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Take a look at a selection of our recent media coverage:
16th April 2024
From his base in Leeds, Dr Rani Khatib champions holistic, person-centred approaches and the collaborative power of the multidisciplinary team in cardiac care. Here, the newly appointed fellow of the European Society of Cardiology speaks to Allie Anderson about his innovative services that have enjoyed local, national and international acclaim, and how his own recent experiences as a patient have bolstered his professional work.
Dr Rani Khatib is a trailblazer in cardiology and cardiovascular pharmacy, achieving success locally and nationally through clinical work and research. As well as a consultant pharmacist in cardiology and cardiovascular research at Leeds Teaching Hospitals NHS Trust, he is visiting associate professor at the Leeds Institute for Cardiometabolic Medicine at the University of Leeds.
He has enjoyed acclaimed in Europe, too, sitting on cardiology allied professional groups for the European Society of Cardiology (ESC), and last year Dr Khatib was elected Fellow of the ESC in honour of his distinguished career.
‘It’s a huge recognition and becoming a Fellow of the ESC as a pharmacist rather than a cardiologist is an added bonus,’ Dr Khatib says. ‘The Society includes non-physicians as part of its structure because, simply, the care of patients with cardiology conditions requires input from multiple healthcare professionals.’
Dr Khatib embodies this multidisciplinary approach, not only contributing to but spearheading a number of pharmacy-led services at his Trust – and beyond. At their core are medicines optimisation and managing patient risk. ‘Cardiovascular disease is one of the biggest killers worldwide,’ he explains, ‘so there is a huge opportunity to ensure patients are on the right therapies and to optimise those therapies.’
Having noted suboptimal secondary prevention medicine (SPM) regimes and low adherence among myocardial infarction (MI) patients, Dr Khatib embarked on a project to ‘re-engineer’ post-MI care. Together with a consultant cardiologist, he established a post-MI multidisciplinary medicines optimisation clinic. Patients who had been hospitalised following an MI could see Dr Khatib, who is an independent prescriber, for a 30-minute consultation post-discharge to discuss any questions or problems they had with their medication.
He could manage patients autonomously but also escalate cases to the consultant cardiologist where necessary. ‘That was important because we worked together to identify the best set-up, so that we have access to each other, we work collaboratively, and we deliver what is best for the patients,’ Dr Khatib says.
Ahead of the clinic, patients were asked to complete a ‘My Experience of Taking Medicines’ questionnaire, known as MYMEDS. This self-reporting tool was designed to assess use of SMPs and to identify modifiable barriers – actual or perceived – to adherence. The completed questionnaire is a starting point for Dr Khatib to dig deeper.
‘It enabled patients to raise concerns about their medicines, whether that’s side effects or fitting medicines into their daily routine,’ he says. ‘Patients will often say “yes”, they remember to take their medicines, but if you have a further conversation using the MYMEDS tool, you might identify that they’re having problems swallowing the tablets so actually, they found taking them challenging.’ After identifying a barrier, Dr Khatib adds, he can work with the patient to overcome them.
The service was piloted between October 2015 and December 2016 among 270 patients. Optimisation of drugs improved significantly, with numbers of patients taking the recommended doses of ACE-inhibitors or ARBs increasing from 16.3% to 73.9%.
Patients reported significantly fewer concerns with their medications, non-adherence rates fell by up to 70.8% and readmission rates decreased.
In recent years, there has been a sharpened focus on holistic patient care and, with it, more emphasis on tackling multimorbidity. Patients with cardiovascular disease and type 2 diabetes have historically been managed by two distinct teams, but in Leeds, Dr Khatib spotted an opportunity to drive improvements in both specialties.
‘We identified that cardiology patients with type 2 diabetes were not necessarily receiving the best care,’ he says. ‘Newer diabetes medicines like SGLT2 inhibitors and GLP1 agonists also confer significant cardiovascular and renal benefits, so looking at the interplay between cardio-renal-metabolic seemed obvious.’
Dr Khatib established the CaReMe service, which streamlined cardio-renal-metabolic services into a ‘one-stop clinic’ for these comorbid patients. The consultant pharmacist-led clinic, supported by wider multidisciplinary teams, assesses patients six to eight weeks after an MI event.
It uses an adapted version of the MYMEDS tool – MYMEDS-Cardiometabolic – so as well as optimising medicines use and adherence, the consultant pharmacist provides a comprehensive review of the patient’s cardiovascular, diabetes and renal management needs. Such needs include key cardio-renal-metabolic biomarkers; analysis of risk factors; post-MI SPMs; and dietary, weight management and other lifestyle advice.
