Cardiovascular Health Campaign

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SEPTEMBER 2017 HEALTHAWARENESS.CO.UK READ Day-to-day advice for living with heart failure. P04

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on heart disease with the BHF.

Cardiovascular Health Cricket legend, James Taylor shares his personal story with a lifechanging diagnosis

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IN THIS ISSUE

Diagnosed with heart failure?

Do not sit on the side lines!

How well do you know your heart rhythm?

Join the celebration and join the campaign for World Heart Day.

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Heart disease doesn’t discriminate – it affects us all Seven million people in the UK are currently living with cardiovascular disease. People of all ages are being affected by the conditions.

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ince the 1960s we’ve made significant steps forward in treating heart and circulatory disease. If you had a heart attack in the 1960s, you had a very poor chance of surviving.

Thanks to generous support for medical research funders, countless hours of laboratory research and advances in technology, the majority of heart attack patients now survive.

With more people surviving heart attacks, death rates have fallen dramatically, but after decades of this steep downward trend, progress is levelling off and we could be grinding towards a plateau.

At the same time, we’re facing a worrying situation, whereby more Follow us

people are living with heart and circulatory disease than ever before.

Heart and circulatory disease, or cardiovascular disease, is an umbrella term for conditions such as coronary heart disease, angina, heart attack, stroke and vascular dementia.

Around seven million people in the UK are currently living with a cardiovascular disease, costing the NHS billions of pounds every year.

This is a number that is likely to rise with an ageing and growing population. Records show that the number of hospital visits for cardiovascular disease has reached the highest level for decades.

It is a myth that heart disease is a ‘man’s disease’ and only affects people in later life when their bad lifestyle habits start to catch up with them. facebook.com/MediaplanetUK

Simon Gillespie Chief Executive of the British Heart Foundation

“It is a myth that heart disease is a ‘man’s disease’ and only affects people in later life” @MediaplanetUK

Heart disease doesn’t discriminate; it can affect anyone at any time. From the elderly living with heart failure to children born with holes in their hearts, from athletes at the peak of fitness – but have inherited faulty genes, such as England cricketer, James Taylor – to young mothers whose hearts are damaged during pregnancy. With such a wide range of people affected there is so much more for us to learn and understand.

The ‘holy grail’ of heart research is to find a way to stop atherosclerosis – the build up of fatty plaque in the arteries that leads to coronary heart disease. As you age, fat is gradually deposited in your arteries, which can block vital blood flow to your heart muscle. It’s a condition that eventually affects most people (some more than others) depending

on your lifestyle and genes.

While reducing or avoiding risk factors, such as smoking and poor diet, can delay the onset and impact of this condition we still have no way of preventing it. This is why we need to continue supporting medical research to better understand the process and find a way to stop it.

Looking ahead, there are opportunities for us to capitalise on our position in the UK as the world’s leading centre for cardiovascular research and discover new and better ways of preventing, diagnosing and treating cardiovascular disease.

But to make it happen we need investment in medical research, international collaboration with the very best scientists and support to help make tackling cardiovascular disease a priority again.

@MediaplanetUK

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Project Manager: Kirsty Elliott E-mail: kirsty.elliott@mediaplanet.com Content and Production Manager: Kate Jarvis Business Development Manager: Jake Crute Digital Content Strategist: Chris Schwartz Managing Director: Alex Williams Social Media Coordinator: Jenny Hyndman Designer: Juraj Príkopa Mediaplanet contact information: Phone: +44 (0) 203 642 0737 E-mail: info.uk@mediaplanet.com

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The best day-to-day advice for coping with heart failure People diagnosed with heart failure can follow some simple guidelines for a better life, says Louise Clayton, Heart Failure Advanced Nurse Practitioner.

By Tony Greenway

What is heart failure?

It means the heart pump is weaker than it should be and is failing to meet the demands of the body. There are many reasons it occurs, including coronary heart disease and high blood pressure — and it’s common, particularly as we age. It’s not curable.

What are the main symptoms?

You may have breathlessness on exertion during what would normally be, for you, routine activity.

For example, people who are generally fit may notice that they can’t walk around the park as quickly as they used to, or that they get more breathless going up the stairs. At the extreme end, they may get breathless washing or dressing. Fatigue — not simply tiredness — is another common symptom, and they may have swollen ankles and feet.

What are your tips for living well with heart failure?

The quicker you see a specialist, via GP referral, the better! It’s also

Louise Clayton Heart Failure Advanced Nurse Practitioner, University Hospitals of Leicester

vital to take your medication as prescribed; if it isn’t working, or you have side-effects, see your doctor.

Taking regular exercise is key. I’m not talking trampolines and treadmills: walking is free! Start small and build up gently, and the best way of doing that is going through a formal rehabilitation programme.

Don’t smoke; drink alcohol in moderation; eat a healthy diet with lots of fruit, veg and oily fish; and watch your fluid intake. The British Heart Foundation advises no more than two litres a day.

Do you have any advice for family members or carers?

Learn about the condition and talk to a specialist, which can reduce anxiety. Take time out for yourself: it’s really important not to get ‘carer weary’.

Be vigilant of any changes to the person you care for, but make sure they retain their independence as much as possible.

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Why self-monitoring is essential for heart failure patients Heart failure patients should be aware of the warning signs which indicate their condition is worsening. Careful monitoring may even delay or halt the need for a hospital admission.

By Tony Greenway

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ver the last decade, there has been a deliberate effort on the part of clinicians to encourage heart failure patients to monitor their own conditions. “Heart failure is a chronic condition, characterised by phases of stability interrupted by phases of ‘decompensation’ (worsening),” says Professor Iain Squire, Professor of Cardiovascular Medicine at the University of Leicester and Honorary Consultant Physician, University Hospitals of Leicester. “Unfortunately, a decompensation phase is often associated with the need for hospital admission, so it’s important to empower patients and/or their carers to identify the signs of deterioration before things get to the admission stage.”

