News & Information For Arrhythmia Clinicians
National Cardiac Audit Programme (NCAP) annual report 2018
Towards healthier hearts: driving improvement from real-world evidence
Public Health England cardiovascular disease prevention initiatives, 2018 to 2019
Over the last few decades, great strides have been taken in reducing premature deaths due to CVD in England. However, the problem still remains a significant cause of disability, death and health inequalities.
An autoantibody identifies arrhythmogenic right ventricular cardiomyopathy and participates in its pathogenesis
In a study published in European Heart Journal, Dr. Robert Hamilton led the discovery of a new way to diagnose Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC), a life-threatening hereditary heart condition. ARVC genes share a common thread: they make the links called desmosomes that hold muscle cells together. Dr. Hamilton recognized that desmosomes perform a similar role in the skin, where blistering diseases can be caused by either mutations of or antibiodies to these structures. A search for such antibodies in ARVC found that, regardless of the specific genes involved, anti-DSG2 (anti-Desmoglein-2) antibody is observed in every patient with ARVC.
This anti-DSG2 antibody can be identified in a routine blood test and is the first autoantibody linked to ARVC. The blood test is simpler, more sensitive and far less expensive than annual heart tests. Anti-DSG2 is specific for ARVC, and its level may be linked to the severity of disease as well. The next step is to transform this finding into a clinical test available to clinicians around the world. The identification of autoimmunity in ARVC may also lead to new therapies.
This research was supported by the Labatt Family Heart Centre, the Canadian Institutes of Health Research (CIHR) and the SickKids Foundation through donations from the Caitlin Morris Memorial Fund, Alex Corrance Memorial Fund, Carter Family Heart Rhythm Fellowship and Meredith Cartwright, LLB.
Against the Odds: Successfully Scaling Innovation in the NHS' report publication
The spread of innovation is a continuous quest. Whether under the guise of scaling up new products or practices, reducing variation or high-quality care for all, the pursuit of equitable access to optimal care has been a preoccupation of healthcare services in the UK since Aneurin Bevan spoke in the 1946 NHS Bill of the ‘contract with the British people…that we should universalise the best, that we shall promise every citizen in this country the same standard of service’.
Trudie Lobban MBE, Founder and Trustee of the Arrhythmia Alliance quotes on page 34 - The spread of Implantable Cardioverter-Defibrillators (ICDs).
Click here to read.
Preventing Stroke:Uneven Progress
The burden of stroke on countries, communities and individuals is well-documented, with stroke survivors being troubled by a greater range of disabilities than those with any other condition.1 Fortunately, the risk factors for stroke are relatively well-understood by medical professionals, and opportunities have been identified to implement effective prevention and management strategies. However, these best practices are not consistently implemented around the world.
This report is based on the findings of a scorecard assessing 20 countries across a number of criteria, as well as seven in-depth interviews with experts. It aims to shed some light on the best strategies to tackle stroke risk and discover which countries are taking steps towards better prevention. The report concludes with a look at future policy options.
Keeping Britain Working
How medical technology can help reduce the cost of ill health to the UK economy.
The North-South NHS Divide: How where you are not what you need dictates your care
CCG variation ‘The North-South NHS Divide: how where you are not what you need dictates your care’ has now been released – please see the report online here. The report highlights regional disparities in commissioning and waiting times in the areas most relevant to medical technology. The report looked at NHS 18 Week RTT results and the Atlas of Variation to get an overview of how each CCG was performing- this highlighted a north-south divide in favour of the north.
Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis- June 2017
A national screening programme for atrial fibrillation is likely to represent a cost-effective use of resources, with systematic opportunistic screening more likely to be cost-effective than systematic population screening. Nurse pulse palpation or modified blood pressure monitors would be appropriate screening tests, with confirmation by diagnostic 12-lead electrocardiography interpreted by a trained GP, with referral to a specialist in the case of an unclear diagnosis. Implementation strategies to operationalise uptake of systematic opportunistic screening in primary care should accompany any screening recommendations.
Cardiac tachyarrhythmias and patient values and preferences for their management: the European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE)- June 2017
Cardiac tachyarrhythmias are recurrent or chronic and in some cases life-threatening conditions. Heart rhythm disturbances are often highly symptomatic and the psychological impact of the disease can be significant. Patients' beliefs and knowledge about their health (and illness), medications, and healthcare they receive are important determinants of whether or not they accept recommended treatments; influence their coping responses to their illness and treatment; adherence to recommended therapy; and ultimately affects health outcomes. Incorporation of patients' values and preferences for therapy should now be considered as an integral part of the decision-making process and treatment strategy. It is important to acknowledge and understand the impact of cardiac tachyarrhythmias on the patient. To address this issue, a Task Force was convened by the European Heart Rhythm Association (EHRA), and endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE), with the remit to comprehensively review the published evidence available, to publish a joint consensus document on patient values and preferences for the management of cardiac tachyarrhythmias, and to provide up-to-date consensus recommendations for use in clinical practice.
Cardiac Resynchronization Therapy With Wireless Left Ventricular Endocardial Pacing- May 2017
The SELECT-LV (Safety and Performance of Electrodes implanted in the Left Ventricle) study is a prospective multicenter non-randomized trial assessing the safety and performance of the WiSE-CRT system.
The Journal of Innovations in Cardiac Rhythm Management, 8 (2017)
Pacemaker and Defibrillator Implantation in Patients with Transposition of the Great Arteries
National tariff payment system 2017/18 and 2018/19
A set of prices and rules to help providers of NHS care and commissioners provide best value to their patients.
Cardiopulmonary resuscitation (CPR) is attempted in nearly 30,000 people who suffer out-of-hospital cardiac arrest (OHCA) in England each year, but survival rates are low and compare unfavourably to a number of other countries.
