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Take a look at a selection of our recent media coverage:
15th January 2025
Repeated doses of paracetamol in older patients can lead to an increased risk of several severe complications, researchers have reported.
An analysis of 20 years of GP data found an increased risk of gastrointestinal, cardiovascular and renal complications associated with regular use of the painkiller.
The researchers from the University of Nottingham said the findings highlighted that care must be taken when used regularly for chronic conditions such as osteoarthritis.
Analysis of health records from 180,483 people over the age of 65 years who had been prescribed paracetamol repeatedly (≥2 prescriptions within six months) and 402,478 controls of the same age found an increased risk of peptic ulcers, heart failure, hypertension and chronic kidney disease.
The study also identified a dose-response relationship for paracetamol use and perforation or ulceration or bleeding, uncomplicated peptic ulcers, and chronic renal failure.
That pattern was the same when researchers only looked at the patients who had taken paracetamol, they reported.
It is also difficult to calculate exposure when most people take paracetamol episodically or for multiple reasons, they added.
A subgroup analysis focusing on patients with osteoarthritis also aligned with the overall findings, the researchers reported in the journal Arthritis Care and Research.
The team did note they could not account for paracetamol bought over the counter which is why they focused on those who would have received free prescriptions.
Study leader Professor Weiya Zhang from the NIHR Nottingham Biomedical Research Centre and professor of epidemiology, Faculty of Medicine & Health Sciences at the University of Nottingham, said to its perceived safety that paracetamol has long been recommended as the first-line drug treatment for osteoarthritis by many treatment guidelines, especially in older people who are at higher risk of drug-related complications.
Yet their findings further challenge ‘whether acetaminophen [paracetamol] should be retained as the first-line oral analgesic’, especially in older people for common chronic painful conditions, given its non-clinically meaningful benefits and potential harms, he concluded.
It also supports recommendations by NICE to not prescribe paracetamol for osteoarthritis, he added.
‘Whilst further research is now needed to confirm our findings, given its minimal pain-relief effect, the use of paracetamol as a first line pain killer for long-term conditions such as osteoarthritis in older people needs to be carefully considered.’
A version of this article was originally published by our sister publication Pulse.
A team from Leeds Teaching Hospitals NHS Trust is leading the national rollout of a new radiographer-led nasogastric tube position check pathway after their efforts showed long-term positive results. Here, the team discusses the need for such a pathway, how it has been shown to improve safety and how other Trusts can get involved.
Over 967,000 nasogastric (NG) tubes are purchased by the NHS each year.1 Less than one in 20 NG tubes are misplaced in the lung, however, failure to recognise this can lead to a never event.2 A ‘never event’ is defined as a ‘serious incident that… (is) wholly preventable’ and results in serious patient harm or death.3
Between 1 April 2014 and 31 March 2024, there were 270 misplaced NG tube-related never events recorded by the NHS in England.4 This has been recognised as a patient safety issue with six national patient safety alerts issued to healthcare providers between 2005 and 2016.1 Despite local systems being implemented and consistent effort from healthcare providers, incidents relating to misplaced NG tubes continue to occur.1
The Health Services Safety Investigation Body (HSSIB), formerly the Healthcare Safety Investigation Branch, is an organisation that investigates patient safety concerns across England to improve patient care. The HSSIB published a report in 2020 on incidents relating to misplaced NG tubes and identified radiographic misinterpretation of NG tube check radiographs as the leading cause of NG tube related never events.1 This is due to the lack of a standardised framework for assessing radiographic interpretation of NG tube radiographs.1
In 2024, a group of professional bodies including the Royal College of Radiologists, British Society of Gastrointestinal and Abdominal Radiologists, the Society and College of Radiographers, and Report and Image Quality Control (RAIQC), collaborated to create a new radiographer-led pathway for utilisation in NHS Trusts and Health Boards across the UK in order to reduce the number of NG tube related never events.
A standardised competency-based training programme was created by the project team and hosted on the web-based platform RAIQC. Here, radiographers are trained to provide contemporaneous radiographic interpretation and to act on their findings. This includes removal of misplaced tubes and arranging for ward staff to attend the department to advance tubes that are not sited far enough into the stomach to be considered safe. This eliminates delays and risk associated with waiting for misplaced tubes to be removed, and, once the tube is correctly sited, allows feeding to be initiated promptly.
