Effect of implementing a heart failure admission care bundle on hospital readmission and mortality rates: interrupted time series study.

This study aimed to evaluate the impact of developing and implementing a care bundle intervention to improve care for patients with acute heart failure admitted to a large London hospital. The intervention comprised three elements, targeted within 24 hours of admission: N-terminal pro-B-type natriuretic peptide (NT-proBNP) test, transthoracic Doppler two-dimensional echocardiography and specialist review by cardiology team. The SHIFT-Evidence approach to quality improvement was used.

Description and development of a nurse-led cardiac assessment team.

A problem was identified where patient care was affected because of delays in receiving specialist cardiology input. This report describes the experience of developing a specialist cardiac assessment where senior cardiac nurses were trained to provide a 24-hour presence in the emergency department (ED). We describe the service and our evaluation of the service.

Fitness predicts long-term survival after a cardiovascular event: a prospective cohort study.

Objectives: To identify the role of fitness, fitness change, body mass index and other factors in predicting long-term (>5 years) survival in patients with coronary heart disease.

Design: Cohort study of patients with coronary heart disease recruited from 1 January 1993 to 31 December 2002, followed up to March 2011 (1 day to 18 years 3 months, mean 10.7 years).

Characteristics of patients entering cardiac rehabilitation in the United Kingdom 1993-2006: implications for the future.

Purpose: : To analyze changes in clinical characteristics of patients entering a cardiac rehabilitation program between 1993 and 2006 and to consider the implications on the delivery of cardiac rehabilitation programs in the future.

Methods: : Data were analyzed for 4692 coronary heart disease patients who joined the Phase II cardiac rehabilitation program between January 1993 and December 2006.

Results: : Over the study period mean age increased from 60.

Outpatient cardiac rehabilitation attendance in England: variability by region and clinical characteristics.

Purpose: Cardiac rehabilitation is an effective but underprovided treatment for patients recovering from acute cardiac events. The geographical spread of provision has not been investigated recently in any country. This study aimed to investigate the level of participation in cardiac rehabilitation programs of patients following myocardial infarction or revascularization (eligible patients) and the geographical equity of attendance.

Cardiac rehabilitation in the United Kingdom.

Cardiac rehabilitation (CR) is a cost-effective, life-enhancing and life-saving treatment for patients recovering from cardiac illness--from myocardial infarction, revascularisation, angina, heart failure, etc. Its main aims are to help the patient to recover as quickly and completely as possible and then to reduce to a minimum the chance of recurrence of the cardiac illness--it should be an integral step in the management of the patient's condition. Despite the inclusion of CR in the National Service Framework for coronary heart disease only a minority of cardiac patients join CR programmes.

The rise and fall of cardiac rehabilitation in the United Kingdom since 1998.

Background: Provision of cardiac rehabilitation is inadequate in all countries in which it has been measured. This study assesses the provision in the United Kingdom and the changes between 1998 and 2004.

Methods: All UK cardiac rehabilitation programmes were surveyed annually.

Cardiac rehabilitation in England: a detailed national survey.

Aims: The purpose of this study is to conduct a detailed analysis of cardiac rehabilitation programmes in England to compare actual provision with the recommendations of the National Service Framework and Scottish Intercollegiate Guideline Network guidelines.

Methods: Questionnaires and interviews were conducted with key staff from one centre in each Strategic Health Authority in England to establish staffing levels, patient throughput, programme details, data collection and funding.

Results: There were major discrepancies between programmes and the national recommendations.

NSF for CHD: 3 years of 12-month follow-up audit after cardiac rehabilitation.

Background: The coronary heart disease (CHD) National Service Framework (NSF) sets standards and milestones. For acute myocardial infarction (AMI) or coronary revascularization, 'Milestone 3, of Standard 12 requires that, by April 2002, every hospital should have clinical audit data no more than 12 months old showing 'total number and % of those recruited to cardiac rehabilitation who, one year after discharge, report: regular physical activity of at least 30 minutes duration on average five times a week, not smoking and a Body Mass Index (BMI) of <30 kg/m2'. This study looked at cost, method and practicalities of retrieving this data.

