Findings from the study showed a 45% reduction in mortality rates, 20% reduction in emergency admissions, 15% reduction in A&E visits, 14% reduction in elective admissions and 14% reduction in bed days.

Speaking at the launch of the Strategy for UK Life Sciences in London, Mr Cameron said the aim of the new campaign is to improve three million lives over the next five years.  “This is going to make an extraordinary difference to people,” he said. “Diabetics taking their blood sugar levels at home – and having them checked by a nurse.  Heart disease patients having their blood pressure and pulse rate checked – without leaving their home”.

“This is not just a good healthcare story. It’s going to put us miles ahead of other countries commercially too as part of our plan to make our NHS the driver of innovation in UK life sciences.”

SEHTA, the South East Health Technologies Alliance, has welcomed the announcement, having established its International Centre for Excellence in Telecare (ICE-T) in 2009.  “This is a very significant announcement and commitment which we welcome with open arms,” says Dr David Parry, CEO of SEHTA.  “Members of the ICE-T have for some time been developing a whole range of innovative products and services that are designed to help people live ways that suit them, their families, and those providing care”.

“Our members have also shown how telecare and telehealth can be of significant benefit, not just in terms of assisting people, but helping the NHS and other healthcare providers to achieve greater efficiencies and reduce their costs.”

“ICE-T members are ready to help deliver this commitment by government now that the case for telecare and telehealth has been proven through the Whole System Demonstrator,” he added.

And also…

Internet service improves care for newborns and chronically ill

Anna Gund, Chalmers University of Technology

The first dissertation² in the new research field of e-health at Chalmers University of Technology (Gothenburg, Sweden) has been completed, evaluating a new internet service developed at the University (Care@Distance).

Anna Gund, who publicly defended her doctoral dissertation recently, has worked with the new internet service including, a website where the chronically ill, or parents to newborns that require more careful follow-up, regularly fill in measurement values and other data related to their state of health.  Patients and care workers only need a computer or a smart phone with internet capability to use the system.

“Similar systems are tested now and again, with positive outcomes, but it seems to be hard to make them part of routine care,” says Gund. “We have developed a system based on the technology that is already used in most homes, and we believe that this can facilitate further dissemination”.

Care@Distance was tested in two groups: seniors with heart failure, and premature infants. Findings showed that staff actively embracing the technology and providing regular feedback on the information submitted by the patients was a key factor. 

“In cases where they have done so, patients were very positive and felt more secure and happy,” says Gund.

She has also performed a questionnaire survey regarding what care workers think about using telecare support in their work. It showed that they are generally very interested and have considerable confidence in the technology, but in practice some staff did not use the system as it was intended.  Anna Gund intends to find out why this was the case in her future research.

References

1 Whole system demonstrator programme: Headline findings – December 2011. Department of Health, 2011.  (Available from: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_131684).

2 Gund A.  On the design and evaluation of an eHealth system for management of patients in out-of-hospital care.  Chalmers University of Technology, Gothenburg, Sweden 2011.  (Available from: publications.lib.chalmers.se/records/fulltext/77891.pdf).

The study population included subjects poorly represented in clinical trials but commonly admitted as heart failure patients – including the very elderly, those with atrial fibrillation (AF), and those previously treated with a pacemaker or other cardiac device.

Analysis of the survey data showed that at, one year (average) follow-up, 81% reported a self-assessed improvement in their symptoms (with 16% no change and 4% a deterioration).  The survey also found that almost 25% of the subjects had died or been re-hospitalised within the 12-month follow-up period.  Patients implanted with a pacing device only (CRT-P) had higher rates of mortality than those whose device had an additional defibrillator (CRT-D).

First author Dr Nigussie Bogale (Stavanger University Hospital, Norway) said: “This is the largest study reporting a difference in outcome between CRT-D and CRT-P. Most patients with an indication for CRT have also an indication for a defibrillator. So unless they have contraindicating co-morbidities, it is now our belief that these patients should be considered for CRT-D implantation”.