Be aware of changes In this age of tech-driven innovation, are devices routinely available

to help do this effectively? No, says Squire: it’s not quite that simple. For example, you may think that standard ECG (electrocardiogram) monitors — such as Holter monitors and loop monitors — keep check on heart failure stability, but they don’t.

“Individuals who are asked to wear ECG monitors by health professionals will include those with heart failure,” says Squire. “But this type of monitor only records abnormal heart rhythm activity which indicates that a further intervention may be necessary.” There are implanted devices that do monitor heart failure stability, called pulmonary artery pressure monitors, but, as these are for patients with chronic heart failure, it’s technology which is not cheap and therefore not routinely available.

The best way to monitor heart failure is simply to be alert to any changes in your health —these are easy to spot.

The main symptoms include breathlessness, fatigue and fluid retention

– usually in the ankles – which can quickly cause weight gain.

Professor Iain Squire Professor of Cardiovascular Medicine, University of Leicester and Chair, British Society for Heart Failure (BSH)

“Main symptoms include breathlessness, fatigue and fluid retention”

Importance of early intervention If a friend or someone in your family has been diagnosed with heart failure, it’s important to notice changes on their behalf, because they might not. “Many patients with heart failure are elderly and may have impaired faculties,” says Squire.

“Their eyesight and hearing may not be good and they may have a degree of cognitive impairment.” And, of course, the earlier you make their GP or cardiac specialist aware of any changes, the better.

In the UK, the vast majority of heart failure patients have access to a community-based specialist heart failure nurse who will regularly monitor weight, blood pressure and pulse.

For some, a trip to see the nurse may head off a trip to see their consultant — or, in worse case scenarios, a stay in

hospital. “Community heart failure nurses can encourage patients who are showing signs of fluid retention to increase their diuretics — and so reduce fluid — before they make contact with their own health care professional,” says Squire.

And while heart failure remains incurable, its treatment has improved markedly in recent years, which means that patients are living longer and better lives. “We’re lucky to have a large number of leading research scientists in this area in NHS institutions and UK universities,” says Squire. “Plus, we’re fortunate to be able to prescribe heart failure patients with medication and devices whose benefits have been proven in large, well-run clinical trials.”

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Changing Changingthe thepractice practiceof ofmedicine medicine AtAtNovartis, Novartis,we weharness harnessthe theinnovation innovationpower powerofofscience sciencetoto address addresssome someofofsociety’s society’smost mostchallenging challenginghealthcare healthcareissues. issues.

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How insight from C heart failure patients a can make real change

By Tony Greenway

Heart Failure 1 2

Heart Failure affects 900,000 people in the UK.1

3 4 5 6 7 8

30-40 per cent of those diagnosed with heart failure die within the first year.3

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Between 1998 and 2012, survival rates for people aged over 45 with heart failure showed no improvement, in contrast to cancer survival rates in the UK which have doubled in the last 40 years.9

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Heart failure represents the second highest cost to the NHS for any disease after stroke.10

Heart failure is debilitating and outcomes are poor: 5 year survival rate is worse than breast or prostate cancer.2

Heart failure is a major cost to the NHS. It is a leading cause of hospital admission in over 65s.4 One of five long-term conditions responsible for 75 per cent of unplanned hospital admissions.5 It is recommended that patients with suspected heart failure have ready access to echocardiograms.6 There is an acute shortage of echocardiographers in the UK.7 According to the National Heart Failure Audit: a. 80 per cent of patients admitted to hospital with symptoms of heart failure are seen by a heart specialist (indicating that one in five is not receiving specialist input). b. The mortality of patients hospitalised with heart failure remains high overall at 8.9 per cent8

1

https://www.nice.org.uk/guidance/cg108/chapter/Introduction

2

http://circoutcomes.ahajournals.org/content/circcvoq/early/2010/10/05/ CIRCOUTCOMES.110.957571.full.pdf

3

http://heart.bmj.com/content/83/5/505.long

4

https://www.nice.org.uk/guidance/cg187

5

https://www.england.nhs.uk/wp-content/uploads/2014/03/red-acsc-em-admissions-2.pdf

6

https://www.england.nhs.uk/wp-content/uploads/2014/03/red-acsc-em-admissions-2.pdf

7

http://bmjopen.bmj.com/content/4/3/e003866.full#T2

8

http://www.ucl.ac.uk/nicor/audits/heartfailure/documents/annualreports/ annual-report-2015-6-v8.pdf

9

https://academic.oup.com/fampra/article-lookup/doi/10.1093/fampra/cmw145

10

https://academic.oup.com/fampra/article-lookup/doi/10.1093/fampra/cmw145

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How patients can use social media

Patients with heart failure shouldn’t sit on the sidelines.

Their valuable insights not only help others with the condition but add to the NHS’s knowledge to improve patient quality of life and outcomes.

When it comes to the medical treatment of heart failure patients, it’s the clinicians — such as heart failure specialists, like consultant cardiologists, heart failure nurses and GPs — who know best. However, “it is the individual heart failure patients who know their condition, says Nick Hartshorne-Evans, – “they can tell you what having the condition is really like”, which is why it’s so important that their voices are heard and listened to by bodies such as the NHS, NICE, the new Sustainability and Transformation Partnerships (STPs), Clinical Commissioning Groups (CCGs) and Academia.

