a Statin, Placebo, or No Treatment to Assess Side Effects
    Imperial College have published an innovative study in the BCS demonstrating that adverse symptom related to statin, placebo or no treatment. The study design was innovative and the clear result showed that 90% of the induced adversity symptoms could also be induced by placebo. This is a critical message for all those treating patients with elevated cardiac risk.
  • Tony Gershlick
    Tony was a leading light of interventional cardiology for more than 35 years and a tireless advocate of the importance of trials to guide clinical practice.
  • Enhanced Follow Up for Patients with Trifecta Aortic Valve Bioprostheses: A Statement from BHVS, SCTS and BCS
    Statement following a Medical Device Alert issued by the MHRA
  • Women NOT in cardiology – where are we going wrong?
    Dr Rebecca Dobson addresses the findings from a recent survey on why trainees don’t pursue careers in cardiology.
  • ESC Congress 2020 – The Digital Experience
    Dr Nadir Elamin, Cardiology SpR, reports on the third day of the European Society of Cardiology Congress, taking place entirely online this year due to the banning of public gatherings in the Netherlands to prevent the spread of COVID-19
  • ESC Congress 2021 to Be Held Online
    Meetings and courses to remain online during COVID-19 pandemic
  • BCS Announcement On The Annual Conference 2021
    Announcement on the staging of the 2021 edition of the BCS Annual Conference
  • ESC Congress 2020 – The Digital Experience
    Day Two, as reported by three BCS members in attendance
  • Evidence based research on CVD prevention
    We know that across the world a billion people have high blood pressure and 10.7 million people die each year because of high blood pressure. The tragedy is that so many of these deaths are preventable by prevention, detection and effective treatment of high blood pressure. Saturday 17 October was World Hypertension Day. With CVD being the largest cause of health inequalities, the Long Term Plan prioritises CVD prevention, and sets a minimum ambition of detecting 80% of people with high BP and effectively treating…
  • Peter Sleight
    Peter will be remembered as one of the leading academic cardiologists of his generation. Emeritus Professor of Cardiovascular Medicine, Oxford UniversityEmeritus Fellow, Exeter College, Oxford Born 27 June 1929Died 7 October 2020 Professor Peter Sleight died peacefully at the age of 91 last week and will be remembered as one of the leading academic cardiologists of his generation. Peter was born in Hull and studied medicine at Gonville & Caius College Cambridge and St Bartholomew’s Hospital, London. He qualified as a doctor in 1953 and…
  • Impact of COVID-19 on the Incidence and Management of Out of Hospital Cardiac Arrest in Patients Presenting with Acute Myocardial Infarction
    Abstract Authors: Muhammad Rashid, Chris P Gale, Nick Curzen, Peter Ludman, Mark De Belder, Adam Timmis, Mohamed O Mohamed, Thomas F Lüscher, Julian Hains, Jianhua Wu, Ahmad Shoaib, Evangelos Kontopantelis, Chris Roebuck, Tom Denwood, John Deanfield, and Mamas A Mamas This abstract in the Journal of the American Heart Association covers recent studies on the higher rates of Out of Hospital Cardiac Arrest (OHCA), particularly in older women from an Asian background and the higher rate in hospital mortality in England, UK. Background Studies have reported significant reduction in acute myocardial infarction (AMI) related hospitalisations during the COVID-19 pandemic. However,…
  • Cancellation of Cardiac Procedures During COVID-19
    BCS Statement The COVID-19 pandemic has placed immense pressure on the national health service, with frontline hospital services re-organised to handle the surge in cases. This re-organisation has had a wider impact on non-emergency procedures. The British Cardiovascular Society has issued a statement highlighting the (intended or unintended) implications of cancelling cardiac procedures and sets out its recommendation for the interventions that should take priority as the backlog of procedures is addressed. Read the full statement  (Unintended but Inevitable) Consequences of Cancellation of Cardiac Procedures…
  • ESC Congress 2020 – The Digital Experience
    Day One By Dr Noor Sharrack, Cardiology SpR With public gatherings banned in the Netherlands due to the COVID-19 pandemic, the 2020 edition of the European Society of Cardiology Congress, originally due to take place in Amsterdam, was staged online from 29 August to 1 September. BCS members in attendance share their experience of the first day of this new format. Read the full article… Professor Barbara Casadei nicely opened the conference in her inaugural lecture with a stark reminder of the importance of unity…
  • COVID-19: Disentangling Ethnicity and Cardiovascular Risk
    BCS Editorial By Ashwin Ajay and Ahmed Adlan Pneumonia of unknown cause began spreading in Wuhan, China, in late 2019, which led to the discovery of the severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) as the underlying cause.1 SARS CoV-2 virus causes the disease named COVID-19, which has drastically impacted the world in an unprecedented manner. Much research has been conducted to analyse the spread of the virus and to identify potential risk factors associated with transmission and adverse outcomes. Since the start of the COVID-19…
  • RAPID GUIDELINE: National Institute for Healthcare and Excellence (NICE)
    The purpose of the guideline is to help healthcare professionals who are not cardiology specialists identify and treat acute myocardial injury and its cardiac complications in adults with known or suspected COVID-19 but without known pre-existing cardiovascular disease.
  • COVID-19: Significant drop in ACS admissions
    News Article The COVID-19 pandemic has seen a decline in patients admitted with acute coronary syndromes, a report in the Lancet finds. Reduced admissions with acute coronary syndromes on an unprecedented scale, were reported by a very distinguished group of authors this week in the Lancet. This national data collection exercise demonstrated a 23% reduction in STEMI and a 42% reduction in NSTEMI. Even within hospitals, practice has changed with a drop of more than 75% in cardiac surgery. Although there is some recovery over time,…
  • COVID-19 and Digital Health: From Bed-Side Manner To Web-Side Manner
    BCS Editorial By Amir Aziz The COVID-19 pandemic has had a massive global impact like no other. The pressure for healthcare services to deliver has been immense. With limited resources, innovative solutions are required to ensure optimal care is given to our patients. The pandemic has brought into focus the use of technology in healthcare to help protect patients and healthcare workers from the virus, improve efficiency and make healthcare processes become leaner. This editorial outlines the use of digital health during the pandemic and…
  • BCS Editorial: Computed Tomography Coronary Angiography in Stable Coronary Heart Disease: The UK Perspective
    By Kenneth Mangion One in ten of all chest pain presentations to primary care have been reported to be due to coronary heart disease (CHD).(1,2) In the UK, rapid access chest pain clinics have been proven to be an effective way of identifying patients with angina.(3,4) There are a variety of non-invasive tests available for the investigation of patients with stable chest pain including anatomical imaging with CT coronary angiography (CTCA) and functional testing including stress electrocardiography, radionuclide scintigraphy, echocardiography, or magnetic resonance imaging.(5–10) Historically, the mainstay non-invasive…