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Take a look at a selection of our recent media coverage:

Heart failure to be covered by virtual wards, NHS England says

26th October 2023

Virtual wards should be expanded to include heart failure patients to help reduce recovery times and ease pressure on hospital beds during the winter season, new NHS clinical guidance has outlined.

NHS England has now pushed for integrated care boards to work with cardiac clinical networks to better understand their heart failure population needs and workforce competencies.

The expansion is set to build on the use of and learning from virtual wards for acute respiratory infection and frailty.

It comes after the NHS met its target last month to deliver 10,000 virtual ward beds, through which more than 240,000 patients treated successfully since April 2022.

There are currently a dozen heart failure virtual wards up and running, NHS England said. This includes Liverpool University Hospitals NHS Foundation Trust and Mersey Care NHS Foundation Trust, which together have supported more than 500 people on virtual wards for heart failure.

According to the guidance, as a minimum requirement the new virtual wards should ensure people with heart failure have access to rapid specialist advice and guidance, including via video or telephone, where necessary.

ICBs must also make sure these digital wards feature a daily virtual review with the heart failure team or a multidisciplinary team, with robust processes for escalating concerns.

NHS England also advised an ICB’s approach support ‘seamless patient care’, which may include:

  • Access to multimorbidity specialist input
  • A single point of access
  • Ambulatory care
  • Same day emergency care
  • Rapid response teams
  • Urgent community response
  • Virtual ward plans communicated across the local system.

NHS England’s national clinical director for heart disease Professor Sir Stephen Powis said: ‘More than 240,000 patients have already benefitted from virtual wards, and now we are growing this service to patients with heart failure.

‘This is a positive development in how the NHS can treat patients, and testament to the hard work of our staff after hitting our target of 10,000 virtual ward beds last month.

‘The expansion has been implemented at a key time just before winter, when there will be a lot more pressure on our hospitals and will free up beds for those who need them the most.’

Around 200,000 people a year are diagnosed with heart failure and often require significant NHS support, including long or frequent hospital stays. Some 5% of all emergency hospital admissions in the UK are attributed to the condition.

A version of this story was originally published by our sister publication Healthcare Leader.

Study suggests need for early implantable defibrillators in high-risk heart failure patients

12th September 2023

Percutaneous coronary intervention (PCI) combined with implantable defibrillators and optimal medical therapy (OMT) may benefit high-risk heart failure patients with low left ventricular ejection fractions, according to a recent study.

Patients with ischaemic left ventricular dysfunction normally undergo either coronary artery bypass graft or PCI before the insertion of implantable defibrillators. This is based on the assumption that PCI lowers the incidence of potentially fatal ventricular arrhythmias, avoiding the need to insert such defibrillators.

However, a randomised trial by researchers at King’s College London and funded by the British Heart Foundation (BHF) has revealed that PCI does not reliably improve the heart’s ability to pump or reduce the risk of these life-threatening ventricular arrhythmias. As a result, the team has suggested high-risk patients should no longer have to wait the standard 90 days following PCI before assessing the need for insertion of an implantable defibrillator.

Implantable defibrillators combined with PCI

Patients with heart failure and a low ejection fraction benefit from a cocktail of drug therapy which includes ACE inhibitors, beta-blockers and amiodarone. Consequently, the study protocol dictated that all patients should receive OMT as part of the standard treatment.

Some 700 patients with ischaemic left ventricular systolic dysfunction were randomised to receive either PCI with OMT or OMT alone. Although the use of an implantable defibrillator was considered to be an integral component of OMT for all patients, the decision to implant such a device was at the discretion of heart teams at recruiting centres.

The researchers set a composite primary outcome of all-cause death or aborted sudden death, which was defined as an appropriate implantable defibrillator therapy or a resuscitated cardiac arrest, at a minimum of 24 months.

The median left ventricular ejection fraction was low at 28%, and 53.1% of patients had an implantable defibrillator inserted before randomisation or during the study follow-up.

All-cause death or aborted sudden death occurred in a similar proportion of patients in each group (hazard ratio, HR = 1.03, 95% CI 0.82 – 1.30, p = 0.80). There was also no between-group difference in the occurrence of any of the secondary outcomes.

