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Take a look at a selection of our recent media coverage:
4th September 2023
Individuals with a greater exercise capacity have a reduced risk of developing atrial fibrillation (AFib), ischaemic stroke and major adverse cardiovascular events (MACE), according to the findings of a large study presented at the European Society of Cardiology (ESC) Congress, 2023.
AFib is the most common cardiac arrhythmia and has a number of different causes including auto-immune diseases such as rheumatoid arthritis.
Whether being physically fit might reduce the risk of developing AFib is unclear, although some evidence reveals a graded, inverse relationship between cardiorespiratory fitness and incident AFib, especially among obese individuals.
The study included 15,450 individuals without AFib who had a mean age of 54.9 years (59% male). All participants were referred for a treadmill test between 2003 and 2012.
Fitness was assessed using the Bruce protocol, where participants are asked to walk faster and at a steeper grade in successive three-minute stages. It was then calculated according to the rate of energy expenditure the participants achieved, which was expressed in metabolic equivalents (METs).
Participants were then divided into three fitness levels according to the METs achieved during the treadmill test: low (less than 8.57 METs), medium (8.57 to 10.72) and high (more than 10.72).
The researchers looked for independent associations between exercise capacity on the treadmill and the risk of new-onset AFib, risk of ischaemic stroke and MACE. The results were adjusted for potential confounders including age, sex, cholesterol level, kidney function, prior stroke, hypertension and any medications.
During the period of follow-up, new-onset AFib occurred in 3.33% of participants.
In fully adjusted models, each one MET increase in exercise treadmill testing, there was an associated 8% lower risk of AFib incidence (hazard ratio, HR = 0.92, 95% CI 0.88 – 0.97).
In addition, this one MET increase was also associated with a lower risk of ischaemic stroke (HR = 0.88, 95% CI 0.83 – 0.94) and a 14% reduced risk of MACE (HR = 0.86, 95% CI 0.84 – 0.88).
In fact, the probability of remaining free from AFib over a five-year period was calculated to be 97.1%, 98.4% and 98.4% in the low, medium and high exercise capacity groups, respectively.
Study author Dr Shih-Hsien Sung of the National Yang Ming Chiao Tung University in Taipei, Taiwan, said: ‘This was a large study with an objective measurement of fitness and more than 11 years of follow up. The findings indicate that keeping fit may help prevent atrial fibrillation and stroke.‘
31st August 2023
The total cost of cardiovascular disease (CVD) in the EU reached an estimated €282bn in 2021, according to new research presented at the European Society of Cardiology (ESC) Congress 2023.
Cardiovascular healthcare accounted for €130bn (46%) of the expenditure, while productivity losses associated with absenteeism and retirement due to illness and disability (5%) and premature death (12%) were estimated at €15bn and €32bn, respectively.
This is the first study to use Europe-wide patient registries and surveys rather than relying on assumptions and, for the first time, includes the costs of long-term social care, which accounted for €25bn (9%) of the total.
A wide variation between countries was identified in the proportion of healthcare budgets spent on CVD, ranging from 6% in Denmark to 19% in Hungary.
The total cost of CVD equated to €630 per EU citizen, varying from €381 in Cyprus to €903 in Germany.
A collaboration between the ESC and the UK’s University of Oxford, this was the most comprehensive and up-to-date analysis of the economic costs of CVD to EU society since 2006.
Study author Dr Ramon Luengo-Fernandez, associate professor at the University of Oxford, said: ‘CVD had a significant impact on the EU27 economy, costing a total of €282bn in 2021. That’s equivalent to 2% of Europe’s GDP and is significantly more than the entire EU budget itself [€186.6bn in 2023], used to fund research, agriculture, infrastructure and energy across the Union.’
In the study, healthcare included primary care, emergency care, hospital care, outpatient care and medications, while social care included long-term institutionalised care, and care at home.
The main contributor to the expenditure was hospital care at €79bn, representing 51% of CVD-related care costs, and CVD medications accounted for €31 billion (20%). Residential nursing care home costs totalled €15bn (9%).
Informal care, which includes the work or leisure time, valued in monetary terms, that relatives and friends gave up to provide unpaid care accounted for €79bn (28%) of the costs. The research found 7.5 billion hours of unpaid care were provided by relatives and friends for patients with CVD.
What’s more, million working-days were lost in the EU in 2021 because of CVD illness and disability, while 1.7 million people died due to CVD across the EU, representing 1.3 million working-years lost.
ESC board member and study author Professor Victor Aboyans, head of cardiology at University Hospital Limoges in France, said: ‘This study underscores the urgent need to act collectively on the European scale to better combat the cardiovascular risk of European citizens, in particular through regulations for better cardiovascular prevention and investment in research.
‘By choosing not to invest in cardiovascular disease we are simply deferring the cost. These data force us to ask the question: do we invest in cardiovascular health today or be forced to pay more at a later stage?’