And also…

FDA advisory panel approves Medtronic CRT-Ds

Michael R. Gold, M.D., Ph.D

The overall clinical benefits of Medtronic cardiac resynchronization therapy with implantable cardioverter defibrillator (CRT-D) devices outweigh the risks in treating certain mildly symptomatic heart failure patients, according to a recent determination from the US Food and Drug Administration’s (FDA) Circulatory Systems Devices Advisory Panel.

The recommendation was based on data from the RAFT (Resynchronization/Defibrillation in Ambulatory Heart Failure Trial) and REVERSE (REsynchronization reVErses Remodeling in Systolic left vEntricular dysfunction) clinical trials. While the CRT-Ds are currently approved for patients with moderate-to-severe heart failure, these studies found that their use could benefit mildly symptomatic heart failure patients by reducing mortality and heart failure hospitalisation rates.

The Advisory Panel voted in favor of the CRT-D devices’ safety (Yes: 5 votes, No: 0 votes) and efficacy (Yes: 3 votes, No: 2 votes) profile in treating a mildly symptomatic patient population. The panel voted in favor of the overall risk-benefit profile (Yes: 3 votes and No: 2 votes)

The FDA will consider the Panel’s feedback as it reviews Medtronic’s request to expand its CRT-D indication to include New York Heart Association (NYHA) Class II heart failure patients with a left ventricular ejection fraction (LVEF) of less than or equal to 30%, left bundle branch block (LBBB), and a QRS duration greater than or equal to 120 milliseconds.

“We look forward to working closely with the FDA during the regulatory process so that we may expand the use of our innovative portfolio of CRT-D devices in an effort to enhance patient outcomes in a broader heart failure population,” said Pat Mackin, president of the Cardiac Rhythm Disease Management business and senior vice president at Medtronic.

“As was seen in the RAFT and REVERSE trials, clinical evidence demonstrates that CRT-D prevents hospitalization and can save lives in mildly symptomatic patients,” said Dr Michael R Gold, REVERSE study investigator and steering committee member (Medical University of South Carolina). “Utilizing this lifesaving therapy earlier in a milder heart failure population would allow us to treat these patients before their symptoms exacerbate, ultimately enabling us to better address this serious, often debilitating and costly disease”.

RAFT Clinical Trial

Findings from the landmark RAFT clinical trial, published in the New England Journal of Medicine, showed that CRT-D significantly reduced mortality for mildly symptomatic heart failure patients (NYHA Class II) by 29% when compared to patients treated with guideline-recommended implantable ICDs and medical therapy. The study also demonstrated a significant reduction (27%) in combined mortality and heart failure hospitalizations for this population, consistent with previously published studies. All patients were followed for at least 18 months, and had an average follow-up of 40 months, making it the longest follow-up and largest patient months-of-experience of any study of CRT therapy.

REVERSE Clinical Trial

With 610 patients studied, REVERSE was the first large-scale, global, randomised, double-blind trial to demonstrate the impact of CRT in mild heart failure patients or asymptomatic patients who previously had heart failure symptoms. All of the randomised subjects received a Clinical Composite Response at 12 months. The Clinical Investigation Plan pre-specified that a comparison would be made between subjects with CRT and those without. The results showed that 21% of subjects without CRT worsened, compared with 16% with CRT.

In a post-hoc analysis, more patients in the trial improved with CRT than without (54% vs. 40%, respectively). The Clinical Composite Response measure for heart failure consists of several different endpoints, including death, hospitalisation for heart failure, crossover to the opposite arm due to worsening heart failure, a progression to a worsened NYHA class, or a moderate or marked worsening of the patient’s self-assessment (administered by the blinded clinician).

Furthermore, the analysis of secondary endpoints in the REVERSE trial showed that CRT leads to improvement in both cardiac structure and function as measured by echocardiography, meaning the heart size improves and beats more effectively. In an additional analysis, REVERSE also demonstrated that CRT delayed the time to first heart failure hospitalisation in this patient group and reduced hospitalisation or death by 51%.