Commenting on these findings, one of the research team, Dr Holly Morgan, BHF clinical research fellow at the King’s College London BHF Centre of Research Excellence, said: ‘Our findings have revealed that many patients with a high-risk of heart failure could benefit from receiving an ICD [implantable cardioverter defibrillator device] straight away, rather than facing a 90-day wait.‘

She continued: ‘We hope our findings will influence existing guidance, so patients can be spared unnecessary waits to receive a potentially lifesaving defibrillator.‘

Dr Sonya Babu-Narayan, associate medical director at the BHF, added: ‘The results from this large UK-wide trial could lead to re-evaluation of how best to treat people living with severe heart failure due to coronary heart disease. The findings suggest that the current “wait and see“ approach to find out whether a patients’ heart function improves with medication and stents isn’t always best, and that an unnecessary wait could even be the difference between life and death.‘

ESC: Intravenous iron reduces hospitalisations for iron-deficient heart failure patients

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.

FCM therapy and rates of hospitalisation

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.

NICE recommends extending dapagliflozin use in heart failure to reduce hospitalisations

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.

Positive global study for dapagliflozin

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.

Prominent cardiologist Dr Andrew Coats to speak at HHE event

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.

Cardiology content

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.

Focus on heart failure: Dr Andrew Coats

17th April 2023

Dr Andrew Coats describes himself as a career cardiologist specialising in heart failure. He is CEO and scientific director of the Heart Research Institute in Sydney, Australia.

Andrew Coats

Spending around two-thirds of his time in Australia and the remainder in the UK, Dr Coats has had three separate careers. He left medicine to pursue several management and fund-raising roles, took up an academic position and finally moved into commercialisation – currently holding many patents and three start-up companies focusing on devices related to heart failure.

He spoke to Hospital Healthcare Europe about his career and work in cardiology.

Tell us about the work done by the Heart Research Institute

The Institute is dedicated to heart disease and is a basic science research institute looking at novel treatments. In addition to running the Institute, I still find time to see patients, where my focus is on heart failure. The centre is involved with the delivery of a wide range of cardiovascular treatments and interventions, including transplantations.

What do you think are the main challenges in setting up a clinical centre?

The challenge in healthcare is getting funding for ever more that you can do. Running a clinical service in the NHS, as I did in the early 2000s, brings its own challenges, especially managing performance, but having an MBA management qualification helps a lot. While most managers look for ways to increase staff performance, in the NHS setting I had to manage performance differently. Given a fixed annual budget for the services we could provide, my role was to prevent surgeons and cardiologists from undertaking too much work and spending the fixed annual budget too quickly. But managing a service is difficult with the overarching challenge being to make it all work under cost pressures, disease pressures, surviving the Covid-19 era, dealing with political diktats and doing it all affordably, despite the demand from an ageing population and expectations increasing.

Are there any professional achievements that particularly stand out for you?

While there are many clinical and scientific achievements within the organisation, the people are both our best weapon and our worst enemy. Consequently, it is fundamental to achieve a sense of team spirit, effective leadership and communication – you can do 10 times more if you align people and if they’re working together. You can have people who are working furiously for what they perceive as the important pressures and what they’re trying to achieve, but a lot of that effort is wasted if they’re not co-ordinated. The biggest challenges and the greatest successes are achieving a joined-up sense of working together.

It’s not so much the written strategy for an organisation that is ultimately important but the process of writing one because you get people to talk to each other and understand each other’s perspective. This creates a shared understanding of what they are trying to achieve together and not just their piece of the puzzle. This shared understanding is crucial to the success of a service, largely because it allows clinicians, whose primary focus is patient care, to appreciate the wider perspective of the service as a whole.

Does the Institute offer clinician training?

The Institute has formalised and written curricula, which are accredited, for young doctors wishing to specialise in cardiology. These doctors are allocated to hospitals with dedicated trainers and educators to allow them the necessary time to gain experience and become independent consultants a few years later. Over the last 10 to 15 years, there has been a greater and separate accreditation for their ability to perform certain complex or high-risk procedures. This requires the clinician to demonstrate capability, audit their practice and do a minimum number of procedures every year to maintain their accreditation.

Tell us about the clinical research you’re involved in for heart failure

Today, I’m a clinical researcher who evaluates patients rather than undertaking laboratory-based work. In other words, assessing patients’ responses to treatment or the impact of novel devices and involvement with clinical trials. I’ve been involved in many studies over the years and some have led to changes in clinical practice. For instance, I was the first to demonstrate the huge benefits of exercise among those with end-stage heart failure awaiting a transplant, dispelling the perceived wisdom at the time that such patients should not exercise. While not the only group, my team and I were able to show that beta-blockers – which were thought to worsen heart failure and should therefore be avoided – could in fact improve survival if started slowly. More recently, I’ve worked with others to discover that the SGLT-2 inhibitors designed for use in type 2 diabetes are effective in heart failure.