Using patient insight Hartshorne-Evans — a heart failure patient himself — is the CEO and founder of the Pumping Marvellous Foundation, a UK, patient-led heart failure charity. Hartshorne-Evans also sits on the NICE Chronic Heart Failure Guidelines Committee. “The patient has a unique perspective,” he says.

“They are driven by need and unconcerned with cost. They add real value to the conversation around heart failure because they have insights about the patient experience and solutions to discuss. The knowledge within the patient population is generally untapped. Bear in mind that the heart failure patient population is huge: roughly 900,000 people are affected by the condition. That’s a massive bank of knowledge from individuals from all walks of life that can be a powerful resource for the NHS.” For example, Hartshorne-Evans, recently polled the online heart failure patient community to ask how they would like to receive information about their condition: digitally or in print? (Print is still favourite but online they could explore their condition further). Other patient insights might include concerns about medication, worries about life expectancy, employment concerns and general

Nick Hartshorne-Evans CEO and Founder, the Pumping Marvellous Foundation

day-to-day living; life with heart failure is very uncertain.

How individuals felt when they were given their diagnosis by their healthcare professional is a very prominent concern. How would you feel having been told: ‘You have Heart Failure’? “We’ve asked patients about their reactions to this news, because a medical professional’s tone at diagnosis is so important,” says Hartshorne-Evans. “It’s useful to hear from those who’ve experienced it, and to understand what they feel that tone should be. Some may want to be told ‘how it is’, others require a different, more rounded approach.” Doctors need to decipher how to tailor their communications style. If this kind of insight is taken on board by doctors, it will ultimately help other patients.

Patients should talk to each other It can also help if patients talk to each other. Social media platforms have an advantage over face-to-face meetings because, in moderated, well-managed, closed community groups, people can dip in and out of conversations. They can find answers when they need to get instant feedback, rather than having to wait for an appointment. “In one group we run, someone commented: “I’ve been a member of this group for two years, haven’t posted anything but watched and learnt how to manage my heart failure. But I now have a question.

Can anyone help?” This individual had been reading about other people’s heart failure experiences without active interaction, but when they had an issue themselves they felt able to speak up about it. That demonstrates the power of peer led online forums.”

These days, many people are lookingCoc to manage their health differently,fou says Hartshorne-Evans. Technologycho enables patients to access informa-iden tion very quickly. Many want as muchin k information at their fingertips asvein quickly possible about their conditionbet before they see their healthcare pro-bod fessional. They like asking questions on social media platforms becauseScie peer to peer feedback can help themway make informed decisions. “Theynols might say: ’I’m going to see my cardi-pate Blo ologist tomorrow. What kind of ques-mor tions should I ask?’ Well-managed online communities are also beneficial from a clinician’s point of view, because patients will be equipped with more knowledge about the choices they are able to make. They’ll then begin to develop a mutually beneficial doctor-patient relationship, which is very important when you are managing a chronic condition like heart failure. Ultimately, this will lead to better outcomes for the patient.”

More knowledge reduces cost There’s another advantage from the clinicians’ side: figures from the British Heart Foundation published in 2015, show that heart failure accounts for two per cent of the total NHS budget, with 70 per cent of these costs due to hospitalisation. A typical cost per hospital admission episode for heart failure amounts to £3,796, while five per cent of all emergency admissions are due to the condition.

Yet, if a patient can self-manage their condition more effectively by using the peer-to-peer network, they may not have to make unnecessary trips to A&E or hospital, says Hartshorne-Evans. “You can have a better quality of life with heart failure if you know how to self-manage and you know when and where to interact with the NHS. Greater knowledge can help you feel more in control, however, this is not a replacement for well-managed clinical care, but it compliments it well.”

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Correct’ for arrhythmias… and perfect Dr Mark Mason Consultant Cardiologist, Royal Brompton & Harefield Hospitals Specialist Care

Is there a link between sport and cardiac arrest?

Can high intensity sport cause cardiac events?

It may if you have an undetected cardiovascular condition — but, for the vast majority of people, exercise remains hugely beneficial.

Over the years, a number of high-profile sportspeople under the age of 35 have been affected by undetected cardiovascular conditions. Footballer, Fabrice Muamba, and cricketer, James Taylor, both survived their cardiac events but, tragically, there have been fatalities, including Cameroonian international, Marc-Vivien Foé and Livorno’s Piermario Morisini.

“Affected people under 35 could have an inheritable condition — although they may be the first person in their family to experience it” says Dr Mark Mason, Consultant Cardiologist at RB&HH Specialist Care. “Broadly, problems result from types of cardiomyopathy (which affect the heart ventricles) or harder to find channelopathies, which are underlying conditions causing abnormal rhythms in an otherwise normal heart.” Most over-35s who experience a cardiac event, meanwhile, will do so because of previously undiagnosed coronary artery disease.

Know the symptoms If you have an undetected cardiovascular condition, longer duration, high intensity exercise could heighten the risk of a cardiac event, particularly in the over-35s. However, Dr Mason stresses, the overwhelming evidence is that exercise is hugely beneficial for the vast majority of people. So it’s important to keep active.

“To put it in perspective, around one in 20,000 exercisers per year have a cardiac event,” says Dr Mason. “Instances are probably lower for the under-35s who are generally healthy, and a bit higher for those over 35 with underlying cardiovascular risk.” Symptoms can include shortness of breath, lightheadedness or blackouts, heart palpitations or chest pain (“which could be tightness, heaviness, or the sensation of having a belt being tightened around your chest,” says Dr Mason).

Make lifestyle changes Over 35s can reduce their risk of cardiovascular disease by eating a healthy diet and cutting out smoking. In the under 35s, however, reducing risk of a cardiac event is more challenging — particularly if you don’t know you have a problem to begin with.

“Then we get into the contentious issue of mass screening programmes,” says Dr Mason.