National Audit of Cardiac Rhythm Management Devices - April 2015-March 2016
Frontline pharmacists: Making a difference for people with long term conditions
November 2016 - Royal Pharmaceutical Society
The Royal Pharmaceutical Society (RPS) believes that pharmacists have a crucial role to play in the support of people with long term conditions.
The management of long term conditions represents a significant strain on an already overstretched primary care system and an unnecessary burden on secondary care resources through avoidable hospital admissions.
The RPS believes that the expertise and clinical knowledge of pharmacists must be fully utilised to support people with long term conditions and help them to achieve the desired outcomes from their medicines, thereby making more efficient use of National Health Service (NHS) resources.
A qualitative study of decision-making about the implantation of cardioverter defibrillators and deactivation during end-of-life care
Holly Standing, Catherine Exley, Darren Flynn, Julian Hughes, Kerry Joyce, Trudie Lobban, Stephen Lord, Daniel Matlock, Janet M McComb, Paul Paes and Richard G Thomson
Managing reversal of direct oral anticoagulants in emergency situations
Anticoagulation is the cornerstone of prevention and treatment of venous thromboembolism (VTE) and stroke prevention in patients with atrial fibrillation (AF). However, the mechanisms by which anticoagulants confer therapeutic benefit also increase the risk of bleeding. As such, reversal strategies are critical. Until recently, the direct oral anticoagulants (DOACs) dabigatran, rivaroxaban, apixaban, and edoxaban lacked a specific reversal agent. This report is based on findings from the Anticoagulation Education Task Force, which brought together patient groups and professionals representing different medical specialties with an interest in patient safety and expertise in AF, VTE, stroke, anticoagulation, and reversal agents, to discuss the current status of anticoagulation reversal and fundamental changes in management of bleeding associated with DOACs occasioned by the approval of idarucizumab, a specific reversal agent for dabigatran, as
well as recent clinical data on specific reversal agents for factor Xa inhibitors.
British Cardiovascular Society Working Group Report:
Out-Of-Hours Cardiovascular Care: Management of Cardiac Emergencies and Hospital In-Patients
Delivery of ‘out-of-hours’ cardiovascular care is of particular concern. Patients who require emergency treatment for heart disease should have immediate access to appropriate and timely investigation and treatment at any time of day or night. For many inpatients, however, the treatment pathway pauses overnight or at weekends as tests and senior medical staff may not be readily available. This variation in care can influence service quality and can delay discharge of patients from hospital with a knock-on effect for service delivery at other times during the week.
The British Cardiovascular Society commissioned a working group to gain some insight into the provision of ‘out-of-hours’ cardiovascular care across the United Kingdom. The working group report sets standards for the delivery of ‘out-of-hours’ cardiovascular services and makes recommendations to ensure equitable access to prompt, safe, effective and high quality care at all times.
Management of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia and Vasovagal Syncope
Satish Raj, Robert Sheldon - August 2016
Click here to read the full article.
Foreword from Trudie Lobban, CEO of the Arrhythmia Alliance
Firstly, I would like to thank all the contributors to the audit from the designated cardiac implantation centres across the UK, and to the audit team and authors for producing the 10th UK Cardiac Rhythm Management Audit report. The robust data within the report must now be used as a catalyst and stimulus for action as it clearly demonstrates significant variation in implantation rates across the UK, and an overall unacceptable level of performance when compared to our European counterparts.
Although this audit was not structured to measure patient outcomes related to the levels of implantation rates recorded, we can only assume that many patients and their families have suffered unnecessary negative outcomes through lack of cardiac implantation to manage their symptoms – and we must find ways to measure the direct impact of low implantation rates on patients, and how many patients this affects in the UK.
Arrhythmia Alliance, the UK’s leading heart rhythm charity, believes in working together to improve the diagnosis, treatment and quality of life for all those affected by arrhythmias – and as stated in the recommendations of this report all patients with symptomatic bradycardia, without AV block, or with an arrhythmia and/or heart failure, where device implantation is the most appropriate treatment, MUST be able to have this treatment on the NHS. This is our mandate for action!
The audit report raises a number of fundamental questions that need to be explored and addressed if we are to see any significant improvement in implantation rates at a local and national level, we believe this can only be done by driving through best practice that is resonant and applicable at the local level. Guidance on its own is not enough to ensure positive change.
Where is the breakdown? Is it a lack of understanding and/or referral at primary care level, is there a need for better co‐ordination and provision of cardiac implantation services to manage local populations? Are there identifiable resource challenges? We can only hypothesise on the reasons until we get down to grass roots level to identify the problems and explore solutions.
During 2015 Arrhythmia Alliance ran a series of educational Cardiac Update meetings related to the management of arrhythmias and ran a number of pilot projects in areas where implantation rates needed to improve in partnership with local clinical physiologists, commissioners, primary care and industry. In 2016 we intend to extend the pilot program to at least 10 areas in the UK where implantation rates need to improve and local, multidisciplinary teams want to work together to create local action plans to improve the overall management and treatment of patients with arrhythmias.
Trudie Lobban MBE FRCP (Edin)
Founder & CEO Arrhythmia Alliance
In 2014 The National Institute for Health and Care Excellence (NICE) issued a clinical guideline on the management of atrial fibrillation (AF), which included recommendations on the use of optimal anticoagulation for prevention of AF-related stroke.
This report looks at data one year on to consider what has changed.
This report sets out the current situation in the prevention of AF-related stroke and identifies how stakeholders across the NHS can embrace innovation in stroke prevention, utilising the availability of these new therapies to evaluate and optimise existing anticoagulation services, improving outcomes and easing the emotional and financial burden of this condition in England.