References

1 Bogale N, Priori S, Cleland JGF, et al. The european CRT survey: 1 year (9-15 months) follow-up results.  Eur J Heart Fail 2011; doi:10.1093/eurjhf/hfr158.

NOAF occurred in 44 patients at a median time of 48 hours following TAVI, and its incidence was increased in patients with larger left atrial size and those undergoing transapical TAVI.  Up to 40% of the NOAF episodes occurred either during or within the 24 h following the procedure (figure 1).  NOAF was associated with a higher rate of stroke/systemic embolism, but not a higher mortality, at 30 days and at 1-year follow-up.

Figure 1. Timing of first atrial fibrillation (AF) episodes following transcatheter aortic valve implantation in 44 patients with new-onset AF. Adapted from original

Figure 2. Duration of new-onset atrial fibrillation episodes following transcatheter aortic valve implantation. Adapted from original

The authors say the increase in cardioembolic events associated with NOAF offers an  “important new insight into the mechanisms of cerebrovascular events following TAVI. Indeed, some…events seemed to be related to the no initiation of anticoagulant therapy upon documentation of the AF episode, which further emphasizes the clinical relevance of optimizing antithrombotic treatment in this high-risk subset of patients”.

They add that “future studies will have to determine the potential usefulness of implementing preventive strategies to reduce the occurrence of NOAF and its potentially devastating consequences in the setting of TAVI”.

References

1 Amat-Santos IJ, Rodés-Cabau J, Urena M, et al. Incidence, predictive factors, and prognostic value of new-onset atrial fibrillation following transcatheter aortic valve implantation. JACC 2012;59. doi:10.1016/j.jacc.2011.09.061.

“These studies open the way for the early identification of myocardial damage at the subclinical level, thereby allowing clinicians to identify patients who might benefit from either changes in cancer therapy or the delivery of protective treatments,” says European Association of Echocardiograpy (EAE) president Dr Luigi Badano (University of Padua, Italy).

The cardiotoxic effects of cancer treatments encompass a heterogeneous group of disorders, says Dr Helder Dores (Santa Cruz Hospital/São Francisco Xavier Hospital, Lisbon, Portugal): “They range from relatively benign arrhythmias, and hypertension, to potentially lethal conditions such as thromboembolism, myocardial infarction and cardiomyopathy with symptomatic heart failure”.

In October 2011 the EAE announced that it is working with the American Society of Echocardiography (ASE) and American Society of Clinical Oncology (ASCO) to issue joint recommendations on the usefulness of echocardiographic evaluations in cancer patients, expected to be published in 2012. “The document should lay down guidance for the frequency of assessment with different chemotherapy agents, and also identify when patients should stop treatment or be prescribed protective treatments,” says Dr Badano.

In the first study Dr Dores and colleagues set out to identify early warning signs of adverse cardiac effects in women treated with trastuzumab for breast cancer. In the study 51 consecutive women, enrolled for treatment between May and September 2010, were assessed at baseline with echocardiography and then again at three months.
The investigators found that within the first three months no patients presented with overt signs of heart failure or significant left ventricular systolic function deterioration, although almost one-fifth developed impaired ventricular relaxation.

“Patients with impaired ventricular relaxation are known to be at higher risk for progression to advanced stages of cardiac dysfunction (both systolic and diastolic), making it important for these patients to be subject to more frequent evaluations both during and after therapy,” says Dr Dores.

Further studies are now needed, he says, to assess whether impaired ventricular relaxation occurs in larger populations of patients prescribed trastuzumab.  “We need studies identifying the women who go on to develop overt cardiac dysfunction to see whether we can more accurately determine predictors of these adverse events at an earlier stage of treatment.”

In the second study Dr Radulescu and colleagues used echo-Doppler echocardiography to investigate whether the ACE inhibitor lisinopril and the statin rosuvastatin might confer a cardio protective effect on patients treated with anthracyclines for a range of malignancies.