While there have been many benefits associated with medical treatments, devices are very much a growth area. This includes several device therapies that, for instance, can cause electrical stimulation and blockade of the reflex control system, as well as those pacing the heart in a more sophisticated way. Or even devices to control blood flow across the chambers of the heart. Such devices, together with stem cell and gene therapy and monoclonal antibodies, mean the developments in heart failure occur from a variety of different sources.

Looking forward, what do you feel are the key remaining challenges in heart failure and cardiovascular disease?

Perhaps one of the biggest challenges in cardiovascular disease is the need for a paradigm shift in the treatment approach. There are currently two diametrically opposed approaches: splitters and lumpers. The splitters’ philosophy is predicated on the belief that because every patient is unique, treatment should be personalised. In contrast, lumpers believe it is more productive to focus on a particular disease and perform trials to see what works. However, while the lumper approach identifies benefits for patients with a particular condition, these interventions are not always 100% effective.

In heart failure, for example, there are actually two types: a low and a high ejection fraction. Drug treatments mainly work in low ejection fraction. In fact, when drug therapy was used in those with a high ejection fraction, the treatment was ineffective simply because there are several possible causes of this type of heart failure. In trying to better understand which patients are likely to respond to a treatment intervention, cardiologists have borrowed the strategy of precision medicine used by oncologists.

It therefore becomes possible to define patients into much smaller subtypes of disease and then optimise the treatments for this subgroup. While patient identification may initially be more expensive, the overall cost to the health service is lower as there are a smaller number of patients within each subtype. In short, the challenge is therefore to move cardiology from lumpers to splitters and develop more precision medicine.

I’m also involved in multiple research projects developing a raft of innovations, and these will hopefully deliver improvements to the care of patients with heart failure in the coming years.

Dr Coats is an advisory board member for HHE Clinical Excellence in Cardiovascular Care. He will be chairing a panel discussion at the event on 10 May 2023. Find out more and register for free here.

Cardiac sphericity a possible early marker for cardiomyopathy and related adverse outcomes

6th April 2023

In a study using deep learning-enabled image segmentation of cardiac magnetic resonance imaging data, US researchers identified how variation in the left ventricle (LV) sphericity index in otherwise normal hearts, predicts the risk for cardiomyopathy and related outcomes such as atrial fibrillation.

Dilation of cardiac chambers and or a decline in systolic function are key indicators of disease and which can be assessed using conventional imaging modalities to quantify such changes. Moreover, deep neural networks have shown a great potential in image pattern recognition and automated methods achieve a performance on par with human experts in analysing cardiovascular magnetic resonance images and deriving clinically relevant measures. Cardiomyopathies of different aetiologies can often result in a similar end-stage phenotype of a more round, spherical ventricle. In fact, in patients with cardiac diseases, a greater sphericity of the left ventricle, has, for example, been shown to be an independent predictor of 10-year survival following an acute myocardial infarction. In the current study, researchers thought that even among those with normal heart function, there was likely to be variation in cardiac sphericity, in particular, sphericity of the left ventricle and that this may serve as marker of cardiac risk, especially among those with an underlying genetic risk.

Using automated deep-learning segmentation of cardiac magnetic resonance imaging (MRI) data, the researchers estimated and analysed the sphericity index in patients who were part of the UK Biobank database but excluded those with either abnormal left ventricular size or systolic function.

Cardiac sphericity and risk of cardiomyopathy

In a total of 38,897 participants, the researchers calculated that for one standard deviation increase in the sphericity index, or roundness of the heart, there was an associated 47% increased incidence of cardiomyopathy (hazard ratio, HR = 1.47, 95% CI 1.10 – 1.98, p = 0.01). In addition, the same increase in the sphericity index, was associated with a 20% increased incidence of atrial fibrillation (HR = 1.20, 95% CI 1.11 – 1.28, p < 0.001) and which was independent of clinical factors and traditional magnetic resonance imaging (MRI) measurements. In contrast, similar increases in the sphericity index were non-significantly associated with the risk of both heart failure (p = 0.3) and cardiac arrest (p = 0.70).