This collaborative position check pathway is based on an existing pathway from Leeds Teaching Hospitals NHS Trust, which has been in place for the past 11 years. Empowering the radiographer workforce by expanding their skillset and taking on greater responsibility has prevented further radiograph-related NG tube never events at this multisite Trust since the pathway’s inception.
Regular local audits over these 11 years have demonstrated an accuracy of 99% in the NG tube radiographic interpretation when compared to radiologist review, illustrating the importance of the radiographer workforce in reducing the number of patient safety incidents.
Radiographer training and empowerment to immediately evaluate and act on NG tube check radiographs has produced sustained prevention of patient harm.
The Leeds project team – with support from two radiologists from University College Hospital and Oxford University Hospitals who are involved with the RAIQC platform – is now leading the national roll out of this new radiographer-led pathway project, sharing their experience of utilising the pathway to support implementation at other hospitals.
New and potential site adopters are provided with governance documents and guidance for implementation and encouraged to attend weekly drop-in sessions hosted by the project team for mentoring and support.
Radiologists are key to getting this pathway implemented at Trust level. Any teams interested in adopting it in their service should liaise initially with their clinical lead and contact: [email protected].
Dr Sairah Razak
Radiology registrar
Gillian Roe
Extended imaging practitioner
Dr Damian Tolan
Project lead and consultant gastrointestinal radiologist
Leeds Teaching Hospitals NHS Trust
13th January 2025
Specific combinations of long-term conditions – or multimorbidity – are linked to a worse health-related quality of life and should be taken into account when assessing patients, a new UK-wide study suggests.
Research led by the University of Glasgow identified 24 clusters of multimorbidity which, when occurring in specific combinations, such as chronic pain, depression and cardiovascular disease, alongside other long-term conditions, were found to be associated with a reduced health-related quality of life.
The findings, published in the journal BMC Medicine, highlight the urgent need for targeted, cost-effective healthcare strategies to treat patients with multimorbidity.
In the UK, around 20-40% of adults live with multimorbidity, rising to over half in people aged 65 and over. Improved treatments and changing lifestyles mean more people live longer but are more likely to develop multimorbidity.
In socioeconomically deprived areas in the UK, the onset of multimorbidity can occur two decades earlier than in more affluent areas. Currently, healthcare systems most commonly treat single health conditions, leaving people with multimorbidity experiencing a high burden of treatment and disconnected healthcare, resulting in an increased morbidity risk.
Using data from over half a million people in the UK Biobank and the UK Household Longitudinal Study (UKHLS), the researchers identified age-stratified clusters of multimorbidity across four age strata: 18–36, 37–54, 55–73, and 74 years and over, and adjusted for sociodemographic and lifestyle variations.
The analysis showed 24 different multimorbidity clusters. Clusters of conditions related to pulmonary and cardiometabolic long-term conditions were common across all age groups. High blood pressure was also common across clusters in all age groups. In younger age groups, depression featured in multimorbidity clusters, and chronic pain and arthritis were associated with clusters of multimorbidity from middle age onwards.
Clusters involving chronic pain, depression and cardiovascular disease were all associated with worse overall quality of life. The data analysed from the UK Biobank showed that clusters of multimorbidity with a high prevalence of painful conditions were associated with the lowest quality of life. In the UKHLS data, cardiometabolic disease clusters were linked to a low quality of life.
The researchers found that those living with pain-related multimorbidity consistently experienced a low quality of life, regardless of the number of painful conditions they had.
Dr Bhautesh Jani, a clinical senior lecturer and honorary consultant at the School of Health and Wellbeing at the University of Glasgow, who was involved in the study, said: ‘Treatment and monitoring of long-term conditions is largely organised with a one-size-fits-all approach.
‘This study has identified potential combinations of long-term health conditions which often have the worst impact on long-term health-related quality of life. People with these combinations may benefit from tailored treatment and monitoring, which in turn may improve their long-term health and quality of life.’
A version of this article was originally published by our sister publication Nursing in Practice.
9th January 2025
Dr Chris Coulson, ENT consultant at Queen Elizabeth Hospital Birmingham, UK, and CEO of Endoscope-i, talks to Beth Gault about how a new iPhone-compatible device being piloted in the West Midlands aims to streamline throat cancer referrals.
Chris Coulson (CC): Me and another ENT surgeon selfishly tried to solve our problems. We spend a lot of time looking in people’s ears, noses and throats and we generally use an endoscope for that, which you put to your eye to look through and see the area of concern.
