Most patients with heart failure have mild or moderate renal dysfunction. This reflects the combined impact of chronic renal parenchymal disease, renal artery disease, renal congestion and ...hypoperfusion, neuroendocrine and cytokine activation and the effects of treatments for heart failure. Remarkably, with good treatment, the average annual rate of decline in renal function is similar in patients with chronic heart failure and healthy people of a similar age. Urea appears to be a stronger marker of an adverse prognosis than creatinine-based measures of renal function. Recent evidence suggests that minor, transient increases in creatinine in the setting of acute heart failure are not prognostically important but persistent deterioration does indicate a higher mortality. The poor prognosis of patients with worsening renal function ensures that few require renal dialysis but this may change as methods to prevent sudden death improve and new ways are found to control fluid congestion. Reversing renal dysfunction and stopping its progression remain important targets for treatment of heart failure.
The indications, complexity and capabilities of cardiovascular magnetic resonance (CMR) have rapidly expanded. Whether actual service provision and training have developed in parallel is unknown.
We ...undertook a systematic telephone and postal survey of all public hospitals on behalf of the British Society of Cardiovascular Magnetic Resonance to identify all CMR providers within the United Kingdom.
Of the 60 CMR centres identified, 88% responded to a detailed questionnaire. Services are led by cardiologists and radiologists in equal proportion, though the majority of current trainees are cardiologists. The mean number of CMR scans performed annually per centre increased by 44% over two years. This trend was consistent across centres of different scanning volumes. The commonest indication for CMR was assessment of heart failure and cardiomyopathy (39%), followed by coronary artery disease and congenital heart disease. There was striking geographical variation in CMR availability, numbers of scans performed, and distribution of trainees. Centres without on site scanning capability refer very few patients for CMR. Just over half of centres had a formal training programme, and few performed regular audit.
The number of CMR scans performed in the UK has increased dramatically in just two years. Trainees are mainly located in large volume centres and enrolled in cardiology as opposed to radiology training programmes.
This article provides information and a commentary on key trials relevant to the pathophysiology, prevention, and treatment of heart failure presented at the annual meeting of the American Heart ...Association held in Chicago in 2010. Unpublished reports should be considered as preliminary, since analyses may change in the final publication. In patients with mild heart failure (HF), EMPHASIS‐HF showed that the addition of eplerenone to standard therapy was well tolerated and reduced both the risk of death and hospitalization. The addition of cardiac resynchronization therapy to implantable cardioverter defibrillator (ICD) therapy reduced the incidence of all‐cause mortality and HF hospitalizations in patients with NYHA class II–III HF compared with ICD alone in RAFT. Telemonitoring failed to improve outcome compared with a high standard of conventional care in patients with chronic HF (TIM‐HF study) and a telephone‐based interactive voice response system failed to improve outcome in patients recently hospitalized for HF (Tele‐HF study). ASCEND‐HF suggested that nesiritide was ineffective but safe in patients with acute decompensated HF. ROCKET‐AF suggests that the factor‐Xa inhibitor rivaroxaban may be as effective as warfarin in patients with atrial fibrillation. The PROTECT study provided more data to suggest that amino‐terminal B‐type natriuretic peptide guided therapy may be beneficial in patients with left ventricular systolic dysfunction.
In IONA, a large randomised trial, nicorandil also improved outcomes.7 Xanthine oxidase inhibition by allopurinol is yet another non-haemodynamic action that could be exerting its putative ...anti-ischaemic effects by various mechanisms,6 including preventing the deleterious effects of oxidative stress on endothelial dysfunction and energy supply.8 Hyperuricaemia has long been known to be a risk factor for cardiovascular events and has a potential adverse effect on outcome in heart failure.9 A previous study from the Dundee group,10 however, did not show any increase in exercise capacity in patients with heart failure, albeit at only half the dose used in today's angina study.
Aims
Most studies on acute heart failure (HF) exploring the relationship between admissions to hospital for HF and subsequent outcomes have focused only on HF coded as the primary diagnosis, but many ...other patients have admissions complicated by HF requiring attention. Failure to quantify the total hospital burden of HF underestimates its health economic impact, leading to underprovision of resources for its care.
Methods and results
The First Euro Heart Failure Survey (EHFS‐1) screened consecutive deaths and discharges, regardless of cause, from medical wards in 115 hospitals from 24 European countries during 2000–2001, to identify patients with known or suspected HF. Information on presenting symptoms and signs were gathered. Of 10 701 patients enrolled, HF was reported as the primary reason for admission in 4234 (40%), a secondary reason for admission if it complicated or prolonged stay in 1772 (17%), and in 4695 (43%) patients it was uncertain whether HF was actively contributing to the admission. Mortality on the index admission was 301 (7%), 290 (16%), and 189 (4%), respectively, with hazard ratios of 1.73 (P < 0.001) and 3.26 (P < 0.001) compared with the ‘uncertain’ group. In the 12 weeks following discharge, 287 (7%) patients with a primary, 117 (8%) with a secondary, and 238 (5%) with an incidental or uncertain diagnosis of HF died.