The team also identified four loci associated with sphericity at genome-wide significance and concluded that the variation in left ventricular sphericity in otherwise normal hearts, predicts the risk for cardiomyopathy and related outcomes and is caused by non-ischaemic cardiomyopathy.

Vukadinovic M et al. Deep learning-enabled analysis of medical images identifies cardiac sphericity as an early marker of cardiomyopathy and related outcomes. Med 2023

Increased NT-proBNP levels over time linked to greater risk of heart failure and death

1st March 2023

Increased levels of NT-proBNP over time lead to an elevated risk of both heart failure and mortality among those without heart failure

Increases in the level of N-terminal B-type natriuretic peptide (NT-proBNP) over time are associated with a higher risk of incident heart failure and death among those initially without the disease according to the findings of a study by US researchers.

NT-proBNP levels serve as an important biomarker for patients with chronic heart failure. In fact, higher levels of the protein upon admission to hospital with COVID-19, have also been associated with an increased mortality risk and other complications in patients with and without heart failure. However, in many studies, NT-proBNP has been assessed at a single time-point and in the current work, researchers looked at changes in the biomarker over time and whether this might be prognostic for the development of heart failure among those who were initially free of the disease.

The team used data from the Atherosclerosis in the Communities (ARIC) study and included participants who had measurements of the biomarker at year 2 and 6 (i.e., 4 years apart) but had not been diagnosed with heart failure. The primary exposure variable was the change in NT-proBNP between visits 2 and 4, categorised as either <125 pg/mL or ≥125 pg/mL and the primary outcome measures were set as incident heart failure (HF) hospitalisation and all-cause mortality.

NT-proBNP and risk of heart failure

Data were available for 9,776 individuals (mean age = 57.1 years, 56.5% female) and who were included in the analysis.

Individuals with NT-proBNP levels of 125 pg/mL or higher at both visits had a significantly higher risk of incident HF compared to those with levels below this threshold (adjusted Hazard Ratio, aHR = 2.40, 95% CI 2.00 – 2.88). Similarly, there was an elevated risk of mortality (aHR = 1.68, 95% CI 1.47 – 1.91). Interestingly, those with NT-proBNP levels of 125 pg/mL or higher at visit 2 but which was lower at visit 4, still had a higher risk of HF although the result was not significant (HR = 1.01, 95% 0.71 – 1.43) when compared to those who levels were below the threshold at both visits. There was also a significant increase in HF and mortality risk based on the percent change in the biomarker per 1 standard deviation increase. There were also significant associations with cardiovascular risk factors such as systolic blood pressure, body mass index, triglyceride and low-density lipoprotein cholesterol and the change in NT-proBNP.

The authors concluded that the changes in NT-proBNP over time, reflected a dynamic change in the risk of HF events and death among those without prevalent clinical HF. They added that serial measurements of NT-proBNP could be use to improve risk stratification of patients pre-heart failure.

Jia X et al. Association of Long-term Change in N-Terminal Pro-B-Type Natriuretic Peptide With Incident Heart Failure and Death. JAMA Cardiol 2023

Torsemide and furosemide all-cause mortality similar in heart failure

24th January 2023

Torsemide treatment leads to similar levels of all-cause mortality as furosemide among patients hospitalised with heart failure

Treatment with the loop diuretic torsemide (TM) leads to a similar level of all-cause mortality and all-cause hospitalisations as furosemide (FM) following hospital discharge in patients with heart failure according to the findings of a randomised trial by US researchers.

Heart failure is growing public health concern with an estimated global prevalence exceeding 37.7 million people. Both fluid retention and congestion are key features of the condition which are treated with loop diuretics and this approach is recommended in therapy guidelines. Although furosemide is an established loop diuretic, another agent, torsemide, has both a longer half-life and greater oral bioavailability than furosemide. Moreover, some evidence points to a lower mortality in patients with congestive heart failure treated with torsemide compared to furosemide. However, studies have not been sufficiently powered to address mortality differences between the two agents.

In the present study, researchers undertook an open-label, randomised trial to examine the comparative effectiveness of TM and FM in patients discharged from hospital following an admission for heart failure, irrespective of their ejection fraction. The researchers hypothesised that torsemide would lower all-cause mortality by 20% compared to furosemide. Patients were eligible if they were hospitalised for either de novo heart failure or a worsening of chronic heart failure and randomised 1:1 to either furosemide or torsemide. The researchers set the primary effectiveness outcome as all cause mortality whereas one of the main secondary outcomes was all-cause hospitalisations.

