HEART UK Chief Executive Jules Payne said: “It is encouraging that many patients are offered cardiac rehabilitation after they have had a heart attack but the variation in uptake across the country is unacceptable. Action is needed on both a national and local level to ensure that all patients are offered this service to help them to recover and return to normal life as soon as possible after their heart attack”.

“HEART UK is deeply concerned that in some areas of the country less than 40% of patients are undertaking cardiac rehabilitation so there is a huge educational job to be done as well. Patients have such an increased chance of recovery if they undertake the vital and tremendously valuable aftercare that hospitals should be providing to all.”

Although 95% of patients are offered cardiac rehabilitation after MI, the report uncovers regional variations in the percentage of patients who take up invitations to cardiac rehabilitation – ranging from just 36.7% in Mid Cheshire Hospitals NHS Foundation Trust to 99.8% in Royal Devon and Exeter NHS Foundation Trust.

Dr Henry Purcell, Senior Fellow in Cardiology, Royal Brompton Hospital, London, said: “Cardiac rehabilitation can accelerate recovery and reduce mortality by up to 25%, following an acute coronary syndrome (ACS). There is abundant evidence that many UK patients are not participating in these programmes and are not receiving optimal lifestyle and pharmacological interventions to prevent further cardiac events. The present report addresses these issues. It sets out a large number of recommendations, including the development of a quality standard on secondary prevention after an ACS. Hopefully this pragmatic report will be read and acted upon by all UK health care professionals”.

Other key findings in the report, which was collated by HEART UK and MHP Health Mandate, include:

• There is limited evidence of hospitals  undertaking sufficient follow up activities to encourage participation in cardiac rehabilitation programmes
• There is variation in the content of cardiac rehabilitation programmes and not all areas offer all four phases of cardiac rehabilitation which are recommended by the National Institute for Health and Clinical Excellence (NICE)
• Cardiovascular disease will need to contribute around £1.54 billion savings in order for the NHS to meet the Nicholson challenge, which aims to find £20 billion in efficiency savings by 2015 yet there are examples of providers offering expensive cardiac rehabilitation services that do not lead to better outcomes for patients
• Twenty five NHS hospital trusts  have selected measures relevant to cardiac rehabilitation in their commissioning priorities; this prioritisation should be translated into clear action on ensuring high quality services for patients
• The report makes 20 recommendations about how to improve participation in cardiac rehabilitation and capitalise on the NHS reforms to improve outcomes for patients who have had a heart attack

The most recent data from 2008 show that 191,000 people died from heart and circulatory diseases, including 88,000 deaths attributed to coronary heart disease (CHD). Of these, 50,000 people died prematurely (under the age of 75) as a result of cardiovascular disease, accounting for more than one in four deaths in men and one in five deaths in women.

References

1 After the event: getting care right for patients after a heart attack: getting care right for patients after a heart attack. HEART UK, 2012.  Available from: http://www.heartuk.org.uk/pressroom/images/uploads/2012_16Jan_After_the_event.pdf

The app also features a live CV news feed, helping clinicians to keep up to date with developments in CV medicine and management. Market research in 2010 demonstrated that clinicians wanted immediate access to breaking CV news, according to AstraZeneca. Their research also showed clinicians wanted an app which allowed them to capture and share notes from presentations at medical congresses.

UK healthcare professionals can download the ‘Quest’ app by registering on www.ACSunited.co.uk. ACS United is an acute coronary syndromes (ACS) specific website designed to facilitate cross-discipline interaction amongst those managing the disease across the UK.

“The positive safety and efficacy data from this trial provide a strong scientific rationale for moving forward with this novel drug in ACS and potentially other indications,” said Dr. Tardif.  “There were also no subsequent major adverse cardiac events in the high dose group, which correlates well with VT-111’s impact on two prognostic cardiac biomarkers, Troponin I and CK-MB, whose predictive value have been demonstrated in other studies. It may also be possible for VT-111 to have an even greater impact if delivered in a larger dose than the low dose of 15 micrograms per kilogram (µg/kg) tested in this trial.”

In this double-blind, placebo-controlled Phase IIa trial, 48 patients received intravenous doses of placebo or VT-111 once daily for three days starting immediately before their stenting procedure.  Subjects were then followed for three days in the hospital and returned  at two weeks, four weeks, three months, and six months for evaluation of safety and a variety of inflammatory and cardiac biomarkers.

A statistically significant, dose-dependent reduction in levels of the cardiac damage biomarker Troponin I was associated with VT-111 treatment at eight, 16, 24, and 54 hours following the initial dose.  The VT-111 treated patients also showed a statistically significant reduction in the cardiac damage biomarker creatine kinase myocardial biomarker (CK-MB) at eight, 16, and 24 hours.  VT-111 also showed strong trends toward reducing Major Adverse Cardiac Events (MACE, a clinical endpoint comprised of myocardial infarction, revascularization, coronary artery bypass graft (CABG) or death) in the higher dose group, with no MACE events at the six month follow-up, compared to the placebo group, which had >18% MACE.

Previously published studies have shown that a reduction in the rise of Troponin I and/or CK-MB in the first 24 hours after stent placement is predictive of whether a patient will experience a subsequent clinical event.

The study showed no difference between the treatment and placebo groups for the key safety measures, including coagulation markers and adverse events.  In-stent plaque area and lumen area, as assessed by intravascular ultrasound at six months, were similar for both groups. VT-111 demonstrated no drug-related adverse events and no neutralizing antibodies (low immunogenicity) in the patient population.

“This drug candidate is Viron’s first successful adaptation of a viral anti-inflammatory protein into a therapeutic for the treatment of human disease, validating Viron’s unique approach and our proprietary PROSPECT™ technology, a platform for the discovery of new immune-modulating protein therapeutics from pathogens,” said James Rae, Chief Executive Officer of Viron Therapeutics.  “To complement these studies in patients with vascular disease, we plan to initiate a clinical trial for VT-111 in solid organ transplantation, an area with a well-defined patient population where novel anti-inflammatory drugs have significant potential to address an unmet medical need.”

Notes

The presentation was entitled “Viral Anti-inflammatory Treatment of Unstable Coronary Syndromes: The VT-111 Acute Coronary Syndrome Trial”.  A copy of Dr. Tardif’s presentation is available on Viron’s website, www.vironinc.com.

About VT-111

VT-111 (Serp-1), an immune-modulating protein therapeutic, is the world’s first viral-derived human therapeutic.  It is a novel inhibitor of the monocyte / macrophage influx to sites of injury and has demonstrated potent efficacy in preclinical models of acute injury in which inflammation plays a key role. VT-111 recently completed a Phase IIa trial of 48 patients with Acute Coronary Syndromes receiving coronary stents.  In addition to advancing the cardiovascular program, Viron is moving to conduct appropriate preclinical studies prior to a clinical program to evaluate the effects of VT-111 in solid organ transplantation.

About Viron Therapeutics Inc. (www.vironinc.com)

Viron is a biopharmaceutical company pioneering the development of viral proteins, a ‘revolutionary’ new class of drugs. The Company’s proprietary PROSPECT™ technology, PROtein Screen for Pathogen-Evolved Combination Therapeutics, is a platform for the discovery of new immune-modulating protein therapeutics.  VT-111, the Company’s lead compound, is in development to treat Acute Coronary Syndromes and solid organ transplant rejection.