About 12 years ago, we recognised we had a decent camera in our pocket, on our phone, and thought why don’t we connect it with the endoscope. So, we did. We created an adapter to align the endoscope with the phone to allow you to take an image or video of the ear, nose or throat, which is what the device is.
We progressed to thinking we could train someone to take a video, which then comes through to me and if the clinician has filled out a history and done a hearing test, then I could just sit down and look at them remotely. So, we put that system together.
ENT is an interesting field in that only 10% of people who see me in clinic need an operation, 90% of people – with appropriate information – can be managed remotely. That’s classically done through a face-to-face consultation, but we wondered how much of that information can I get through other means?
CC: You just attach the aligner, which is a bit like a phone case, with the endoscope and the iPhone and then take a video or image and upload it to our cloud system via our referral app. It’s currently only on iPhone, not Android, but the iPhones are included with the service.
CC: The symptoms that are concerning with head and neck cancer are also symptoms that sound like a cold, like a hoarse voice or a sore throat. They are general, non-specific symptoms. Most people with a two-week wait referral for cancer do not have cancer.
The number of people picked up from an urgent cancer referral clinic is tiny – about 3%. So, the trouble that us head and neck surgeons have is how do we sift through these huge numbers of referrals to get to people who actually have cancer?
Capacity is a huge problem, so the number of referrals go up and up and up and actually the numbers of cancers are not. But you still have to deal with these referrals because you never know who is going to have the cancer.
We set up this referral pathway in Stoke where anyone with low risk for cancer went to a nurse-led clinic. The nurse used the endoscope with our camera system, took a video of their throat and then sent it to the head and neck surgeons. They were able to have a look and say who did not have cancer, and then who needed a further appointment in the clinic.
It’s really quick for us to look and know whether they do not have cancer, because it’s what we do every day. Within seconds you can look at a video and tell, but in a consultation, it takes 20 minutes.
We found through this that we can safely run a service where the nurse sees the vast majority of patients, but the consultant reports on it so it’s a consultant-level answer.
CC: We designed and delivered it ourselves without funding. But we then got funding from the Small Business Research Initiative to run an assessment of its delivery. We did this in Dorset County Hospital and Stoke University Hospital for head and neck cancer.
CC: We don’t have impressive numbers that say we’ve caught all these cancers, because our aim is not to find cancer, it’s to deal with the people who don’t have cancer. If you deal with them, you can have more capacity to deal with the cancer patients.
We put 1,800 people through the service and found around six cancers. All of these were low risk, so they’d likely go on to have a late diagnosis if they hadn’t used the service.
CC: Up to now it’s been Trust funded, because it’s a way of increasing their capacity and saving money. But we do have a couple of ICBs around the country who are looking at it for delivery in their patch. My guess is in a few years we will have a combination of ICBs and hospitals. However, the one thing we won’t have is GPs funding this. The location of delivery could be in primary care, which I think is advantageous to the population, but I don’t think it will be primary care-led funding.
CC: Around £100,000 upfront for the kit, training and integration and then there’s a monthly license fee for security updates and ongoing support.
CC: I don’t see GPs using it, it’s one of the core things we’re trying to do is to make things easier for GPs, not delivering something else for them to do. It would work best with someone doing it in high volumes, rather than intermittent users, so it might be that trained staff will go out to practices or any healthcare facility to do it. It would work well in a diagnostic treatment centre as well.
We are also looking at artificial intelligence and if at some stage we can automate some diagnoses or letters, this would further increase efficiency.
CC: There’s clearly a huge opportunity for digital tech to improve healthcare. But one of the challenges is how can you make sure that your digital tech doesn’t make things worse. We’ve got to be cautious that we don’t make things more complex.
But it’s also got to be clinically led. As soon as there’s tech designed by tech people with tech people in mind, most of us struggle to get on with it. It needs to solve a clinical problem.
This article was originally published by our sister publication Healthcare Leader.
7th January 2025
Significant strides are being taken in oncology, with treatment innovation and expanding skill sets supporting best practice among the multidisciplinary team. Speaking to Saša Janković, clinical and oncology pharmacist and ESOP president Professor Klaus Meier discusses the significant opportunities and challenges in the field and how collaboration is the key to an even brighter future.
‘Oncology works better when we give more power to pharmacists’, says Professor Klaus Meier. It’s a bold but thought-provoking statement, and he practices what he preaches.