In Italy, for example, anyone between the ages of 16 and 35 has to undergo screening – by law – before participating in sport at any level. “As a result, it’s estimated that Italy has reduced its instances of cardiac events by around 90 per cent,” says Dr Mason. “The problem in the UK is that we don’t have any formal infrastructure for mass screening at this point. But there are charities out there who — at times — run screening programmes for worried individuals.”

For more information visit rbhh-specialistcare.co.uk

Atri term hea risk

By Tony Greenway

Arrhythmias (heart rhythm disorders) can be a mystifying condition for many — from a “simple faint” through to AFrelated stroke and sudden cardiac death. It is time we talked more about it, says one heart rhythm charity founder.

Most people are blissfully unaware of arrhythmias, says Trudie Lobban MBE, Founder and Trustee of Arrhythmia Alliance. But that has to change, because anyone with undiagnosed arrhythmia is at high risk of a debilitating or life-threatening AF-related stroke or sudden cardiac death. And arrhythmias are treatable — if diagnosed and treated.

Arrhythmia Alliance is a coalition of charities, patients, carers, healthcare professionals, medical organisations, policy makers, allied professionals and all those with an interest in cardiac arrhythmias (heart rhythm disorders).

“One of our aims is to make arrhythmia a household word by 2020,” says Lobban, “so that everybody knows about and understands it, and knows the rhythm of their own heart.” This is key because arrhythmias are abnormal heart rhythms that are either too fast, too slow or irregular.

“At Arrhythmia Alliance, we talk about ’Detect, Protect, Correct’,” says Lobban. “Detect arrhythmia through a simple pulse check; Protect against AF-related stroke with anti-coagulation therapy (not aspirin); and Correct the irregular heart rhythm with access to appropriate treatment.”

What is the difference between arrhythmia and a heart attack?

Unlike a heart-attack, which Lobban describes as “a problem with the heart’s plumbing” (because of, say, a blocked artery or a burst blood vessel), arrhythmia should be thought of as an “electrical fault”, which can cause the heart’s complete and immediate shut down.

To put it into context, Lobban uses the illustration of a washing machine.

“If you have a leak in your washing machine, it may nevertheless get to the end of its cycle,” she says. “OK, so it will be full of water, but its lights will still be on. That’s a heart-attack — and a person who has one may have the chance to call for emergency help. If you have a power-cut or a blown fuse, however, the washing machine suddenly stops

treatment for AF.

The livin Syncope — the Greek word for ’faint’yet t — may be a sign of arrhythmia. “Faint-pop ing might happen because of low bloodto ri pressure or because of overheating. Allprev too often, though, it’s because of an ar-ulat rhythmia — and a potentially fatal one,rin o which could lead to sudden cardiac ar-tico rest; there is no such thing as a ’simplewell faint’.” Sudden cardiac death can affect anyone at any age; AF affects one in fourThe people over 65 years of age. Some ar-The rhythmias are genetic and can lead tople sudden cardiac arrest. clud pati Importance of pulse checking fact Of course, we all get heart palpitationsthe p from time to time, but there is a quick way to reassure yourself if you are worried about an arrhythmia: with a simple pulse check. Anyone experiencing irregular or abnormal heart rhythms but whose pulse is regular, is unlikely to need medical attention. Anyone whose heart is racing and whose pulse is irregular during a period of rest should see a medical practitioner as a matter of urgency. “If we are all aware of our pulse rhythm, we can reduce death and AF-related strokes, and also reduce the burden on the NHS by visits from the worried well,” says Lobban.

If your healthcare professional does diagnose an arrhythmia, the next steps depend on what kind you have. You should seek further advice from them if your pulse races some or most of the time and you have been feeling unwell.

Even if you don’t feel unwell but your pulse feels irregular (jumping around) you should also seek medical advice.

We are all different and so are our pulse rates so it can be difficult to assess irregular rhythms. If your heart rate is consistently above 120bpm or below 40bpm you should seek advice from a medical professional.

Remember there is no such thing as a ‘simple faint’. If a person experiences a loss of consciousness they need a 12-lead ECG to rule out an underlying, potentially fatal arrhythmia. In working together we can perfect the patient pathway and enable the ‘patient’ to go back to being a ‘person’.

Fainting and your heart

Trudie Lobban MBE Founder and Trustee of Arrhythmia Alliance

– it is dead. That’s sudden cardiac arrest (SCA).” SCA kills more people in the Western world than lung cancer, breast cancer and AIDS combined and, in the UK, 100,000 people die from it every year. It can be caused by an arrhythmia such as ventricular tachycardia, a rapid abnormal heart rhythm. With rapid CPR (cardiopulmonary resuscitation) and the use of an automated external defibrillator (AED), the person has up to 70 per cent chance of survival – without an AED it is almost certain death.

Affecting people of all ages The most common form of arrhythmia — and the number one cause of AF-related stroke — is atrial fibrillation (AF), when the heart beats erratically and irregularly. Incredibly, 1.5 million people in England have AF, and it is estimated that another half a million have the condition but are undiagnosed.

“The heart has four chambers through which the blood flows freely,” explains Lobban. “But if each of those chambers begins quivering at a different rate, the blood has difficulty flowing and a clot can form. If a clot breaks off, it can travel and cause heart failure, thrombosis or an AF-related stroke.

AF-related strokes are often more devastating — or fatal – than other forms of stroke.” People whose symptoms include breathlessness, tiredness and heart palpitations should see their doctor to check for AF. A simple pulse check can detect an irregular heart rhythm and with new technology such as handheld electrocardiogram (ECG) monitors – we can be diagnosed quickly and provide evidence for our doctor for appropriate anticoagulation therapy to reduce the risk of an AF-related stroke plus access to appropriate

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Can safer, supported self-care really work for patients dliving with long-term conditions?