As well as improving patient outcomes, services like these highlight the crucial role of consultant pharmacists in multidisciplinary teams. They also create opportunities to expand input from appropriately trained senior pharmacists. Such initiatives free consultants to deliver other specialist services, thereby increasing capacity.
Moreover, Dr Khatib’s work has been taken further to not only reach patients in Leeds but nationally as well, notably with PCSK9 inhibitors. Designed to treat high cholesterol in patients who are not suitable for or poorly controlled on other lipid-lowering therapies, PCSK9 inhibitors are underused in optimising lipid management according to Dr Khatib.
‘We are always trying to improve access to innovative medicines, and bring what pharmacy can offer into the patient pathway to forward the cardiovascular agenda,’ he comments. ‘So, to improve access to these drugs, we set up another pharmacist-led, multidisciplinary clinic.’
Established in 2017, the clinic – the only service that was prescribing PCSK9 inhibitors in the Leeds area – also provides patient support, education and monitoring to promote adherence, as well as tackling statin intolerance.
The service proved successful and has yielded significant improvements in patients’ total and LDL cholesterol levels that are maintained at 12-month follow-up. It was deemed cost-effective and patient feedback was positive.
Furthermore, the project caught the attention of stakeholders at the Accelerated Access Collaborative (AAC), a UK-wide initiative aimed at extending access to high-quality healthcare, through improving uptake of the best treatments, for example. Harnessing his experience delivering the pharmacy-led service, Dr Khatib worked with NHS England and the AAC to develop a NICE-endorsed national lipid management pathway and the statin intolerance pathway.
‘Our model, uniquely, established a centralised service run by a consultant cardiology pharmacist and advanced cardiology pharmacists. We offered a vehicle for these medicines to be prescribed and demonstrated that lipid optimisation doesn’t have to be managed only by lipidologists,’ Dr Khatib explains. ‘We need to tap into the pharmacy profession more, and through collaboration with cardiology and lipidology colleagues the patient receives the best care, and the pharmacist is well-supported to deliver it.’
Dr Khatib believes that person-centred care must underpin every aspect of pharmacy. ‘As much as we talk about it, it’s often missed because it’s not as easy to apply as we think,’ he comments. However, being on the other side of the patient-clinician partnership has given Dr Khatib a broader understanding of the dynamics.
Having contracted Covid-19 in November 2020, he spent seven months in hospital in what he describes as ‘a terrible ordeal’ that caused multiple organ failures and cardiac arrests. This left him with extensive deconditioning and multiple morbidities – all of which he has documented in a Journal of Cardiac Failure editorial. His book with full reflections and lessons about this experience will soon be published.
‘I continue to live the patient experience and it has opened my eyes to a lot of things you only see as a patient, and not as a healthcare professional,’ he says, adding that it gives him a fresh perspective on patient need when it comes to multidisciplinary working.
‘Often patients said they preferred to see a cardiologist because they felt they’re more likely to get a rounded view, rather than just a medicines-focused discussion, which triggered something in my mind: we need to change the way we do pharmacy-led clinics to a more patient-centred approach,’ he explains.
This requires what Dr Khatib calls a ‘zoom out’ mindset, aided by tools like MYMEDS to support a holistic view. ‘So, when patients tell me about their experiences, I am ready to hear about their anxiety, their challenges going back to work, or how they’re getting on with lifestyle modifications,’ he comments. ‘I may not be able to solve those problems, but I can be considerate of them.’
In that way, Dr Khatib believes, pharmacy-led services can tick patient-centricity boxes while also helping to improve adherence and outcomes. He concludes: ‘I believe this is a better way of delivering the medicines optimisation concept.’
22nd May 2023
NICE has recommended the extension of dapagliflozin as a treatment option for symptomatic chronic heart failure in patients with preserved or mildly reduced ejection fraction.
In final draft guidelines, the committee said it had reviewed evidence from AstraZeneca that adding dapagliflozin (Forxiga) to standard care with diuretics reduces the combined risk of dying from cardiovascular causes or hospital admission with heart failure.
The committee noted in its decision that hospitalisations for heart failure with preserved or mildly reduced ejection fraction place a substantial burden on the NHS and this is the first NICE-recommended treatment for this type of heart failure.
This follows EU approval of dapagliflozin across all ejection fractions in heart failure in February 2023.
More than 550,000 people in England have heart failure and around 50% have preserved or mildly reduced ejection fraction, of whom up to 150,000 would be eligible for treatment with dapagliflozin, NICE said.