“While the exact mechanism of anthracycline related cardiotoxicity is not fully understood, animal studies have pointed to oxidative stress and inflammation.   Both ACE inhibitors and statins are known to play an important role in reducing oxidative stress and inflammation at the level of the heart muscle cells,”says Dr Andreea Parv.

In the prospective study left ventricular ejection fractions and LV diastolic function were compared for the study group of 26 patients treated with the anthracycline epirubicin who were also given the cardio protective treatments Lisinopril 10 mg and Rosuvastatin 10 mg, and a control group of 31 gender and age-matched patients who received epirubicin but had no accompanying cardioprotective treatments.

Results show that in comparison with patients receiving cardio protection the patients who receive no protection showed further deterioration of LV diastolic function, calculated as the ratio of early diastolic filling velocity(E) to filling velocity after atria contraction E/A (p<0.02).
“This is the first human prospective study documenting the cardioprotective effect of lisinopril and rosuvastatin in anthracycline induced cardiotoxicity,” says Dr Radulescu.  Further studies, she adds, are now needed in larger numbers of patients, exploring a range of different types of malignancies.



References

1 Dores H, Gandara F, Correia MJ et al. Early Trastuzumab induced cardiotoxicity in breast cancer patients.  Abstract P315
(Available from: http://spo.escardio.org/AbstractDetails.aspx?id=101200&eevtid=49).

2 Radulescu L, Radulescu D, Andreea P et al. Cardioprotective role of lisinopril and rosuvastatin in the prevention of anthracycline induced cardiotoxicity.  Abstract P316 (Available from http://spo.escardio.org/AbstractDetails.aspx?id=101201&eevtid=49).

Full scientific programme available here: http://www.escardio.org/congresses/euroecho2011/Pages/welcome.aspx

“Mobile markets anticipate a growth for as many as 2 billion smartphones a year and our new and first-ever app is a step in adjusting our services to anticipate this massive change. We are positive that as one of the leading agencies in this field, our app will make positive humanitarian difference,” he added.

Studies by the charity show that, although 81% of people believe everyone should know basic first aid, just half of those surveyed felt confident they would be able to help if someone collapsed in front of them.

Mulligan told ArWatch: “We cover matters of cardiac arrest under the ‘unconscious and not breathing’ section.  Symptoms related to this condition are significantly explained in the app as we learnt the public find it a complex state to respond to. Our tips and advice are packaged in a simple way to ensure people respond confidently when faced with such circumstances”.

“We believe that having basic first aid skills helps keep families and communities safer. The Red Cross encourages everybody to take the responsibility to learn first aid before an emergency strikes. This app makes our knowledge and experience in first aid readily accessible to smartphone users who can not only access it instantly when they need it, but also allows them to learn first aid at a time that suits them”.

To download the British Red Cross first aid app, use the Quick Response (QR) codes at redcross.org.uk/app or find it on iTunes AppStore, Android Market or Blackberry Appworld.

The material (ERM®-DA200a Frozen Human Serum – Digoxin, High Level and ERM®-DA201a Frozen Human Serum – Digoxin, Low Level) are intended for use by clinical laboratories for determining digoxin levels in human serum through method validation and performance monitoring of methods, providing a means of measurement traceability.

Gill Holcombe, Head of Reference Material Production at LGC explains: “Assays for determining levels of digoxin in human serum are independently calibrated but without traceability to an accepted high order reference material. This means that concentration values may not be comparable between different methods or hospital laboratories, posing potential risks to patients”.

“LGC’s new reference materials will improve confidence in measurement, helping clinicians to ensure optimum therapeutic effect and minimise the occurrence of adverse events,” he added.

Liquid chromatography tandem mass spectrometry instrumentation is used in conjunction with LGC’s exact matching isotope dilution procedure, to assign reference values to the digoxin in serum reference materials. Credit: Andrew Brookes, www.andrewbrookes.co.uk

To assess his role in mortality and walking speed, a team of researchers based at Concord Hospital in Sydney, Australia analysed the walking patterns of 1,705 men aged 70 and over who were participating in The Concord Health and Ageing in Men Project (CHAMP).