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Atrial fibrillation (AF) is a longterm condition involving a heart arrhythmia that leads to risk of stroke.

There are 1.2 million people in the UK living with AF of whom 500,000 are aint’yet to be diagnosed. Due to an ageing aint-population, this number is expected loodto rise. Many AF-related strokes are . Allpreventable if the patient’s anticoagn ar-ulation (AC) therapy (such as warfaone,rin or the more newly available anc ar-ticoagulation drugs) is effective and mplewell controlled. ffect fourThe self-care challenge e ar-The proactive management of peod tople with long-term conditions, including the promotion of self-care for patients, is a priority for the NHS. In ng fact, more personalised care, where ionsthe patient is engaged in their health uick worsimcing hms ly to hose s irould atter our and the the

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management, has been discussed as a fundamental factor in ensuring the sustainability of healthcare systems across the globe.

National guidelines suggest that better control – and therefore better outcomes – are achieved through regular monitoring and consistent medication adherence as well as lifestyle improvements, where patients are empowered to better understand and manage their condition. However, despite the consensus that self-care is the right course, the realities of moving individuals towards this level of engagement are challenging in terms of patient motivation and care team resources.

Patients need knowledge, skills and confidence to self-care safely.

Recent technology advancements have meant that patients can selfcare and understand more about their condition or therapy. Even so, questions remain around how effectively this technology is presented to patients, and what opportunities they have to access it. The challenges we face at the moment include a lack of patient education around their condition and the wider health impacts that their condition may have.

Patients need support in this learn-

Dr Mark Sullivan Medical Director, LumiraDx

under the continual guidance of the care team – reducing the patient’s feeling of isolation with their condition, strengthening patient and carer communities and also boosting patients’ confidence to adhere to their medication.

Smart technology can support this connection while delivering interactive education to improve the patient’s control and self-care, therefore their health outcomes.

A new model of care ing. Once this support and education is in place, we believe that we will see better understanding of the importance of anticoagulation therapy and more motivate to self-care.

Care teams need the visibility that the patient is safe and adhering to their medication Self-care and better patient understanding of their condition is most effectively delivered through clear and consistent communication between patients and clinicians. Supported self-care means focusing on improving control, freedom and choice but

These challenges inspired us to work with patients and care teams to design a self-care app, named “engage”, to give individuals the all-important knowledge, skills and confidence to self-care via an app which is fully connected to their clinical record.

The engage app supports patients to self-monitor safely. It helps patients to understand the benefits of their anticoagulation therapy with easyto-follow education and regular tips to reinforce the importance of taking their medication properly. The programme enables patients to submit regular digital reviews, which also assess tablet adherence, helping care teams follow NICE (National Institute for Health and Care Excellence)

guidelines without significant impact on clinic time.

Whether patients are on warfarin therapy, or the newer drugs (DOACs – eg dabigatran, rivaroxaban, apixaban, edoxaban), engage motivates individuals to understand and improve their condition management rather than simply recording and tracking data, which many health apps already offer in isolation from the patient’s care team. It’s important to manage all anticoagulation patients in one system, regardless of their therapy choice, so that data is available across whole condition-specific patient population to help us to focus on this way, reducing the prevalence of AF-related stroke at national level.

The tools we need to achieve this aim are based on genuine joint decision making and an on going relationships which involve continuous support, education and learning both for patients and clinicians.

Read more on healthawareness.co.uk

HEART FAILURE AFFECTS EVERY GENERATION Up to 900,000 people in the UK have heart failure.

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Catriona Williams Director, talkhealth

5 tips for a heart-healthy diet With the summer holidays coming to a close and winter around the corner, there’s never a moment without tempting dinner parties and BBQs full of unhealthy food choices. See our list of tasty heart-healthy options you can enjoy all year round:

Veggie kebabs: Ditch the lamb or beef kebabs and have veggies on a skewer. Opt for veggies that are heart healthy, like cherry tomatoes, squash, onions, sweet potatoes and asparagus. Spray with some olive oil and grill.

Better BBQ burger: Buy lean/extra lean minced beef and drain off the excess fat after cooking. Tip: halve your meat and mix it with an equal amount of cooked buckwheat, a meaty-in-texture grain. To make it healthier again, try swapping your beef mince for turkey. This lighter substitute can make delicious burgers and tasty spaghetti Bolognese.

Get fishy: Fish, especially oily fish like tuna and salmon, have great nutritional benefits. In the summer months, fish can be a delicious and light addition to any salads. In winter, pair it with some roast potatoes and steamed spinach to give you that extra boost of iron.

Better booze: Although it is healthier to avoid alcohol, red wine and fruit rich cocktails can be a healthier choice. Try a Raspberry Mule - it’s delicious with and without alcohol. Just remember to drink plenty of water in between your boozy beverages.

Fro-yo over ice cream: Fat-free frozen yoghurt is a great alternative to ice cream.

Adding in heart healthy ingredients such as dark chocolate, blueberries and cherries add flavour without any guilt.

Remember: if you ever have any suspicions in relation to your heart health, please do visit your GP or healthcare professional.

Read more on healthawareness.co.uk

PHOTO: BRITISH HEART FOUNDATION

How James coped with a career-changing heart condition

By Tony Greenway James Taylor had to rebuild his life when his promising cricketing career was cut short by a rare heart condition. Keeping positive has helped him through adversity.

Before April 2016, Nottinghamshire and England cricketer, James Taylor, admits that “life was pretty perfect.” He was beginning to establish himself with the England team — always a dream of his — travelling the world, playing a game he loved, in front of thousands of people, and making good money doing it. “I was exactly where I wanted to be,” he says. “I was achieving in cricket and gearing up for the next season.”