As president of the European Society of Oncology Pharmacy (ESOP Global) – the world’s largest multinational oncology pharmacy organisation, founded in 2000 in Prague, and now with a membership of more than 4,500 members from 76 countries – Professor Meier is at the forefront of addressing challenges and harnessing opportunities in this critical specialism. Ultimately, he is a champion of the integration of oncology pharmacy into multidisciplinary clinical practice.
The specialism of oncology pharmacy has grown significantly across Europe since ESOP’s foundation, but the heterogeneity of healthcare systems across the continent remains a key challenge. ‘Every country in the EU has its own responsibility for education, health and related matters, which makes it difficult to implement universal programmes,’ Professor Meier notes.
To address this, ESOP has dedicated efforts to establish standardised education and training for the sector. A full member of the European Cancer Organisation, one of ESOP’s landmark initiatives is the European Certification Program for Oncology Pharmacy (EUSOP) – a comprehensive 100-hour initiative combining e-learning, an international workshop, and national training sessions, with participants achieving the title of European Oncology Pharmacist upon completion to signal their specialised expertise.
‘We aim to give pharmacists the tools they need to contribute meaningfully to cancer care,’ says Professor Meier, ‘and this structured approach underscores the specialism’s role within the broader hospital pharmacy framework, as well as its pivotal contribution to multidisciplinary cancer care teams.’
While medicines shortages and supply issues continue to make headlines across Europe, Professor Meier says one of the most destabilising additional challenges for the oncology pharmacy sector is war and conflict.
‘Much of the work ESOP does is about giving pharmacists the opportunity to come together because we cannot be helpful when we are not full of knowledge, but current conflict situations across the world are hampering these efforts,’ he says. ‘For example, when ESOP started, we initiated an exchange with Russia and Ukraine, and we are waiting for the right moment to pick the personal local exchange up again.’
Further hurdles include the disparity in drug availability across Europe. ‘In some EU countries up to 50% of European Medicines Agency-approved drugs are not available due to governmental or insurance-related barriers, and this impacts not only patients but also clinicians who miss the chance to become familiar with these therapies,’ he says.
ESOP is therefore actively lobbying for cohesive pharmaceutical legislation to ensure equitable access to essential drugs across all EU nations. Its working groups – comprising members from Asia, South America, Europe and Africa – regularly convene to share expertise and develop solutions to dive these efforts forwards.
On the positive side, technological and scientific advancements are reshaping the oncology pharmacy landscape and optimising the care that healthcare professionals can offer patients.
‘Developments such as mRNA cancer vaccines, pharmacogenomics and personalised medicine are going to be transformative for the sector,’ Professor Meier says. And he draws a parallel to the Covid-19 pandemic when pharmacists played a central role when carrying out vaccinations, even in countries where this was previously unprecedented.
‘At the start of the pandemic we knew very little about Covid-19, there was no vaccine, only panic,’ he recalls. ‘But then our pharmacists began to be included in the vaccination programmes in countries where they never have been included before, such as France, but also in community pharmacies, which before had only offered flu vaccinations – like in Germany where it had been unthinkable that pharmacists would do that, as only doctors had the allowance.’
Despite the positive learnings from and progress made during the pandemic, there’s still a long way to go to consolidate pharmacists’ roles, responsibilities and skills across the continent. Professor Meier therefore encourages pharmacists to learn from colleagues and each other and keep an ear to the ground to ensure they are ready for future change.
‘If you made a map of nations, it’s clear that how healthcare is delivered in one is not necessarily how it is done in others, but these advancements underscore the critical need for pharmacists to stay at the cutting edge of innovation and to adapt rapidly,’ he asserts.
To support this adaptation, ESOP places a strong emphasis on education. Its flagship event, the European Congress of Oncology Pharmacy (ECOP), was held in October 2024 in Lisbon and aimed to offer pharmacists a balance of expert scientific content and hands-on guidance.
‘This year’s Congress had high-level lectures about scientific questions, as well as covering a lot of practical training issues, such as how to write a clinical case at the end of the 100-hour education programme,’ explains Professor Meier. ‘We try to make the Congress a useful tool for attendees because when you have no tool you cannot open a box, so we are working on giving everybody the tools to express their knowledge and make collaborative connections with others – and I think we succeeded this year. In fact, I don’t think we’ve ever had a Congress with such positive feedback afterwards.’
Despite largely being aimed at oncology pharmacists, a welcome cohort of community pharmacy colleagues also participated in the Congress. Professor Meier says it’s important to acknowledge that the treatment and care of cancer patients is much broader than just the therapies provided in clinics, partly due to the success of these therapies. The subsequent reduction in morbidity increases the number of chronic patients that need long-term support, which can be provided in a variety of settings. As such, Professor Meier is clear that the community pharmacy sector plays a key role in maintaining joined up working and best practice across cancer care.