Circulating levels of MCP-1 and eotaxin are not associated with presence of atherosclerosis or previous myocardial infarction.

The chemokines are a family of signalling proteins that participate in regulation of the immune system and have been implicated in the pathogenesis of vascular diseases. Deleting the gene encoding the chemokine MCP-1 in mouse models of atherosclerosis reduces lipid lesion formation and circulating chemokines are upregulated in man immediately following myocardial infarction (MI) or coronary angioplasty. We have therefore investigated whether circulating levels of two chemokines (MCP-1 and eotaxin) differ between subjects with and without atherosclerosis.

Results and cost of meeting the National Service Framework for Coronary Heart Disease requirement for 12 month follow-up after acute coronary events.

Background: The National Service Framework (NSF) for Coronary Heart Disease (CHD) set standards, targets and milestones. In the case of acute myocardial infarction (AMI) or coronary revascularization, Milestone 3 of Standard 12 requires a 12 month audit of exercise and smoking habit and of body mass index (BMI) for patients who have attended cardiac rehabilitation (CR). The targets are that 50 per cent of patients should be exercising regularly, not smoking and have a BMI of <30 kg/m(2).

Pacing extremely old patients: who decides--the doctor, the patient, or the relatives?

Decision making competence is not necessarily present or absent. In many cases it is partial or compromised. This applies especially to those over 80 years old, in whom the prevalence of dementia is high.

Psychological assessments for cardiac rehabilitation patients.

Psychological and quality of life measures are important in the assessment of cardiac rehabilitation (CR) patients and the outcome of treatment. This study aimed to assess the utility and sensitivity to change of three simple questionnaires in a CR setting. A total of 1403 patients who entered CR over 51 months were studied.

Rapid and noninvasive diagnosis of the presence and severity of coronary heart disease using 1H-NMR-based metabonomics.

Although a wide range of risk factors for coronary heart disease have been identified from population studies, these measures, singly or in combination, are insufficiently powerful to provide a reliable, noninvasive diagnosis of the presence of coronary heart disease. Here we show that pattern-recognition techniques applied to proton nuclear magnetic resonance (1H-NMR) spectra of human serum can correctly diagnose not only the presence, but also the severity, of coronary heart disease. Application of supervised partial least squares-discriminant analysis to orthogonal signal-corrected data sets allows >90% of subjects with stenosis of all three major coronary vessels to be distinguished from subjects with angiographically normal coronary arteries, with a specificity of >90%.

Patient characteristics and outcomes of cardiac rehabilitation.

Purpose: To investigate changes in physical fitness and psychological characteristics of patients after cardiac rehabilitation, and to assess predictors of defaulting from the program.

Methods: A prospective study of 1902 consecutive patients admitted to a community-based, hospital-linked cardiac rehabilitation program was conducted over a period of 6 years and 7 months. The cardiac rehabilitation program centered on a 2-to 6-month circuit training course with education, stress management, relaxation, and risk factor monitoring.

High titres of serum antinuclear antibodies, mostly directed against nucleolar antigens, are associated with the presence of coronary atherosclerosis.

Background: Inappropriate inflammation is a key mechanism in the development of atherosclerosis. Antibodies against components of the atherosclerotic lesion, in particular, oxidised low density lipoprotein, have been described.

Objective: To determine whether a systemic autoimmune response, characterised by the presence of high titres of antinuclear antibodies, is associated with the presence of coronary atherosclerosis.

Cardiac rehabilitation in the United Kingdom. How complete is the provision?

Purpose: To bring up-to-date information about all the cardiac rehabilitation (CR) units in the UK, including their staffing and the services they offer, and to determine the numbers and diagnoses of the patients they treat.

Methods: Questionnaire survey to establish the continued functioning of the centers, the disciplines of their staff, the number of patients treated, their diagnoses, and the outcomes measured.

Results: 286 centers were identified.