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After the event: getting care right for patients after a heart attack

This report calls on all NHS Trusts to offer cardiac rehabilitation services to heart attack patients after finding that 2,100 patients across England are not being offered rehabilitation despite the clear benefits of the service in improving patient experience and outcomes from the disease.

Heart attack risk ‘rises after bereavement’

“Losing a loved one really can break your heart,” reported the Daily Mail. Several other news sources also reported that a study suggests people are 21 times more likely to have a heart attack within a day of being bereaved. In the days that follow, the risk drops to approximately six times higher than normal, and then declines during the following month.

During the study, researchers interviewed 1,985 people who had recently had a heart attack and asked them about whether they had been bereaved in the period immediately before their heart attack. They also asked about bereavement one to six months before their heart attack, which they used to compare the risk of having a heart attack during a period when they had not experienced a loss. They found that compared to this earlier period, the risk of having a heart attack increased 21-fold in the 24 hours after a bereavement.

Most people will experience bereavement infrequently, and the risk of a bereavement-related heart attack is likely to be much lower than one brought on by other heart attack triggers. However, this study highlights that in the first week after losing someone close, people may have an increased risk of a heart attack. Further research is warranted to see whether additional care or advice during this period could reduce this risk.

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Heart risk ‘raised by blood pressure earlier in life’

“Blood pressure control is key to a healthy heart,” the Daily Express has reported. The newspaper said that keeping your blood pressure levels low before you turn 55 dramatically cuts your  risk of cardiovascular disease.

The news is based on US research that looked for a potential link between blood pressure in middle-aged people (defined as 41-55 years old) and the risk of cardiovascular disease over the rest of their life. The study combined the results of seven previous studies featuring 61,585 men and women and looked at their risk of both fatal and non-fatal health issues after the age of 55, including heart attacks and strokes.

As would be expected, the researchers found that the overall cardiovascular risk was slightly higher for men than for women, and that ethnicity also had an effect (cardiovascular risk has been observed to be greater in people of African or Asian backgrounds). They also found that people who reduced or maintained their blood pressure at normal levels between the ages of 41 and 55 had lower cardiovascular risk than those who maintained or developed high blood pressure (hypertension) over the same period.

High blood pressure has long been a well-established risk factor for cardiovascular disease, and this study lends further support to the importance of controlling blood pressure. While some risk factors, such as ethnicity, cannot be changed, the research suggests that controlling so-called “modifiable” factors, even at a younger age, can have notable benefits.

Study rates heart scan techniques

“Magnetic resonance imaging (MRI) scans should be used to assess patients with suspected heart disease, rather than standard checks,” reports BBC News today.

This story is based on a large, well-designed study comparing a new technique called cardiovascular magnetic resonance (CMR) imaging against the commonly used alternative test, single-photon emission computed tomography (SPECT). The researchers tested the scan’s ability to diagnose significant coronary heart disease, also looking at how they compared against standard angiography, where dye is introduced into the blood vessels to highlight any blockage or narrowing. The study found that CMR performed as well or better than SPECT on a number of key diagnostic measures. Together with the fact that CMR does not expose patients to ionising radiation, the researchers say the results show that CMR should be more widely adopted.

However, CMR will not be suitable for all patients, including some with medical implants and those who could experience claustrophobia inside the scanner. Further research will also be needed to demonstrate that improved diagnosis through techniques such as CMR actually improves patient outcomes. That said, these results do suggest the technique has merit.

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Stem cells may aid heart repair

The Daily Telegraph reported that it may be possible for patients to use their own stem cells to repair the damage caused by heart attacks. The newspaper said that heart repair with stem cells could be the “biggest breakthrough in a generation”.

The news is based on a small safety trial that tested whether people with heart failure could have stem cells extracted from their heart, grown in a lab and safely injected back into the heart. The study, which is still in progress, found that the treatment did not lead to any negative effects in the year after treatment. Participants also saw improvements in heart function, scarring and quality of life compared with before treatment. A group of volunteers with heart failure who were not given the treatment showed no improvements in the symptoms of their heart failure.

This trial has shown another potential application for stem cells, which are at the forefront of medical research. However, the study was designed to look at safety rather than effectiveness, and was, accordingly, short and small. Given the limited nature of the trial, larger, longer trials will now be required to see whether these initially promising results can be replicated and whether the technique will prove safe and effective in the long-term.

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Heart risk of painkillers examined

A painkiller taken by millions can increase the risk of heart attack and stroke by 40%, the Daily Mail has today reported. The newspaper says that researchers are calling for the drug, called diclofenac, to be available on prescription only.