For example, a pioneering ESOP initiative in Germany seeks to engage the country’s 18,000 community pharmacies in supporting oncology patients.
The Oral Cancer Therapy Initiative provides community and hospital pharmacists with essential information about cancer drugs, side effects and adherence, while patients are given tools to document their experiences and facilitate better communication with the healthcare professionals they come into contact with throughout the system.
‘Community pharmacists can give patients a plan that makes sure they are able to take their cancer drugs in the right way at the right time,’ says Professor Meier. ‘If after two or three days they are having side effects, the patient can go back to the community pharmacist and check they have taken the drug in the right way, and if they still feel bad the pharmacist can make an immediate appointment with their doctor to check if what is prescribed is the right concentration or not – positioning community pharmacists as the coordinator between the patient and the doctor.’
Available in 10 languages, the initiative has recently been rolled out in Poland, and it is also due to commence in Hungary in 2025. A working group is poised to ensure it is then implemented further afield. And for pharmacies that are not yet equipped for its full application, the ESOP website offers a scaled down version with basic information in English that each country can translate into its own language.
Dismantling barriers to cancer care is a recurring theme in Professor Meier’s vision and this was his key message at the ECOP Congress.
‘As pharmacists, we are part of the multi-professional action that enables comprehensive care for patients,’ he says. ‘It is not drugs that is the measure of all things, but the implementation culture with the direct involvement of the other players in the healthcare system and, above all, the patients.’
ESOP’s quality standards, first published in 1996, serve as a foundation for such collaboration. These essential requirements for best practice, now in their seventh iteration as QuapoS 7 and translated into 23 languages, cover everything from aseptic preparation to drug administration and education and, according to Professor Meier, ‘enable oncology pharmacists to work confidently and collaboratively, whether they are in Bulgaria, South Africa or Mexico’.
Looking ahead, Professor Meier is optimistic about the future and the ability for pharmacists to proactively support progress in oncology. He concludes: ‘Our goal will continue to be to empower oncology pharmacists to use their knowledge to its fullest potential, embracing advancements in technology and personalised medicine, while continuing to advocate for patients in the face of systemic challenges, so oncology pharmacists can make even greater strides in optimising cancer care.’
3rd January 2025
A recent study identifying critical indicators related to medication adherence emphasises the complexity of the issue and the difficulty in predicting adherence to medications. The findings suggest a need for tailored, country-specific interventions and health policies to increase adherence, improve health outcomes and reduce economic burdens.
Researchers identified and prioritised indicators related to medication adherence (IRMAs) across 39 European countries and Israel through an online expert survey. Follow-up work involved collecting country-specific data on IRMAs in two countries through a targeted literature review and subsequent data validation with a second online expert survey.
Survey participants were medication adherence experts from various clinical fields, including physicians, pharmacists, psychologists and nurses who were all part of the European Network to Advance Best Practices and Technology on Medication Adherence (ENABLE).
A total of 17 out of 34 invited ENABLE members responded to the initial survey, resulting in 205 indicators of IRMA. The second survey saw 21 participants rank the 205 indicators, and 25 indicators emerged with a relevance score above 3.5.
The researchers were able to group the IRMAs into six main categories:
In addition, the researchers included ‘country population’ as an additional indicator because of its essential role in facilitating comparative analyses across countries in the future.
The findings offered a comprehensive understanding of the factors influencing medication adherence and successfully highlighted the priority areas as perceived by healthcare professionals engaged in this field. They will have significant implications for policymakers, healthcare providers and researchers, according to the researchers.
‘These results suggest that effective adherence-enhancing interventions must extend beyond addressing patient and therapy-related factors to include broader socio-economic and healthcare system-related determinants,’ the researchers said.
The researchers said the findings will enable fair comparisons across countries and provide a basis for the prediction of medication adherence rates in further studies.
Further research is also needed to rank these indicators accordingly and better comprehend their impact, and this could benefit from incorporating patient viewpoints to enhance the comprehensiveness and applicability of the findings, the researchers added.
Reference
Ágh T et al. and European Network to Advance Best Practices and Technology on Medication Adherence (ENABLE) Collaborators (2024). Identifying and presenting key country-specific indicators related to medication adherence: a comprehensive study across European countries. Front. Pharmacol. 15:1390629. doi: 10.3389/fphar.2024.1390629.
