The effect of heart failure nurse consultations on heart failure patients' illness beliefs, mood and quality of life over a six-month period.

AIMS AND OBJECTIVES: To explore the effect contact with a heart failure nurse can have on patients' illness beliefs, mood and quality of life. BACKGROUND: There is growing interest in patients' illness beliefs and the part they play in a patients understanding of chronic disease. DESIGN: Secondary analysis on two independent datasets. Patients were recruited from five UK hospitals, four in London and one in Sussex. Patients were recruited from an inpatient and outpatient setting. The first dataset recruited 174 patients with newly diagnosed heart failure, whilst the second dataset recruited 88 patients with an existing diagnosis of heart failure. METHODS: Patients completed the Minnesota Living with Heart Failure Questionnaire, Hospital Anxiety and Depression Scale, Illness Perception Questionnaire and the Treatment Representations Inventory at baseline and six months. We used a linear regression model to assess the association that contact with a heart failure nurse had on mood, illness beliefs and quality of life over a six-month period. RESULTS: Patients who had contact with a heart failure nurse were more satisfied with their treatment and more likely to believe that their heart failure was treatable. Contact with a heart failure nurse did not make a statistically significant difference to mood or quality of life. CONCLUSIONS: This study has shown that contact with a heart failure nurse can improve patient satisfaction with treatment decisions but has less influence on a patient's beliefs about their personal control, treatment control and treatment concerns. With appropriate support, skills and training, heart failure nurses could play an important role in addressing individual patient's beliefs. There is a need to further investigate this. RELEVANCE TO CLINICAL PRACTICE: Exploring patients' illness beliefs and mood could help to enhance person-centred care. Heart failure nurses would need additional training in the techniques used.

A modified subcutaneous implantable cardioverter-defibrillator implant in a patient with a previous left ventricular epicardial defibrillation patch.

We describe a case of subcutaneous implantable cardioverter-defibrillator (ICD) implant in a patient with an existing epicardial defibrillation patch. Potential issues with shock vector shielding were overcome by a modification of the generator implant site and poor sensing were successfully managed by programming a sensing vector which excluded the generator.

Mode of death in patients with newly diagnosed heart failure in the general population.

BACKGROUND: Early prognosis for incident (new) heart failure (HF) patients in the general population is poor. Clinical trials suggest approximately half of chronic HF patients die suddenly but mode of death for incident HF cases in the general population has not been evaluated. AIMS: To describe mode of death in the first six months after a new diagnosis in the general population. METHODS: Two-centre UK population-based study. RESULTS: 396 incident HF patients were prospectively identified. Overall mortality rates were 6% [3-8%], 11% [8-14%] and 14% [11-18%] at 1, 3 and 6months respectively. There were 59 deaths over a median follow-up of 10months; 86% (n = 51) were cardiovascular (CV) deaths. Overall, the mode of death was progressive HF in 52% (n = 31), sudden death (SD) in 22% (n = 13), other CV death in 12% (n = 7), and non-CV death in 14% (n = 8). On multivariable analysis, progressive HF deaths were associated with older age, lower serum sodium, systolic hypotension, prolonged QRS duration at baseline and absence of ACE inhibitor therapy at the time of discharge or death. CONCLUSION: Early prognosis after a new diagnosis of HF in the general population is poor and progressive HF, rather than sudden death, accounts for the majority of deaths.

Elimination of phrenic nerve stimulation occurring during CRT: follow-up in patients implanted with a novel quadripolar pacing lead.

BACKGROUND: Phrenic nerve stimulation (PNS) occurs at follow-up in approximately 20% of patients with bipolar leads. The quadripolar Quartet model 1458Q (St. Jude Medical, Sylmar, CA, USA) left ventricular lead (LV) has four electrodes (one distal tip and three ring) capable of ten different pacing vectors which may allow reprogramming to eliminate PNS. METHODS: Forty patients underwent attempted CRT-D implantation between October 2009 and October 2010 with the Quartet lead. Pacing parameters, lead position, complications and presence of PNS were collected at implant, pre-discharge and at 3 and 6 months follow-up. RESULTS: A quadripolar LV lead was successfully implanted in 95% (38/40) of patients. During follow-up, one patient (3%) had a lead displacement requiring reposition. LV pacing parameters remained stable at 6 months follow-up (mean threshold 1.3 V at 0.6 ms and impedance 948 Ω). PNS at the time of implant was observed in 12 patients (32%) all of which were overcome by using the additional vectors available on the quadripolar LV lead or by repositioning the lead at the time of index implant. During 6 months follow-up there were five (13%) cases of PNS, all of which were successfully treated by reprogramming to a different vector. No cases required reintervention, surgical epicardial lead placement, or that lead be turned off. CONCLUSION: The quadripolar Quartet lead is associated with a high implant success rate, stable pacing parameters and a low displacement rate during the first 6 months after implant. The ten LV pacing vectors available with this lead allowed PNS and capture threshold problems to be overcome at implant, and importantly at follow-up, thus obviating the need for lead reposition.

Lyme disease and the heart in the UK.

Heart involvement from Lyme disease is uncommon in the UK but, when it does occur, can be rapidly progressive and require intensive therapy. A history of exposure and frequently a characteristic rash (erythema migrans) are the cardinal features in diagnosis.

Entitlement to hospital treatment in the UK: qualifiers, challenges and comment.

Entitlement to NHS care is in some cases complex. Regulations include inter-country reciprocal agreements and specific categories of individuals who qualify. This article describes the current, albeit fluid, situation with discussion around some of the more contentious areas.

Atrial fibrillation-related cardiomyopathy: a case report.

Sustained chronic tachyarrhythmias often cause a deterioration of cardiac function known as tachycardia-induced cardiomyopathy or tachycardiomyopathy.The incidence of tachycardia-induced cardiomyopathy is unknown, but in selected studies of patients with atrial fibrillation, approximately 25% to 50% of those with left ventricular dysfunction had some degree of tachycardia-induced cardiomyopathy. It is an important clinical entity due to the high incidence and potential reversibility of the disease process.This case describes a cardiomyopathy induced by excess caffeine consumption. Six months following withdrawal of caffeine from the subject's diet, full resolution of symptoms occurred.