Figures show 94,185 hospitalisations in England for heart failure in 2019/20, making it one of the leading causes of avoidable hospitalisations.
And around a quarter of people with heart failure die within the first year and over half within five years.
Results from the DELIVER trial considered by NICE (a global study but with no UK patients) showed dapagliflozin plus standard care reduced the composite outcome of cardiovascular death or worsening heart failure by 18% over a median follow-up of 2.3 years.
The committee said the population in the trial were about 10 years younger than would be expected in real-world the but said results were generalisable to NHS clinical practice.
An economic analysis took into account hospitalisations but also GP appointments, the final draft guidance said. Overall it found cost effectiveness to be below £20,000 per quality of life year gained – below the NICE threshold for an acceptable use of NHS resources.
Helen Knight, director of medicines evaluation at NICE, said: ‘Until now there have been no treatments available to delay or slow the progression of this type of heart failure.
‘The committee heard from patient and clinical experts who described how the lack of research and available treatments in this area led to a lack of hope and support that impacts the quality of life and mental health of people with the condition.
‘And we know that chronic heart failure also places a significant burden on the NHS through hospitalisations.’
She added: ‘Today’s draft guidance means that for the first time there is an effective treatment available on the NHS for people with this type of heart failure.
‘Not only does dapagliflozin have the potential to help them live well for longer, but it could also save the NHS money and free up space by reducing their risk of having to go to hospital for unplanned emergency treatment.’
A version of this story was originally published by our sister publication Pulse.
26th April 2023
Hospital Healthcare Europe‘s new editor Helena Beer discusses her journey to healthcare journalism and exciting new developments for the publication, including the launch of Clinical Excellence events – the first of which focuses on cardiology
At the age of 12, I was admitted to hospital with appendicitis. There are a few stand-out moments from the few days I spent in the NHS’ care, not least seeing my kidney on an ultrasound scan, which fascinated me. But it was the unparalleled level of healthcare I was afforded by the A&E staff, nurses and my surgeon, that made a lasting impression.
It impacted me so much that not only did I name a soft toy I was given during my recovery after this surgeon – a duck named Roly for those of you wondering – I decided I wanted to become a paediatrician. And at Great Ormond Street, no less. Now, my science grades may not have resulted in an application to medical school, but, one history degree and a journalism master’s later, I was on the road to becoming a magazine journalist instead.
At first, it didn’t occur to me that my interest in healthcare could align with my new chosen career. It wasn’t until I started working for the magazine of a well-known weight loss and wellness brand that I first dipped my toe into healthcare by writing about diabetes and hypothyroidism. This too, I found fascinating, and I realised I could pursue this interest professionally after all. I could make a real difference through my writing and help people just as the healthcare professionals had helped 12-year-old me, if a little more indirectly.
I found my niche and I haven’t looked back. Almost a decade later, having spent much time focusing on consumer healthcare and community pharmacy, and most recently the other side of the coin in pharmaceuticals, I’m now delighted to have joined Hospital Healthcare Europe and Hospital Pharmacy Europe as Editor.
It’s an exciting time for both brands. We have brilliant new content in the pipeline and have recently launched Hospital Healthcare Europe Clinical Excellence events. These virtual events, which can be accessed live or on demand to suit your schedule, are guided by strong advisory boards and bring together a host of renowned experts from recognised Centres of Excellence. The aim? To share best practice and explore the latest advances in clinical care, building on Hospital Healthcare Europe’s existing portfolio of valuable content.
Cardiology takes centre stage for the inaugural event – a clinical area we know is of major interest to our readers. What’s more, we have also created new and unique content to support the event which sits in a Clinical Excellence section on the Hospital Healthcare Europe website. Here, experts discuss their pioneering approaches to optimising and achieving excellence in patient care in cardiology.
For example, we share an insightful interview with our advisory board member and event speaker Amitava Banerjee, professor of clinical data science and honorary consultant cardiologist at UCL and Barts Health NHS Trusts. The interview discusses why the trend of using electronic patient record data to predict outcomes and prognosis is here to stay. Professor Banerjee also shines a light on the prevalence, incidence and outcomes of cardiovascular diseases in homeless individuals.
Join us on 10 May 2023 to explore the latest advances in cardiovascular care from heart failure to interventional cardiology. Understand how to best utilise multidisciplinary teams, gain ideas for improving patient care and much more. Free to attend and delivered virtually live and on demand, this event offers a convenient opportunity to gain CPD hours.