2nd January 2025
More needs to be done to protect children with asthma in England, including proper implementation of the new UK-wide joint BTS/NICE/SIGN guidelines, Asthma + Lung UK has said.
The charity warned that children from the most deprived areas are four times more likely to die from an asthma attack and called on the Government to take ‘urgent action’ to prevent child asthma deaths, including tackling poor housing conditions and air pollution and ensuring children get the care they need.
This comes as the recent National Child Mortality Database Report on Child Deaths Caused by Asthma shows that between April 2019 and March 2023, 54 children died due to asthma – one every four weeks.
More than half (56%) of the children who died came from the poorest communities.
Well-known risk factors for asthma attacks were common in a high proportion of the deaths, including overuse of reliever inhalers, emergency hospital admissions and exposure to air pollution and cigarette smoke, the report said.
It found 87% of the children had three or more short-acting beta-2 agonist (SABA) inhalers dispensed in the year before their death, with half of them having 12 or more.
In addition, 65% had attended an emergency department or had an emergency admission in the year before death.
All the children who died lived in areas with air pollution above levels recommended by the World Health Organization.
And smoking by family members was recorded in nearly half (43%) of the cases, despite the national average of adults who smoke in the UK being 13%.
Reviews of the deaths documented multiple missed appointments for asthma reviews in primary, secondary and tertiary care over many years, and children being discharged from services.
Poor compliance with preventer medication was also documented, and there were examples of children who were managing their asthma without adult oversight, the report found.
There were also examples of services failing to follow up and escalate appropriately, including SABA inhalers frequently prescribed by GPs despite children not being brought for reviews.
In some cases, healthcare professionals repeatedly referred children to social care due to missed appointments and non-compliance with treatment, stating their concerns about risk of significant harm and death, but this was not followed up.
Asthma + Lung UK said there was a ‘pressing need’ to do more to protect the 1.75 million children in England with the condition and called on the Government to ensure proper implementation of the new UK-wide joint BTS/NICE/SIGN asthma guidelines.
This should include provision of basic care in the community, including accurate diagnosis and annual reviews that include an inhaler technique check and written action plan.
Sarah Sleet, chief executive of Asthma + Lung UK, said: ‘A child dying from asthma every month is devastating and unacceptable.
‘More than a decade after the National Review of Asthma Deaths found that two thirds of asthma deaths are avoidable, people with asthma are still not getting the basic care they need and those living in the most deprived parts of the country are most at risk.
‘Bridging this health gap will only be possible if politicians commit to preventing poor lung health in the first place. This means action to cut smoking rates, tackle air pollution and address issues such as poor housing.’
Dr Andy Whittamore, a GP and clinical lead at Asthma + Lung UK, said: ‘Every week I speak to families who are powerless to change the things making their child’s asthma worse, such as living in damp, mouldy housing, or near busy polluted roads.
‘For children from the poorest communities, their chance of good health is determined almost before they’re born. That has to change.’
He added: ‘The new asthma guidelines offer some hope. Recommendations for better treatments and closer follow-up after a flare-up have the potential to keep children with asthma safe.
‘But without adequate funding and an NHS workforce fully upskilled in asthma care, properly implementing them will be impossible.’
A version of this article was originally published by our sister publication Pulse.
Women in Scotland were undertreated compared to men after a myocardial infarction, with the odds of receiving medicines that can prevent another myocardial infarction ‘stacked against you’ if you are female, researchers suggest.
The first national study in Scotland to examine the difference in treatment and outcomes between the sexes found that women are less likely to receive medicines that can prevent future myocardial infarction, strokes and cardiovascular complications.
The findings are published in the European Journal of Preventive Cardiology and build on an earlier study by the same authors, which found that following a diagnosis of heart disease, the death rate from cardiovascular causes for women increased relative to that of men.
Myocardial infarction is a leading cause of death and disability around the world, affecting men and women differently. The overall association between a person‘s sex and myocardial infarction outcomes is unclear and could be related to different treatment practices between the sexes in healthcare systems.
The researchers examined the treatment and outcome of 15,776 women and 31,287 men admitted to hospital after a myocardial infarction across Scotland between 2010 and 2016. Outcomes in the hospital were analysed according to rates of percutaneous coronary intervention, secondary prevention and mortality.
Each patient was followed for an average of eight years post-hospital discharge until the end of 2021, and rates of cardiovascular mortality and new cardiovascular events were monitored.