Torsemide and all-cause mortality

A total of 2,859 patients with a mean age of 64.5 years (36.9% female) were randomised to either diuretic and followed for a median of 17.4 months.

During follow-up, death occurred in 26.1% of the TM group and 26.2% of the FM group and this difference was not significant (hazard ratio, HR = 1.02, 95% CI 0.89 – 1.18, p = 0.76). In addition, all-cause mortality or all-cause hospitalisations occurred in 47.3% of those assigned to TM and 49.3% of patients in the FM group (HR = 0.92, 95% CI 0.83 – 1.02). There were also no significant differences in any of the subgroups analysed, including patients with differing levels of ejection fractions.

Although there were no significant differences between the two loop diuretics, the researchers did acknowledge at least two potentially important study limitations including treatment discontinuation (9.5% of any agent at 6 months) and cross-over (7% for TM to FM) between the two agents could have had an effect.

They concluded that while torsemide did not lower all-cause mortality compared to furosemide, these findings should be interpreted with caution given the rates of discontinuation and cross-over.

Mentz RJ et al. Effect of torsemide vs furosemide after discharge on all-cause mortality in patients hospitalized with heart failure: The TRANSFORM-HF randomized clinical trial. JAMA 2023

Higher plant omega-3 levels reduce death and hospitalisation risk in heart failure

4th November 2022

Higher plant omega-3 levels in heart failure (HF) patients reduces mortality and first HR hospitalisation risk more than marine-based omega-3

A higher level of plant omega-3 levels in ambulatory heart failure patients significantly reduced all-cause mortality and first heart failure hospitalisation risk compared to levels of marine-based omega-3 according to the findings of a study by Spanish researchers.

The supplementation with marine-based omega-3 fatty acids can provide a small beneficial advantage in terms of mortality and cardiovascular-related hospital admission in patients with heart failure. Other work has suggested that omega-3 fatty acid supplements also offer benefits on recurrent heart failure hospitalisation although further work is required to confirm these findings. However, not everyone eats fish or wants to take supplements and for such individuals, omega-3 fatty acids can be obtained through the diet via other sources. For example, plant omega-3 sources include alpha-linolenic acid (ALA) which is present in flaxseed and walnut oil. But whether this plant-based source of fatty acids provides the same benefits to heart failure patients as marine-based acids is unclear.

In the present study, the Spanish team speculated that regular consumption of ALA foods would provide a beneficial effect in terms of morbidity and mortality for patients with heart failure. To provide a more accurate measure of intake, rather than relying on self-reporting, the Spanish team assessed ALA levels in serum phospholipids which provides a more objective measure of ALA intake. For comparative purposes, they also measured serum levels of marine-based omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). The team recruited patients who attended a heart failure unit with a tertiary hospital in Barcelona. The primary outcome was a composite of all-cause mortality or first heart failure hospitalisation although the researchers also separately examined the components of the composite as secondary outcomes. The levels of ALA were split into quartiles and multivariable regression analysis was used and focused on a comparison of the lowest (Q1) versus the highest (Q2 – Q4) levels.

Plant omega 3 levels and heart failure outcomes

A total of 905 patients with a mean age of 67 years (31.7% female) were included and followed up for a median of 2.4 years.

The primary endpoint occurred in 184 patients during follow-up including141 heart failure hospitalisations. When comparing ALA levels between Q1 and Qs 2-Q4, there was a 39% lower risk of the primary endpoint (Hazard ratio, HR = 0.61, 95% CI 0.46 – 0.81, p = 0.001). There were similarly significant reductions for the components of the composite, i.e., all-cause mortality (HR = 0.58, 95% CI 0.41 – 0.82, p = 0.002) and first heart failure hospitalisation (HR = 0.58, 95% CI 0.40 – 0.84).

Interestingly, when looking at the combined levels of EPA and DHA there was no significant effect on the primary endpoint when comparing Q1 with Q2 – Q4 (HR = 1.11, 95% CI 0.82 – 1.51, p = 0.502). The effect on both all-cause mortality and heart failure hospitalisation were also non-significant.

The authors concluded that elevated levels of plant omega-3 fatty acids in serum were related to a lower risk of incident adverse clinical outcomes in patients with heart failure.

Lazaro I et al. Relationship of Circulating Vegetable Omega-3 to Prognosis in Patients With heart failure J Am Coll Cardiol 2022