But then, during a routine warm-up session with Nottinghamshire, James’s chest suddenly started to pound. “It felt a bit like when you get anxious,” he remembers, “although that usually subsides. This didn’t and it seemed as if my heart was going at a million miles an hour. I got on the physio bed, couldn’t breathe and was given oxygen. That was when I thought I was going to die.” He was rushed to hospital, underwent tests and was told he would have to stay in overnight.

Dealing with the diagnosis Then, “things got real”. His doctors diagnosed arrhythmogenic right ventricular cardiomyopathy (ARVC), a rare disease of the heart muscle that prevents blood being properly pumped around the body. James knew a bit about the condition because of the similar near-death experience of footballer Fabrice Muamba, which had led to his retirement in 2012.

For James, it was a devastating revelation: it meant that any exercise could be fatal, and that his promising cricketing career was now over at the age of just 26.

James Taylor Ambassador, British Heart Foundation

“I was the fittest in the team and pound for pound the strongest,” he says, “so this came completely out of the blue. But then I put it into perspective because I was lucky to survive. I sat up in bed with my fiancée and we decided we could either keep crying about it or try to make the best out of a bad situation. I was still alive, after all — and I shouldn’t have been. I’ve always been a positive person. Maybe it’s because I surround myself with good people and I feel I can do anything. On the flip side, that made the situation harder to deal with because suddenly I didn’t feel invincible anymore.”

Coping with change Initially, James wore an external defibrillator to shock his heart back to life, should he experience another cardiac event. He later underwent an operation to implant an internal defibrillator, which has gone off on at least one occasion and, he says, shot him across the room. “Essentially if my heart is not acting normally the defibrillator restarts it,” he says, “although the thought of it going off is pretty scary.” James also

has to take medication every day — but this makes him feel more secure and confident.

He used to monitor his heart rate constantly but doesn’t anymore. “I found it made me more anxious, and I know my body well enough to recognise when my heart starts doing something that it shouldn’t.”

As a young and formerly active man, not being able to exercise has been one of the most difficult things to accept. “It’s an egodent,” he admits. “I’d always prided myself on my fitness and I’d be in the gym every day. I’ve barely done any exercise since it happened. I haven’t run or done any weights. I occasionally go on a light bike ride in the gym — although I do monitor my heart rate then.” His main way of keeping fit now is playing golf.

Leading a fulfilling life James is keen to stress that life is still fulfilling, albeit in a different way. He got married in the summer and has been developing a media career working as a cricketing commentator on Sky Sports and BBC Five Live’s Test Match Special. He’s also coaching. “I’ve met some amazing people — I can’t thank the NHS doctors and nurses enough — and touched base with people I otherwise never would have,” he says.

“The public have messaged me and I try to help them with their problems, whether heart-related or not. I like to think I’m having a positive effect on people.”

To that end, he’s also become an Ambassador for the British Heart Foundation to raise awareness of heart disease and the need for vital medical research.“I thought it would be good to make people aware of this condition and that it can happen to young people too,” he says. “But I also want to reassure them that there is still life after diagnosis.”

worldheartday @worldheartfed

Eating and drinking well gives your heart the fuel it needs for you to live your life

Staying active can help you reduce your risk of heart disease and feel great

Stopping smoking is the single best thing you can do to improve your heart health

29 September 2017

Small changes can make a powerful difference.

On World Heart Day, share how you power your heart and inspire millions of people around the world to be heart healthy. worldheartday.org #worldheartday

in partnership with

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Professor David Wood President, World Heart Federation

Share the power Created in 2009 by the World Heart Federation (WHF), World Heart Day aims to combat the rising number of people with cardiovascular disease (CVD), the world’s biggest killer, by raising awareness and promoting the importance of living a heart-healthy lifestyle.

This year, on 29 September, we urge people to take action by sharing healthy heart tips and attending iconic illumination events. We can all ‘share the power’ and inspire our families, friends and communities around the world to make the small lifestyle changes that can make a powerful difference to heart health.

Fighting against the number one global killer CVD is the leading cause of death and disability in the world, killing 17.5 million people a year. That’s a third of all deaths on the planet and half of all non-communicable-disease-related deaths. By 2030, this is expected to rise to 23 million.

Globally, one in ten people aged 30 to 70 die prematurely from CVD, including heart disease and stroke, but the good news is that at least 80 per cent of these premature deaths could be avoided or postponed.

We cannot underestimate the global importance of good heart health – 31 per cent of all deaths worldwide are from CVD. World Heart Day is our chance to bring people together to tackle the world’s biggest killer and urge more people across the globe to improve their heart health. The power to change is in our hands. Making lifestyle changes such as eating more fruit and vegetables, keeping active and stopping smoking can save millions of lives.

Lighting up red and inspiring each other Every year, to mark World Heart Day, we ask iconic buildings, landmarks and monuments across the world to light up red in support of our mission and to provide a powerful visual symbol for the campaign. This year the list of illuminations includes Table Mountain in Cape Town, South Africa, the Nasdaq screen in Times Square, New York the Singapore Flyer, the Sky Tower in New Zealand, Avala Tower in Belgrade, Serbia, Angel de la Reforma in Mexico City, Jet d’Eau in Geneva, Switzerland, the home of the World Heart Federation, and many others.

More members of the public than ever before are also getting involved by sharing their heart healthy selfies and tips using #WorldHeartDay and attending one of the thousands of events taking place around the world, from walks and talks to health screenings, fun runs and more.

Together we have the power to reduce the burden of, and premature deaths from, CVD, helping people everywhere to live longer, better, heart-healthy lives.