The researchers compared the findings to 81,341 matched healthy people without heart disease.
The study found that women were 13% less likely to undergo percutaneous coronary intervention and 6% less likely to undergo cardiac catheterisation than men whilst they were in hospital. Women were also 9% less likely to receive preventative treatments such as statins, beta-blockers or antiplatelets over the follow-up period.
Overall, female patients had lower long-term death rates in comparison to men, but the ‘female survival advantage’ – an observation in which women usually live longer than men – was less pronounced in the people with myocardial infarction.
The researchers found no significant differences in areas across Scotland, but sex differences were more pronounced in deprived areas.
Dr Tiberiu Pana, honorary early career clinical research fellow at the University of Aberdeen, who led the study, said: ‘Our results confirm the presence of important sex differences amongst Scottish heart attack patients. This important finding should guide patients and doctors to work together to improve prescription uptake and compliance with recommended preventative treatments to reduce the burden of heart disease in our population.
Dr Pana emphasised the need to improve the long-term outcomes of women after myocardial infarction, but the researchers also found that treatment for men could also be improved.
Dr Sonya Babu-Narayan, clinical director at the British Heart Foundation and consultant cardiologist, said it was important that existing evidence-based treatments reach both men and women.
But, she added: ‘Time and time again, data show that the odds of receiving medicines that can prevent another heart attack, or a future stroke appear stacked against you if you are a woman. Solving why, including by redressing system and society biases, could help more women in Scotland and other countries live in good health for longer.’
In May 2024, a study revealed that cholesterol-lowering drugs are less frequently prescribed to women compared to men, despite European Society of Cardiology guidelines recommending statins for all patients with chronic coronary syndrome.
A version of this article was originally published by our sister publication Nursing in Practice.
30th December 2024
Research suggests that children or young people who attend emergency departments for care because of violence are at greater risk of experiencing this again. Dr Sarah Bekaert PhD describes schemes that are putting extra support in place to try to change future outcomes.
Is there a navigator scheme for young people in your local hospital?
These are a valuable resource and growing in number. Navigators provide support to young people who attend the hospital as a result of violence. Connecting with young people at a moment of injury or crisis, where they me be more open to intervention, the navigator works with the young person to potentially stop violence escalation. A navigator offers immediate assistance, at this reachable moment, and a pathway of support beyond the hospital.
Navigators are non-medical or nursing staff, often with youth work training, co-located with the staff in the emergency department (ED). They reach out to the young person in crisis, listen, and potentially link them into ongoing support in the community.
Young people appreciate the normality of this interaction in a fast-paced, alien environment; trust is developed, and therefore they are more likely to continue with this support beyond the hospital setting.
In one example, the Thames Valley Hospital Navigator Scheme, implemented in five emergency departments by five voluntary community sector organisations, 70% of young people referred engage with the service. In this service, referrals are made for young people who have either directly experienced violence, or the possible root causes of violence such as substance abuse or mental health crisis.
While a specific incident may bring young people to the ED, the cause may be a combination of wider issues requiring wider support such as housing, substance misuse or counselling. The navigator begins to work with the young person on these wider or ongoing challenges, starting in the hospital and continuing into the community.
The Thames Valley Hospital Navigator Scheme also brings people with lived experience such as previous drug use or mental health challenges – into the navigator role. This adds value as the young people can see how it is possible to change the pathway.
Through flexible contact and support, offered over time by navigators, positive relationships are developed with the young people.
Not having set parameters around the type of support offered is a strength of the service. They may, for example, accompany young people to community-based services, or advocate for the young person with housing or the GP. Sometimes a formal referral can be made, such as to mental health services or mentorship programmes. The navigator journeys alongside the young person to a point of stability and thriving beyond.
Evaluation of the Thames Valley scheme has shown that most benefitted from a short-term intervention, with 52% achieving a successful outcome within three months. A further 24% received signposting – a brief intervention where the young person was linked straight into appropriate services – and 24% required support beyond three months.
In the hospital, navigators provide invaluable support to the ED team. Navigators can step in to reassure and calm patients, freeing up nursing and medical staff time. More specifically, the support has been shown to respond to a gap in services for young adults – the transition years between child and adult services. For example, in the Thames Valley scheme, 35% of young people referred into the scheme were aged between 18 and 25 years, representing the largest age group supported by the service.
The service also responds to another current societal need, offering rapid response to young people experiencing mental health challenges. While 37% were referred for violence, a significant 27% were referred for mental health support.