Conclusion
Patients admitted to hospital with HF as a secondary rather than a primary diagnosis have a high mortality. More attention should be focused on patients with a secondary diagnosis of HF in terms of both care and research.
Mercury ion (Hg2+) is an extremely hazardous pollutant to humans, soil, and aquatic life. Nanozyme-based sensing approaches are promising for detecting toxic heavy metal ions. However, applying noble ...metal nanozymes in developing affordable and portable sensors remains largely unexplored. Herein, a gold nanoparticle (AuNP)-based colorimetric sensor was established for the ultra-trace detection of Hg2+ by capitalizing the inherent peroxidase-mimetic features of AuNPs for oxidizing the colorimetric indicator 3,3′,5,5′-tetramethylbenzidine (TMB) in the presence of hydrogen peroxide (H2O2). AuNPs of size less than 10 nm were directly prepared in aqueous media using a stimuli-responsive, poly(ethylene glycol methyl ether methacrylate)-b-poly(dimethylaminoethyl methacrylate (p(PEGEMA)-b-p(DMAEMA)) block copolymer, synthesized through RAFT polymerization. The block copolymers efficiently interacted with Au3+ ions toward the formation of stable, monodispersed AuNPs without additional reducing agents or stabilizers. Using TMB, H2O2, and the AuNP colorimetric system, the concentration of Hg2+ in aqueous media was quantitatively and selectively detected over those of other common interfering metal ions. The selective detection of Hg2+ was promoted by the Au-Hg amalgamation process, which is correlated with intensity of the colorimetric response. Colorimetrically, Hg2+ was linearly measured between 10 nM and 3.5 μM and achieved a detection limit of 0.4 nM. Subsequently, an on-field naked-eye sensing strategy was also developed by integrating the colorimetric sensor on a paper analytical device with a detection limit of 3.5 nM. The efficient colorimetric sensing platform for selective and trace detection of Hg2+ is promising for determining mercury contamination in different water and biological samples.
Secondary prevention of stroke largely depends on risk factor control and lifestyle modification. Optimal secondary prevention strategies are limited in rural settings due to the shortage of primary ...care physicians and neurologists. Awareness of community health workers (CHWs) regarding stroke and its management remains largely unexplored. The current cross-sectional study aimed at assessing the knowledge, attitude, and practice (KAP) of CHWs regarding stroke care.
A structured KAP questionnaire was administered among 510 CHWs from randomly selected rural health blocks of Thiruvananthapuram, Kerala, India.
Knowledge assessment showed that the CHWs possessed an average knowledge of stroke care. The mean attitude and practice scores were higher, indicating a favorable attitude and good practice. The overall mean (standard deviation) KAP scores of CHWs were 13.54 (4.43) against a total score of 23. The KAP scores were highest among palliative care nurses. The stroke awareness of the accredited social health activists was comparatively lower than other CHWs. Factors such as age and years of work experience were not correlated to the KAP scores.
Recurrent strokes remain a major challenge in primary care. Overall, the health workers demonstrated average knowledge, favorable attitudes, and positive practices. The study highlights the importance of training accredited social health activists (ASHAs) and other CHWs in stroke to improve secondary prevention strategies.
The navigation, guidance and control (NGC) system of Reusable Launch Vehicle – Technology Demonstrator (RLV-TD) is the most complex system ever flown in ISRO's launches. It includes a navigation ...system employing traditional inertial navigation system along with global positioning system aiding and radar altimeter, ceramic servo accelerometer package, angle of attack-based control, different control systems, including secondary injection thrust vector control, reaction control system and aero control surfaces. Closed loop simulations of integrated NGC system of RLV-TD are of utmost importance to ensure mission success by assessment of system performance in nominal and off-nominal flight conditions. Validation is achieved through progressive evaluations in different levels of integrated simulation, namely autonomous simulations, software in loop simulation, on-board processor in loop simulation, hardware in loop simulation and actuator in loop simulation using Iron Bird test facility. This article discusses the overall NGC system, challenges faced during the realization of the simulation test bed, including system design to validate the new on-board elements, commissioning of Iron Bird facility and validation through various phases of simulation. The outcome of these simulations played a crucial role in bringing about improvements and helping in the evolution of the on-board system to the final configuration, ensuring the success of the mission.
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