Read more on healthawareness.co.uk

Knowing your cholesterol level H could save your life t

By Tony Greenway

Those with raised cholesterol risk

We might not know we have raised cholesterol because it displays no symptoms. But it is linked to an increased risk of cardiovascular disease, so regular testing for adults is vital.

“The trouble with cholesterol is that it’s not a ’sexy’ subject,” says Linda Main, Dietetic Adviser with cholesterol charity HEART UK. “It’s a complex area of science. Also, because raised cholesterol has no symptoms, people don’t take as much notice of it as they should.”

That attitude needs to change, says Main. In fact, if we’re aged between 40 and 75, we should undergo tests every five years to check our levels because raised cholesterol is linked to an increased risk of cardiovascular disease. The first sign we have a problem could be a heart-attack.

Cholesterol is a lipid (or fat) that’s made in the body by the liver; and six out of 10 us have raised or abnormal levels of it. Why this gets complex — and where people get confused — is because the body makes ’good’ cholesterol (HDL) and ’bad’ cholesterol (LDL).

Why we need ’bad’ cholesterol To make it even more bewildering, our bodies need a certain amount of ’bad’ cholesterol to function. “LDL is essential for growth, sex hormones, the production of vitamin D, the production of bile — which is needed for fat digestion — and for tissue repair, etc,” says Main. “The problem is, if we have too much of it, it can be deposited into the linings of blood vessels and, over time, fur up arteries. That can lead to circulatory problems, heart attacks and strokes.”

Linda Main Dietetic Adviser, HEART UK

Our ’good’ HDL cholesterol has an important part to play here. Main likens it to a team of cleaners travelling around the arteries, picking up excess LDL cholesterol and taking it back to the liver where it can be broken down and disposed of.

Understand your cholesterol results So what’s a healthy level of cholesterol? Unfortunately, that’s not simple either. When you have a cholesterol test, the results will include an overall level and a breakdown of numbers to give your GP an indication of the balance between the good and bad cholesterol your body is producing. “For example, if your overall cholesterol level is 7.0, we would consider that to be raised,” says Main. “But if your HDL was at a healthy level — say 2.0 or 2.5 — we would be less concerned than if it was lower: say 0.9.”

If you are otherwise healthy — that is, you don’t have heart disease or some other pre-existing condition — a good result would be a total cholesterol level below 5.0, with an HDL level above 1.0 in men and above 1.2 in women. Make an appointment with your GP who can explain the numbers to you.

Raised cholesterol can be genetic, which may affect around 1 in 250 people. Age is also a major factor, so the An older you are, the higher it will be. Eat- inv ing saturated fat is another cholester- ca ol-raising culprit. “We eat meat that de contains cholesterol,” says Main. “So cutting out fatty meat and eating lean pa meat, such as chicken, is important. su Don’t forget that dairy is a saturated art fat, too.” On the other hand, there is a tre list of food which naturally helps lowbe er cholesterol, such as red and green lentils, porridge, baked beans, oat- ca cakes, pearl barley, soya and tofu.

Exercise is recommended because Cor it increases ’good’ cholesterol (this a lea doesn’t necessarily entail going to wor the gym: a brisk walk will be benefithe cial); and, of course, you should cut out smoking and only drink alcohol ply redu in moderation. che How medication can help (my But if your overall level still stays stubdea bornly high — and once other risk factors have been factored in such as fam- that ily history, body mass index (BMI) and dea blood pressure — your GP will assess dy R your chance of having a cardiac event othe or stroke over the next 10 years. If it’s alm more than 10 per cent, you may be prely, scribed cholesterol-lowering medication such as statins which are well tol- sive erated by the vast majority of people. FFR Raised cholesterol isn’t just associ- of C ated with cardiovascular disease. “It’s to h also linked to kidney disease, demenby c tia and circulatory problems, such as peripheral arterial disease,” says bloc Main. “That’s why the majority of UK was adults should know their cholesterol for levels, understand what it means for save their health and take action to improve them if necessary.”

Find out more at heartuk.org.uk

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ause Coronary artery disease (CAD) is this a leading killer of men and women g to worldwide. CAD develops when nefithe coronary arteries, which supcut ohol ply blood to the heart, narrow, reducing blood flow and causing chest pain (angina), heart attack (myocardial infarction) and even tubdeath. Some people are unaware facam- that they have CAD, and sudden and death is their first symptom. Ransess dy Rochman, an avid runner and vent otherwise healthy individual, was f it’s almost one of them. Fortunateprely, a first-of-its-kind, non-invaicatol- sive test, called the HeartFlow® le. FFRct Analysis, found evidence oci- of CAD, which limited blood flow “It’s to his heart and had been missed menby conventional tests. Once the h as says blockage in his coronary arteries UK was discovered, Randy was sent erol for urgent bypass surgery, which s for saved his life. im-

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Helping patients avoid unnecessary procedures A mounting body of published literature has shown that the HeartFlow FFRct Analysis reduces unnecessary invasive diagnostic

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When was the last time your GP checked your heart with a stethoscope?

Heart Valve Voice, a charity raising awareness of heart valve disease, says a stethoscope check is often the first step in detecting a common disease that affects over one million people over the age of 65 in the UK.

H

eart valve disease is caused by either the wear, disease or damage of one or more of the heart’s valves, affecting the flow of blood through the heart. The most common forms of heart valve disease impact the aortic and mitral valves. Heart valve disease can cause the heart valves to either leak, meaning the valve is failing to close properly and allowing blood to flow back through, known as regurgitation, or become narrowed or calcified, in turn limiting the amount of blood allowed to flow through, known as stenosis.