Professor Panos Vardas, chief strategy officer of the European Heart Agency, added: ‘It is evident that there is significant fragmentation among EU countries in terms of cardiovascular disease healthcare expenditures. This necessitates a re-evaluation by the EU as a whole, and the 27 EU countries individually, to better address the outstanding needs and invest more effectively in supporting those suffering from cardiovascular disease.’
30th August 2023
The use of intravenous ferric carboxymaltose (FCM) in heart failure patients with iron deficiency reduces the risk of hospitalisation and cardiovascular death, according to research presented at the recent European Society for Cardiology (ESC) Congress 2023 in Amsterdam.
Researchers undertook a meta-analysis of individual participant data from three randomised, placebo-controlled trials of FCM in adult patients with heart failure and iron deficiency: CONFIRM-HF, AFFIRM-HF and HEART-FID.
Across the three trials, a total of 4,501 patients with heart failure and reduced or mildly reduced left ventricular ejection fraction and iron deficiency were randomly assigned to FCM (n = 2,251) or placebo (n=2,250) for 52 weeks. The mean age of the total population was 69 years, 63% were men and the mean left ventricular ejection fraction was 32%.
Researchers set the primary efficacy endpoints as a composite of total cardiovascular hospitalisations and cardiovascular death, as well as a composite of total heart failure hospitalisations and cardiovascular death. Key secondary endpoints included individual components of the composite endpoints.
The trial results revealed FCM therapy significantly reduced the co-primary composite endpoint of total cardiovascular hospitalisations and cardiovascular death compared with the placebo (rate ratio, RR = 0.86, 95% CI 0.75 – 0.98, p = 0.029).
Although there was a trend towards reduction of the co-primary composite endpoint of total heart failure hospitalisations and cardiovascular death, this was not statistically significant (RR = 0.87, 95% CI 0.75 b- 1.02, P = 0.076).
Nevertheless, FCM therapy was associated with a 17% relative rate reduction in total cardiovascular hospitalisations (RR = 0.83, 95% CI 0.73 – 0.96, p = 0.009) and a 16% relative rate reduction in total heart failure hospitalisations (RR = 0.84, 95% CI 0.71 – 0.98 p = 0.025). Despite these benefits, FCM therapy had no effect on mortality.
Professor Piotr Ponikowski, the principal investigator and vice-rector of Wroclaw Medical University, Poland, said: ‘This was the largest and most up-to-date analysis of the effect of FCM in iron-deficient heart failure patients with reduced or mildly reduced ejection fraction.‘
He added: ‘The findings indicate that intravenous FCM should be considered in iron-deficient patients with heart failure and reduced or mildly reduced ejection fraction to reduce the risk of hospitalisation due to heart failure and cardiovascular causes.‘
Heart failure is one of the leading causes of avoidable hospitalisations and iron deficiency is present in over 30% to 50% of patients.
Although iron therapy is known to improve functional capacity, symptoms, and quality of life, until the current meta-analysis, no studies have examined whether treatment impacts on clinical events such as hospitalisation.
Being more sedentary in childhood leads to a higher left ventricular mass in young adulthood, which is an independent risk factor for cardiovascular events. This was the key finding of a study presented at the recent European Society of Cardiology (ESC) Congress 2023 in Amsterdam.
The study also revealed that this increased risk occurred even in those with a normal weight and blood pressure.
The first study to investigate the cumulative effect of smartwatch-assessed sedentary time in young people and cardiac damage later in life, the researchers asked children aged 11 to wear a smartwatch with an activity tracker for seven days. This was repeated at 15 years of age and again at age 24.
Echocardiography which the imaging modality of choice to assess left ventricular end-diastolic and end-systolic volumes, was used assess the mass of the left ventricle. Measurements were undertaken at ages 17 and 24 years of age and reported in grams relative to height (g/m2.7).
The study enrolled 766 children (55% girls). At 11 years of age, the participants were sedentary for an average of 362 minutes a day. This rose to an average of 474 minutes a day in those 15 years of age, and further still to 531 minutes by age 24.
Sedentary time therefore increased by an average of 169 minutes or 2.8 hours per day between childhood and young adulthood.
The researchers calculated that each one-minute increase in sedentary time from 11 to 24 years of age, was associated with a 0.004 g/m2.7 increase in left ventricular mass between the ages of 17 and 24 years.
When multiplied by 169 minutes of additional inactivity, this equates to a 0.7 g/m2.7 daily rise – the equivalent of a 3 g increase in left ventricular mass between echocardiography measurements at the average height gain.
Study author Dr Andrew Agbaje of the University of Eastern Finland in Kuopio, Finland, said: ‘Children were sedentary for more than six hours a day and this increased by nearly three hours a day by the time they reached young adulthood.
‘Our study indicates that the accumulation of inactive time is related to heart damage regardless of body weight and blood pressure. Parents should encourage children and teenagers to move more by taking them out for a walk and limiting time spent on social media and video games’.