Such services also have the potential to contribute to reduced ED reattendance. For example, in the Thames Valley scheme, 77% of young people who accepted navigator support did not re-attend the emergency department within a six-month follow-up period – early signs of an effective demand reduction approach.
There is potential cost saving by reducing ED reattendance, and wider socio-economic savings for society. The cost-benefit saving of hospital navigator schemes has been estimated to be £4.90 per £1 spent with the financial benefits across several public agencies, including acute health.
Consequences of violence have implications for the individual, community and society – these include anxiety, depression, drug and alcohol use, and the likelihood of reactive perpetration. Considering the wider societal impact of an initiative aimed at reducing and preventing violence related injury, the cost benefit of such early intervention schemes has been estimated at £82 for every £1 spent.
In the Crime Survey for England and Wales figures, 1.1 million violent offences were recorded for the year ending December 2022. These occurrences of violence often result in hospital care. A Youth Endowment Fund report states that in 2021, for young people there was a 12% increase in violence against the person – offences such as harassment, common assault, actual or grievous bodily harm.
In 2019, the UK Home Office commissioned 18 Violence Reduction Units to develop effective ways of tackling violent crime and its causes. One approach adopted has been to provide support to vulnerable young people in specific settings, such as healthcare, as an early intervention approach. Many have implemented a navigator scheme within local Trust EDs.
There is a growing recognition in the UK of the benefits of schemes able to reach young people at a moment of crisis and/or injury such as hospital navigator schemes. The model is also being effectively implemented in other settings such as schools and custody. A focus on young people is an opportunity for early intervention and support to interrupt the cycle of violence and promote positive pathways into adulthood.
Dr Sarah Bekaert PhD is a senior lecturer in child health at Oxford Brookes University, registered nurse (RN) Child and research manager for the Thames Valley Violence Reduction Unit.
This article was originally published by our sister publication Nursing in Practice.
27th December 2024
The sodium glucose cotransporter 2 (SGLT-2) inhibitors dapagliflozin and empagliflozin cut mortality in patients with heart failure with reduced ejection fraction whether or not patients have diabetes, a large real-world study has concluded.
The analysis of SGLT-2 inhibitor drugs in patients on a national Danish registry found they were associated with a 25% lower risk of all-cause mortality, ‘supporting their effectiveness in routine clinical practice’.
Reporting in the BMJ, the researchers examined outcomes in patients with heart failure aged over 45 years with left ventricular ejection fraction less than 40% between 2020 and 2023.
In their dataset, they reviewed 6,776 patients who started SGLT-2 inhibitors (79% on dapagliflozin, 21% prescribed empagliflozin) and 14,686 patients taking other standard-of-care heart failure drugs, while taking into account time since diagnosis and other baseline characteristics.
Around 70% of patients taking SGLT-2 inhibitors were men, with an average age of 71 years, and 20% of the cohort had type 2 diabetes.
The results showed 374 deaths among SGLT-2 inhibitor users at a rate of 5.8 per 100 person-years compared with 1,602 among non-users equating to 8.5 per 100 person-years.
The 25% reduction in the risk of all-cause death compared with non-use was consistent across all patient groups, including those with and without type 2 diabetes, they found.
Analysis also showed that SGLT-2 inhibitors were associated with a 23% lower risk of cardiovascular death.
But there was no reduction in a combined measure of cardiovascular death or hospitalisation for heart failure or heart failure hospitalisation alone.
The ‘real-world’ data matches that seen in the clinical trials that had led to the recommendation of SGLT-2 inhibitors in several guidelines, including from NICE, the team concluded.
NICE recommended empagliflozin for chronic heart failure with preserved or mildly reduced ejection fraction in October 2023, following its recommendation to extend dapagliflozin use in heart failure to reduce hospitalisations in May.
‘These results support the benefits of SGLT-2 inhibitors observed in clinical trials and provide novel and important data regarding their effectiveness in real-world clinical settings and across key clinical subgroups, including patients with and without diabetes,’ the researchers from the University of Copenhagen said.
A linked editorial noted that the findings were observational but ‘provide assurance that no unexpected harm results from SGLT-2 inhibitors when they are used for treatment of heart failure outside the clinical trial setting’.
But it also stressed that SGLT-2 inhibitors are still underused, and efforts are needed to ‘tackle barriers to prescribing’ in line with best-practice guidelines.
A version of this article was originally published by our sister publication Pulse.
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