The news is based on a large review that looked at the cardiovascular risks associated with a class of widely used painkillers called non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs in high-dose formulations are usually only available on prescription, but some low-dose NSAIDs, including ibuprofen, naproxen and diclofenac, can be bought over the counter.

The review found that diclofenac raised the risk of heart problems by 22% when taken at over-the-counter doses and by 40% at prescription strength. Naproxen and low-dose ibuprofen were least likely to increase the risk of heart attacks and strokes.

While previous research has highlighted the cardiovascular risks of some NSAIDs, this review of observational studies provides some important new information about the risks associated with all currently available NSAIDs at different doses. As such, its findings will no doubt be important to future decisions about how these drugs should be used and regulated.

However, it is important to note that for a healthy individual who takes diclofenac, the increased risk to the heart is still very small. The nature of this research means it is not possible to estimate accurately how small this risk is. Anyone who is concerned about taking NSAIDs should not stop taking these drugs but should consult their doctor.

Pollution ‘linked to heart attack risk’

“Traffic fumes can trigger heart attacks, say researchers,” The Guardian reported today. It said that “breathing in large amounts of traffic fumes can trigger a heart attack up to six hours after exposure”.

This large study investigated the relationship between the risk of having a heart attack and exposure to different traffic pollutants. Researchers analysed nearly 80,000 heart attacks and the person’s exposure to air pollution in the time leading up to the attack. Certain pollutants were found to be associated with an increased risk of a heart attack within six hours of exposure. After that time there was no increase in risk.

Importantly, as the increase in risk was only short term, the authors suggest that these heart attacks would have happened anyway and that pollution only made them happen earlier. In other words, the study does not appear to show that pollution triggers heart attacks in previously healthy people. It suggests that these attacks were in people already at risk.

This large, complex study is a valuable contribution to this area of research. Previous studies have found a link between pollution and risk of death, especially death from cardiovascular disease, but few have looked at the effects of exposure in the hours leading up to a heart attack.

People who have been diagnosed with heart disease and other conditions are currently advised to avoid spending long periods in areas with high traffic pollution levels.

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Eyelid marks are ‘sign of heart risk’

“Yellow markings on the eyelids are a sign of increased risk of heart attack and other illnesses,” reported BBC News. These markings, called xanthelasmata, are mostly made up of cholesterol and can be treated cosmetically, but are also a warning sign of raised cholesterol.

This study examined the association between these deposits and heart disease, by recruiting 12,745 Danish people in the 1970s, 4.4% of whom had these eye signs. Thirty years later those with xanthelasmata were 48% more likely to have had a heart attack, 39% more likely to have heart disease and 14% more likely to have died.

This was a large, well-conducted study carried out over a long period. The findings will come as no surprise to the medical profession, as xanthelasmata are known to be cholesterol deposits. They suggest raised cholesterol levels, which is a well-known risk factor for cardiovascular disease. What these findings add is an idea of the strength of their association with cardiovascular disease outcomes.

The research highlights that people with these marks should have their cardiovascular risk assessed, taking into account other risk factors, such as age, BMI, smoking, diabetes, family history of heart attack or stroke and raised blood pressure. Together, this knowledge will allow doctors to assess a person’s risk of cardiovascular disease, and allow them to make lifestyle changes to help reduce their risk.

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Safe and sustainable review of children’s congenital heart services in England: report of the public consultation

This report provides a detailed analysis of more than 75,000 responses to a national consultation. During the consultation respondents were asked to share their views on the key principles of the review: four configuration options which would pool surgical expertise into fewer larger centres, the development of congenital heart networks to bring care closer to home and new national quality standards. The report demonstrates strong support for the key principles of the review and nine out of ten support the proposed national quality standards.

http://kingsfund.blogs.com/health_management/2011/08/safe-and-sustainable-review-of-childrens-congenital-heart-services-in-england-report-of-the-public-c.html

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Glasgow University study to tackle heart bypass failure

Scientists in Scotland have been given a £3.9m grant to develop a gene therapy which may prevent heart bypass failure.

During a coronary artery bypass, a vein from the leg – the saphenous vein – is used to boost blood flow to the heart.

This can fail, however, when new cells grow in the vein eventually causing it to narrow and block.

The team from Glasgow University and Golden Jubilee National Hospital aim to prevent new cell growth by using a modified virus.

There are more than 28,000 coronary artery bypass graft operations performed each year in the UK.

Baby heart defect test ‘could save lives’

A quick and cheap test could save the lives of babies born with congenital heart defects, doctors say.

A study of 20,055 newborns, published in The Lancet, showed testing oxygen in the blood was more successful than other checks available.

