Cardiovascular care

A Case of Ventricular Standstill in Hypertrophic Cardiomyopathy: The Role of AV Block and Beta-Blockers (2025)

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Type of publication:

Conference abstract

Author(s):

*Owolabi O.H.; *Yera H.O.; *Choy C.H.; *Htet K.; *Kundu S.

Citation:

Heart. Conference: British Cardiovascular Society Annual Conference, BCS 2025. Manchester United Kingdom. 111(Supplement 3) (pp A30-A33), 2025. Date of Publication: 01 Sep 2025.

Abstract:

Introduction Atrioventricular (AV) nodal disease is a rare but serious complication of hypertrophic cardiomyopathy (HCM), often leading to conduction abnormalities. While atrial fibrillation is common, high-degree AV block (AVB) is rare. We present a case of hypertrophic obstructive cardiomyopathy (HOCM) complicated by ventricular standstill, emphasizing the need for early recognition and management. Case Presentation A 46-year-old man with a family history of HCM (mother with ICD) presented with exertional dyspnea, palpitations, and presyncope for six months. No family history of sudden cardiac death. Examination revealed HR 76 bpm, BP 115/75 mmHg, and an ejection systolic murmur. ECG showed ventricular hypertrophy, dagger-shaped Q waves, Twave inversions, first-degree AVB (280 ms), and ventricular ectopics (figures 1 and 2). Troponin and NT-proBNP were elevated. Echocardiography confirmed HOCM with severe septal hypertrophy, a maximal LVOT gradient of 43 mmHg, and systolic anterior motion of the mitral valve. Indexed left atrial volume was 48 mL/m2 (figures 3 and 4). CT coronary angiogram was normal. He was started on bisoprolol 2.5 mg OD and within 48 hours developed intermittent high-degree AVB (2:1, 3:1). Bisoprolol was discontinued due to worsening conduction abnormalities, but he later developed symptomatic complete heart block, necessitating emergency ICD placement (figure 5). He was started on bisoprolol 2.5 mg OD and within 48 hours developed intermittent high-degree AVB (2:1, 3:1). Bisoprolol was discontinued due to worsening conduction abnormalities, but he later developed symptomatic complete heart block, necessitating emergency ICD placement. Discussion HCM is the most common genetic heart disease, inherited in an autosomal dominant manner in 50% of cases. MYBPC3 mutations are frequently linked to high-degree AV block.1 While atrial fibrillation is common in HCM, highdegree AV block remains rare. First-degree AVB in HCM is increasingly recognized as a marker of disease progression and arrhythmic risk.1 Mechanisms include left atrial enlargement (predisposing to atrial fibrillation and thromboembolism) and myocardial fibrosis, promoting electrical instability.1 Our patient had a 3.1% five-year sudden cardiac death risk and developed high-degree AV block and ventricular standstill. This progression was likely exacerbated by bisoprolol, which slowed AV conduction in the setting of pre-existing firstdegree AV block. Beta-blockers, though essential in HCM management, should be used cautiously in patients with conduction abnormalities. This case underscores the need for personalized HCM management. First-degree AVB may identify high-risk individu- als requiring closer monitoring, medication adjustments, and early device therapy. Conclusion High-degree AV block and ventricular standstill are rare but significant complications of HCM. First-degree AVB may serve as an early risk marker linked to left atrial enlargement, fibrosis, and arrhythmias. Clinicians should monitor conduction abnormalities closely, especially when prescribing AV-slowing medications. Genetic evaluation, surveillance, and individualized treatment strategies are crucial for optimizing outcomes in HCM patients.

DOI: 10.1136/heartjnl-2025-BCS.33

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Lipid Management Post Myocardial Infarction: A Call for Improved Monitoring and Therapy Intensification (2025)

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Type of publication:

Conference abstract

Author(s):

*Bhambra G.; Kukoyi B.; Joshi M.; Tran P.; Lo T.; Ajiboye J.; Oyedeji O.

Citation:

Heart. Conference: British Cardiovascular Society Annual Conference, BCS 2025. Manchester United Kingdom. 111(Supplement 3) (pp A210-A211), 2025. Date of Publication: 01 Sep 2025.