25th August 2023
Survivors of a myocardial infarction (MI) who discontinue aspirin remain at an elevated risk of a subsequent infarction, stroke or even death over the next eight years compared to those who remain adherent to treatment.
These were the findings of a a study presented at the recent European Society of Cardiology (ESC) Congress 2023 in Amsterdam.
While the use of aspirin is no longer recommended for use as a primary preventative strategy, despite continued use, especially in the elderly, it remains an essential component of secondary prevention treatment.
Researchers used Danish nationwide health registries to look at patients aged 40 years and over who had a first MI and were prescribed aspirin during the first year after it. Their aim was to examine the extent to which MI survivors collected a prescription for aspirin over the next two, four, six and eight years and the clinical consequences of not taking the drug.
Adherence to aspirin at each of the four time points was assessed as the proportion of days patients had collected the drug over the preceding two years.
Non-adherence was defined when survivors used aspirin for 80% or less of the time and patients were excluded at each time point if they had experienced another heart attack, a stroke, died, or had been started on other anticoagulants or P2Y12 inhibitors.
The researchers analysed whether patients who did not take aspirin as prescribed had a higher risk of the composite outcome of recurrent heart attack, stroke or death compared with those who consistently took aspirin.
The study included 40,114 patients with a first-time MI. Adherence to aspirin progressively declined with each time point, from 90% at two years post-MI, to 84% at four years, 82% at six years and 81% at eight years.
At each of the time-points, adherence to aspirin was associated with a reduced risk of the composite outcome. For example, when compared to adherent patients, non-adherent patients had a 29%, 40%, 31% and 20% higher likelihood of recurrent heart attack, stroke or death at two, four, six and eight years post-MI, respectively.
Commenting on the findings, study author Dr Anna Meta Kristensen of Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark, said: ‘Our findings suggest that not taking aspirin as prescribed after a heart attack is linked to a higher risk of having another heart attack, a stroke or dying.‘
However, she added: ‘Our results should be interpreted with caution because they show an association but do not establish causality. Since the study is registry-based, we do not have information about the specific reasons as to why patients did not take their aspirin.
‘Furthermore, our findings cannot be generalised to all patients who experience a heart attack, as our study specifically focused on those who received treatment with a coronary stent and were not taking other medications to prevent blood clot formation.
‘With that in mind, the results support current guidelines recommending long-term aspirin after a heart attack.‘
Recognising the signs and symptoms of a myocardial infarction is linked with faster life-saving treatment and reduced in-hospital mortality, according to a recent study presented at the 2023 European Society of Cardiology (ESC) congress in Amsterdam.
Researchers in the Republic of Korea have found a correlation between symptom recognition, time to treatment and mortality in those experiencing a myocardial infarction.
Although AI-based tools are becoming potentially valuable as an aid to quickly diagnose a myocardial infarction, if patients are capable of recognising the most common symptoms, this too could ensure they receive prompt treatment.
The current study, ‘Effect of symptoms recognition in patients with recurrent acute myocardial infarction: from KRAMI-RCC stratification in acute coronary syndromes’, used data from KRAMI-RCC – a registry of myocardial infarction patients in the Republic of Korea.
Trained nurses consulted with survivors of myocardial infarction, asking them if they recognised six sets of symptoms: chest pain; shortness of breath; cold sweat; radiating pain to the jaw, shoulder or arm; dizziness, vertigo, lightheadedness, loss of consciousness; and stomach ache.
Patients were then classified as ‘recognised symptoms‘ if they could identify at least one symptom, otherwise they were classified as ‘did not recognise symptoms‘.
The study included 11,894 myocardial infarction patients, of whom 90.4% had a first-time event and 9.6% a repeat event. Overall, just over half (52.3%) of patients recognised the symptoms.
The majority of patients (92.9%) could identify chest pain as a symptom. However, only a third (32.1%) identified shortness of breath and cold sweats (31.4%) and just 1.3% recognised stomach ache.
Among 57.4% of patients who correctly identified the symptoms, treatment was received within two hours, compared to 47.2% of those who did not recognise the symptoms.
Moreover, the in-hospital mortality rate was much lower for those able to recognise symptoms (1.5% vs 6.7%).
For patients with recurrent myocardial infarction, the recognition rate was 57.5% for those previously enrolled in KRAMI-RCC and just 14.4% of patients with a first-time myocardial infarction could identify the symptoms.
Study author Dr Kyehwan Kim of Gyeongsang National University Hospital in Jinju, Republic of Korea, said: ‘The findings indicate that education is needed for the general public and heart attack survivors on the symptoms that should trigger calling an ambulance.
‘In our study, patients who knew the symptoms of a heart attack were more likely to receive treatment quickly and subsequently survive. Women, older patients, those with a low level of education and people living alone may particularly benefit from learning the symptoms to look out for.‘
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