The symptoms associated with heart valve disease include breathlessness, tiredness, tight chest and dizziness.

Awareness of this disease is very low in the UK, despite its prevalence, with an average of 94 per cent of people over the age of 60 being unaware of what aortic stenosis (the most common form of heart valve disease) is. One of the reasons for the lack of awareness around heart valve disease is that the symptoms are often

thought to be merely a result of getting older and are therefore ignored or put up with. Heart Valve Voice is hoping to change that by making people aware that these symptoms aren’t necessarily just signs of ageing and that they should be mentioned to a primary care professional and, in turn, that primary care professional should listen to their heart.

On average, GPs use their stethoscope on less than two fifths of patients presenting with symptoms of heart valve disease, despite it being one of the first key protocols in detecting the disease, according to research from Heart Valve Voice. “GPs do an excellent job at assessing and diagnosing a wide range of diseases, including heart valve disease. However, in some instances there may be a lack of awareness, and with the growing number of cases in the UK, more needs to be done to ensure there is a systematic plan in place to tackle this disease at all levels,” said Yassir Javaid, GP and Cardiovascular and Diabetes Clinical Lead at Nene CCG. “This is essentially what Heart Valve Voice is trying to facilitate and their work will be crucial to enable

Yassir Javaid GP and Cardiovascular & Diabetes Clinical Lead at Nene CCG

Wil Woan Heart Valve Voice CEO

clinicians to effectively support patients.”

Once a patient has been diagnosed with heart valve disease, they face a number of life changing treatment options. While valve treatment is most commonly performed through surgery, great progress has been made recently on less invasive procedures allowing for less trauma and a much quicker recovery. With procedures such as minimally invasive surgery and Transcatheter aortic valve implantation (TAVI), patients who were once unable to receive sur-

gery due to their age or co-morbidities, are now more likely to get the valve disease treatment they need.

It is being found that once a patient with heart valve disease is diagnosed early enough and receives treatment, their lives transform significantly. New European guidelines released last month will enable healthcare professionals to treat more people, but awareness is still low. Pat Khan, a Heart Valve Voice patient ambassador says, “I got my life back after my valve replacement and even participated in the Heart Valve

Voice cycle ride from London to Paris this past May. I’d put my symptoms down to old age, which was a terrible mistake and an eagle-eyed GP listed to my heart and saved my life”.

“Given the significant challenges that the NHS is facing with an ageing population and the expected increase in cases of valve disease, we believe that it is necessary that patients receive their diagnosis and subsequent treatment as swiftly as possible. If heart valve disease is caught early enough then more severe complications, such as heart attack or heart failure, can be avoided,” said Wil Woan, Heart Valve Voice CEO. “Last year, we published a comprehensive report that has been put forward to parliament containing our key recommendations that we believe are crucial if we are to improve the diagnosis, treatment and care of heart valve disease.”

At Heart Valve Voice’s we say, ‘The more we listen, the more lives we save’ - so make sure you ask your GP to listen to your heart the next time you see them.

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Feeling older than your age?

Think Heart Valve Disease

Marina McGrath’s heart valve disease story Marina was an active woman in her 50s, working hard as a midwife until she noticed symptoms of breathlessness and tiredness. It wasn’t until a visit to her GP that she found out she had aortic stenosis (AS).

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Having chest pain Are you suffering from chest pain, dizziness, or experiencing palpitations

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Exercise difficulties Are you finding it difficult to exercise and move around easily?

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Are you feeling older than your age?

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Respiratory difficulties Are you feeling short of breath?

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Tiredness Are you suffering from tiredness and fatigue?

Visit your healthcare professional for a stethoscope check The more we listen, the more lives we save

ot long after her 50th birthday in 2005, Marina attended a Well Woman Clinic, as many women do, to look into having Hormone Replacement Therapy (HRT). It was during the routine tests at the clinic that she first discovered her blood pressure was quite high. On the clinic’s recommendation, she paid a visit to her GP. Thinking back, Marina also had begun to notice that she would sometimes feel shortness of breath when she exerted herself, but simply thought it was all part of being in your 50s!

Her GP listened to her heart with a stethoscope and immediately suspected aortic stenosis so he referred her to the cardiologist. This suspected diagnosis came as a shock to Marina as she hadn’t heard of valve disease, in fact only seven per cent of over 60s in a recent survey have. Being a fellow clinician, Marina wanted to find out all that she could about her diagnosis and asked as many questions as she could think of. She was told that her symptoms would most

Marina McGarth Heart Valve Voice Ambassador

likely worsen over time and that she would require an aortic valve replacement in the future. Not the news she was hoping to hear!

As her AS was only mild, her cardiologist arranged for her to visit him once a year to see how it was progressing. Each year she would go for her check up and each year she began to notice herself slowing down and her symptoms becoming worse.

In 2010, it become difficult to ignore the fact that she was more breathless than her older peers and she resorted to doing things at a much slower

pace than before. At the same time, her yearly echocardiogram began to show her AS progressing from mild to moderate and finally to severe.

Finally, on 7 June 2014, Marina was admitted to have her aortic valve replacement surgery.

Since her surgery, Marina’s life is finally back to normal and she is feeling much more like her usual self.

She took six months off to recover and get herself back into shape before returning to her work full-time. She has been able to continue with her active lifestyle as well and still finds time to do her favourite activities, especially hillwalking.

“While my experience with aortic stenosis has been a rollercoaster ride, I am so glad that I finally went through with my treatment.” said Marina, “I am now able to keep up with all of my friends on our walks and I still have the energy to work in a job that I get so much out of and contribute so much back to younger midwifes. I have a new lease on life and plan to make the most of it all. To think, it was just because a GP picked up his stethoscope and had listen to my heart!”