Abstract:

Background Lipid management is a cornerstone of secondary prevention in acute coronary syndrome (ACS). Despite established national guidelines, real-world practice often reveal gaps in lipid monitoring and intensification of lipid-lowering therapy. This study investigated these challenges in a large tertiary centre, proposing a streamlined pathway to address these gaps. Methods A retrospective analysis was conducted in 225 ACS patients (92 STEMI and 133 NSTEMI) from July-August 2023. We assessed lipid monitoring on admission and 2-3 months post-discharge, prescription rates of high-intensity statins and use of alternative lipid-lowering therapies. Multivariate logistic regression evaluated the relationship between highintensity statin initiation and lipid monitoring rates on admission and follow-up, adjusted for comorbidities. Results Initial guideline adherence was strong, with 83.1% having lipids checked on admission and 83.6% prescribed high-intensity statins (table 1). After adjusting for ACS type and comorbidities, patients started on high-intensity statin were nearly twice as likely to have lipids checked on admission (90.4% vs. 45.9%, p<0.001). Notably, patients not receiving high-intensity statins were more likely to have a prior history of ACS (43.2% vs 26.1%, p=0.035). Despite the perceived higher severity of STEMI, there was no significant difference in post-discharge lipid-checking rates between STEMI and NSTEMI patients (51.1% vs 53.4%, p=0.735). In terms of follow-up, only 52.4% of patients had lipids rechecked post-discharge, leaving almost half without adequate monitoring. Neither high-intensity statins nor ezetimibe initiation increased the likelihood of follow-up lipids. Among 118 patients with follow-up lipid assessment, 69.5% achieved target levels. However, of the 36 patients (30.5%) not meeting targets, only 3 (8.3%) had therapy intensified limited to the use of ezetimibe, highlighting a critical gap in care. Conclusion This study highlights the dichotomy between strong initial guideline adherence and significant lapses in follow-up care and therapy intensification. Whilst this single- centre study limits generalisability, several interesting observations emerged. The association between high-intensity statin prescription and admission lipid check highlights the importance of fostering a culture of guideline adherence, where attention to one aspect of care positively influences others. Patients with prior ACS were less likely to receive high-intensity statins, potentially due to perceived stability on existing regimen, leading to missed opportunities for therapy intensification. More strikingly, nearly half of the cohort lacked adequate lipid monitoring on follow-up with restricted use of lipid-lowering therapies. This highlights the need for a structured approach involving cardiac rehabilitation and primary care team via the proposed pathway (Figure 1) to ensure better lipid management in this high-risk cohort.

DOI: 10.1136/heartjnl-2025-BCS.206

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CT coronary angiography in the lipid clinic: a pilot study and lipidologist survey (2025)

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Type of publication:

Journal article

Author(s):

Graby, John; Sellek, James; Khavandi, Ali; Thompson, Dylan; Loughborough, Will W; Hudson, Benjamin J; Avades, Tony; Mbagaya, Wycliffe; Luva, Ahai; *Capps, Nigel; Shirodaria, Cheerag; Bayly, Graham; Antoniades, Charalambos; Downie, Paul F; Rodrigues, Jonathan C L.

Citation:

The International Journal of Cardiovascular Imaging. 2025 Oct 09. [epub ahead of print]

Abstract:

Guidelines recommend considering coronary calcium score (CCS) in asymptomatic patients to aid risk stratification. However, calcification occurs late in atherosclerosis. Coronary CT angiography (CCTA) can detect non-calcific plaque and inflammation before calcification develops, but impact on clinical management is not well documented. We compare coronary artery disease (CAD) detection and grading between CCS and CCTA, impact on management, and explore CCTA-derived inflammation biomarker (pericoronary fat attenuation index [FAI]) in the lipid clinic. Exploratory analysis of a prospectively maintained database of lipid clinic patients with CCS and CCTA (2018-2020). CCS grade was compared with CCTA stenosis, presence of high-risk plaque (HRP) and FAI-score analysis. UK Consultant Lipidologists completed an anonymised survey, documenting lipid target and management after sequential unblinding of CCS and CCTA data. In 45 asymptomatic patients (49% female, mean age 55 +/- 9), CCTA re-classified CAD presence in 22% (p = 0.002) and severity in 62% (p = 0.005) vs. CCS. HRP was observed in 20% (9/45), including 56% with CCS <= 100. Median LDL target with clinical vignette was 101 mg/dL (IQR 77-120), reducing to 89 mg/dL (77-120) after CCS, and 77 mg/dL (70-116) after CCTA unblinding. CCS altered LDL target in 12%, and CCTA a further 19% (chi2 57.0, p < 0.005). High FAI-score was demonstrated in 20%, including 22% of those with CCS <= 100 and 75% of those with <= mild CAD on CCTA. CCTA increased CAD prevalence and re-classified severity versus CCS, altering hypothetical management. High FAI-scores were observed across CCS and CCTA severity grades, including patients with no overt CAD.