The men lived in the inner city and suburbs of Sydney and they were recruited from January 2005 to June 2007. The CHAMP study included a high proportion of immigrants and only 50% of the participants were born in Australia, 20% were born in Italy and the other main countries of birth were Great Britain, Greece and China.

The researchers assessed participants’ walking speed at baseline and survival over the five-year study period.  A total of 266 deaths were observed during the follow-up. The results show that their average walking speed was 0.88 metres per second (m/s). No men with walking speeds of 1.36 m/s (3 miles or 5km per hour) or above had contact with the Grim Reaper.

The authors conclude that the results support their theory “that faster speeds are protective against mortality because fast walkers can maintain a safe distance from the Grim Reaper”.

References

1 Stanaway FF, Gnjidic D, Blyth FM, et al. How fast does the Grim Reaper walk? Receiver operating characteristics curve analysis in healthy men aged 70 and over. BMJ 2011;343:d7679. doi: 10.1136/bmj.d7679

The public were found to estimate survival rates following CPR at over 50%, whereas survival to discharge is actually less than 10% for out-of-hospital arrests and 10–20% for in hospital arrests. It is likely that the majority of perceptions are formed through the portrayal of resuscitation in fictional medical dramas, researchers say.

Mr Field said: “Public perception of outcome following a cardiac arrest is very important as it has the potential to influence the motivation for learning and performing CPR as well as making and/or supporting do not attempt cardiopulmonary resuscitation (DNACPR) decisions”.

The Resuscitation Council (UK), which funded the study, advocates a joint approach to DNACPR decision-making. This can involve both the patient, or those close to the patient and the clinical team. They emphasise the importance of accurate public perception regarding cardiac arrest survival, to ensure correct decisions are made and expectations are realistic.

Resuscitations in a public place and involving heroic bystander CPR attempts are more likely to attract the media looking for high-impact news stories, the authors suggest.  In reality around 70% of cardiac arrests occur at home and only 36% of these patients will receive bystander CPR, compared with bystander CPR performed in 75% of events occurring in a public place.

References

1 Field RA, Soar J, Nolan JP, Perkins GD. Epidemiology and outcome of cardiac arrests reported in the lay-press: an observational study.  J R Soc Med. 2011;104:525—31. doi:10.1258/jrsm.2011.110228.

They were stratified into four subgroups: general practitioners (GPs), physicians, surgeons and others and sub-divided again into subspecialties. The top specialties for honours included general practice, paediatrics, psychiatry, public health medicine, pathology, geriatrics, endocrinology and haematology.

GPs head the league table of honours in terms of numbers. Dr Islam says: “This is perhaps not surprising given the fact that GPs collectively constitute the largest single group of the medical workforce. However, when this figure is converted to a percentage of all registered GPs, a relatively small proportion receives honours. Despite ranking fourth overall in absolute numbers, public health medicine comes out top in percentage terms”.

All doctors have to put in at least 30 years of hard graft before they can even expect to be considered for an honour, which the research defined as Knight or Dame, CBE, OBE or MBE. For GPs the mean number of years of clinical practice and subsequent conference of honours is slightly shorter at 31 years, while secondary care clinicians have to work another five years.

Dr Kamran Abbasi, editor of the Journal of the Royal Society of Medicine, said: “The British honours system is one of the oldest in the world and it is extremely competitive. Doctors, like other public sector workers, reach a stage in their careers when they begin to think about being recognised by our honours system. This study has produced two interesting findings. Don’t even think about a gong before you’ve worked for thirty years, and if an honour is your ultimate goal you might want to discard the glamour and scalpels of surgery for a world of hush-puppies and public health”.

References

1 Doctors recognized by the British honours system: A retrospective analysis of the last decade. Islam S, Cole JL, Taylor CJ. JRSM 2011;104:521–4. doi: 10.1258/jrsm.2011.110188.