Find out more about Clinical Excellence in Cardiovascular Care and register here.
And stay tuned for details on future Clinical Excellence events as well as more content covering different clinical areas on our website. Dates for a Respiratory event will be shared soon, with more set to be announced later in the year.
21st April 2023
Hospital Healthcare Europe is delighted to welcome cardiologist Dr Andrew Coats as an advisory board member and speaker at the upcoming Clinical Excellence in Cardiovascular Care event on 10 May 2023.
Dr Coats, Scientific Director and CEO at Sydney’s Heart Research Institute, will chair a panel discussion on the use and misuse of modern technology in the treatment of the heart. He will be joined by consultant cardiologists Matthew Kahn and Jennifer Peal from Liverpool Heart and Chest Hospital and Newcastle’s Freeman Hospital, respectively.
This inaugural event in HHE’s Clinical Excellence series brings together renowned experts from recognised Centres of Excellence to share best practice and explore the latest advances in cardiovascular care from heart failure to interventional cardiology.
Providing the opportunity to gain CPD hours, the day-long event will also focus on how to best use multidisciplinary teams and improve patient care in this area. The agenda has been created by HHE with the support of four advisory board members to offer cardiologists and members of the multidisciplinary team a comprehensive overview of this broad clinical area.
To coincide with the event, a new Clinical Excellence section has been added to the HHE website with a whole host of additional content and interviews with prominent cardiologists from Centres of Excellence and beyond. This includes a fascinating interview with Dr Coats, who is also editor-in-chief of the Cardiac Failure Review journal. HHE spoke to him about his career in cardiology, and heart failure in particular, as well as his pioneering approach to optimising and achieving excellence in patient care.
Find out more about Clinical Excellence in Cardiovascular Care, including the timings and agenda, and register for free, here.
Further events in HHE’s Clinical Excellence series will be announced soon, with respiratory coming first in the summer of 2023.
19th April 2023
ChatGPT shows some promise as an AI-assisted decision-support tool, particularly for questions that are relatively straightforward. However, it performed less well when providing answers to more complicated case vignettes.
Chat Generative Pre-trained Transformer (ChatGPT) is an interactive AI model. The system follows instructions and provides a detailed response. Furthermore, the system has the potential to assist with medical education and even clinical decision-making. In the current study, researchers set out to assess ChatGPT’s performance at answering cardiovascular questions and in providing suggestions in case vignettes. For the questions, the reference standard was the medical expert who developed the questions. As for the 20 vignettes, the standard was the attending physician or consulted expert and the advice provided was checked with reference to clinical guidelines. The straightforward cardiovascular questions, related to several topics including acute coronary syndrome, atrial fibrillation and cardiovascular risk management. Vignettes involved symptoms that were potentially due to a cardiac problem (e.g., chest pain, dyspnoea) or required a diagnostic/treatment plan.
ChatGPT performance
Using 50 multiple choice cardiovascular questions, ChatGPT was correct in 74% (37/50) of cases. Scoring varied from 80% (for coronary artery disease) to 60% (cardiovascular risk management). For the vignettes, when seeking primary care advice, ChatGPT correctly answered questions in 90% of cases. When asked more complicated questions, the system was correct in only 50% of cases.
The authors felt that ChatGPT performed well with straightforward, low complexity questions. However, they felt more work was needed to fully evaluate the system’s potential.
Citation
Harskamp RE et al. Performance of ChatGPT as an AI-assisted decision support tool in medicine: a proof-of-concept study for interpreting symptoms and management of common cardiac conditions (AMSTELHEART-2). MedRxiv 2023
6th April 2023
In support of our mission to provide high-quality clinical education, Hospital Healthcare Europe is proud to announce a new series of events in 2023: the HHE Clinical Excellence programme.
Kicking off with cardiology and developed in conjunction with an expert advisory board of renowned key opinion and thought leaders from UK Centres of Excellence, our first one-day event on 10 May 2023 will allow you to explore the latest advances and innovations in cardiovascular care.
The event is free to attend and comprises individual presentations, panel discussions and sponsored sessions delivered virtually live and on-demand, all tailored to provide maximum convenience and work around your busy schedule.
Why should you attend?
What’s on the agenda?
How do you attend?
Tickets to attend the HHE Clinical Excellence events are free. Book them here. Tickets allow virtual access to all the talks throughout the day. And if you miss any of the sessions, catch up on-demand at a time to suit your schedule!
Save the date! And register to join us on 10 May 2023!
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