The researchers have called for the oxygen test to be used in hospitals across the UK.

The British Heart Foundation said the test could “make a real difference” as cases go unnoticed.

Congenital heart defects – such as holes between chambers in the heart and valve defects – affect around one in every 145 babies.

They are detected by ultrasound during pregnancy or by listening to the heart after birth, however, the success rate is low.

‘Bear bile’ chemical studied for irregular hearts

“Bear bile could help prevent arrhythmia in heart attack sufferers,” reported the Daily Mail.

This headline is based on a laboratory study investigating the effects of bile acid on the electrical signals of foetal heart cells from rats. The study found that the addition of a specific bile acid called ursodeoxycholic acid (UDCA) to a layer of rat foetal heart cells protected them against impaired electrical signals – a characteristic of irregular heart rhythm.

The study provides an important new insight into a potential therapy for heart arrhythmia at the cellular level. However, this study on rat cells in the laboratory cannot show whether UDCA will be effective at reducing arrhythmia in either adults or children.

Further research is needed to see whether the protective effects of UDCA seen in this laboratory study will translate into similar effects on human heart cells and if there are any safety issues. Although UDCA can be derived from bear bile, the drug is more commonly produced synthetically, as was the case in this study.

UK man gets artificial plastic heart

A 40-year-old father has become the first UK patient to receive a portable total artificial heart implant. Before receiving the implant Matthew Green had been critically ill from end-stage heart failure and it was thought he might not survive until a suitable donor heart could be found. However, his symptoms have improved since doctors fitted him with a new artificial heart device. The device can be run using a special backpack power unit rather than the large, fixed machines that must normally be used to power implants in hospital.

Mr Green underwent a six-hour operation carried out by surgeons at Papworth Hospital, Cambridge, in which his damaged heart was replaced with a Total Artificial Heart (TAH). The implant is only a temporary device designed to keep pumping blood to vital organs until a suitable donor heart is found and, eventually, Mr Green will have to undergo a transplant. However, the device appears to be working successfully as a temporary measure as it has eliminated Mr Green’s symptoms of heart failure and allowed him to make an “excellent” recovery. He has now gone home to wait for a suitable donor to be found.

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Study looks at fear after heart attack

“Patients who feel scared of dying during heart attack symptoms may be more likely to suffer another,” the Daily Mirror has reported.

The news is based on a small study in 208 people who were admitted to hospital with chest pain. The patients were asked three questions designed to assess their level of fear, whether they thought they might die and feelings of stress. Researchers compared their answers to the results of blood tests, taken when the patients were admitted to hospital, that measured levels of a chemical associated with inflammation, as well as heart rate or stress hormones three weeks later. Inflammation is known to both damage the heart and occur in response to heart damage.

The study found that people who were more distressed when admitted to hospital had higher levels of inflammation markers as well as lower levels of stress hormones three weeks later. However, the study had several limitations. Principally, it did not assess the risk of a second heart attack, but only looked at markers of inflammation at the start of the study. Also, about 50% of participants chose not to take part in the follow-up tests three weeks after hospital admission. These were mainly people who were unmarried and from poorer backgrounds. This means that the data from this study need to be interpreted cautiously. 

Given the limited scope of this early research, a link between inflammatory markers in the blood and emotional distress needs further investigation.

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Egyptian mummy ‘first to have diseased heart’

An Egyptian princess who lived 3,500 years ago is thought to be the first known person to have developed heart disease, say researchers.

Doctors believe the princess would have needed a heart bypass if she were living now.

Scans showed she had extensive blockages in arteries leading to her heart, brain, stomach and legs.

Computerised tomography (CT) scanning showed evidence of heart disease

The researchers say her case shows heart disease pre-dates a modern lifestyle.

Cardiac researchers from the US teamed up with colleagues at Al Azhar University in Cairo to analyse the remains of 52 mummies, including those of the princess.

They performed full-body scans on mummies at the National Museum of Antiquities in Cairo.

They had found evidence of hardening of the arteries in almost half the mummies scanned, researchers told a medical conference in Amsterdam.

Noble roots

Princess Ahmose-Meryet-Amon was from an illustrious Egyptian family. She lived in what is now Luxor from the year 1580 BC, and died in her 40s.

“Her diet was significantly healthier than ours. She would have eaten fruit and vegetables – and fish were plentiful in the Nile at that time.

“The food would have been organic – and there were no trans-fats or tobacco available then.

“Yet, she had these blockages. This suggests to us that there’s a missing risk factor for heart disease – something that causes it that we don’t yet know enough about.”

The researchers say the findings should not detract from the importance of messages about healthy diet and lifestyle.