DOI: 10.1007/s10554-025-03526-3

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A Literature Review Assessing Whether the Use of Non-steroidal Anti-inflammatory Drugs (NSAIDs) Increases the Risk of Cardiovascular Events (2025)

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Type of publication:

Journal article

Author(s):

*Ahsan, Ammar; Sahu, Muhammad Arham.

Citation:

Cureus. 17(9):e92361, 2025 Sep.

Abstract:

Non-steroidal anti-inflammatory drugs (NSAIDs) are very useful due to their multiple properties, including analgesic, antipyretic, and anti-inflammatory effects. As a result, NSAIDs have become one of the most widely administered drugs in the world. The proposed function of this drug was to act like a steroid without its harmful and common side effects. However, like any other medication, NSAIDs come with their own set of side effects, notably their gastrointestinal and cardiovascular effects. With these known side effects and its ease of availability, it is concerning, and therefore further research was required to determine if there is a significant risk of cardiovascular events associated with NSAIDs. Guideline searches were performed using the following databases: National Institute for Health and Care Excellence (NICE), TRIP, SIGN, and AHRQ, which produced 22 results; however, after screening, only one guideline was included in this review. A literature search for systematic reviews was conducted using the following databases: MEDLINE, Cochrane, and PubMed, which yielded 711 results. However, after full screening, only three systematic reviews were included. The National Institute for Health and Care Excellence (NICE) guidelines are a source of evidence-based recommendations made for healthcare professionals in the diagnosis and management of their patients. The NICE guideline focusing on NSAIDs provides advice regarding the prescription of NSAIDs, including contraindications, dosage, and mechanism of action. Three systematic reviews assessed NSAIDs and their cardiovascular effects. All three systematic reviews found an association between NSAIDs and their cardiovascular effects with varying degrees of strength. In conclusion, this review demonstrates evidence of the cardiovascular side effects related to the use of NSAIDs and raises questions about an increase in events, such as stroke, myocardial infarction, and hypertension. Evaluating the systematic reviews, it was essential to determine whether there was a statistically significant risk of cardiovascular events. All three papers suggested a linked increase in cardiovascular events; however, further research is required in order to understand which specific NSAIDs cause this. As a result, guideline alterations may need to be followed.

DOI: 10.7759/cureus.92361

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Early Versus Delayed Diuretic Administration and Urine-Guided Strategies in Acute Decompensated Heart Failure: A Systematic Review of Clinical Outcomes (2025)

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Type of publication:

Systematic review

Author(s):

Muzammil, Rabeet; Mohammad, Ahmad; Hammad, Muhammad; Ahmed, Adeel; Hussain, Aadil; Rashid, Wardah; Yousaf, Rabia; Singla, Shivam; Singla, Bhavna; *Ekomwereren, Osatohanmwen; Asante Baadu, Francis; Irshad, Ahmad.

Citation:

Cureus. 17(8):e89408, 2025 Aug.

Abstract:

This systematic review explores the impact of diuretic timing and strategy on outcomes in patients with acute decompensated heart failure (ADHF). A total of seven studies were included, comprising randomized controlled trials (RCTs), pre-specified sub-analyses, and observational data. Early administration of intravenous loop diuretics, particularly within the first 60 to 90 minutes of hospital arrival, was generally associated with improved short-term outcomes, including reduced in-hospital and 30-day mortality. Furthermore, guided diuretic strategies using urine sodium or urinary biomarkers showed promise in enhancing decongestion efficiency and predicting therapeutic response, although long-term benefits remain uncertain. Despite some heterogeneity in study design, timing definitions, and outcome measures, this review underscores the clinical significance of prompt and tailored diuretic therapy. These findings highlight the need for timely intervention and more personalized management strategies in ADHF, while also identifying gaps for future large-scale trials.

DOI: 10.7759/cureus.89408

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Acute coronary syndrome rule-out strategies in the emergency department: an observational evaluation of clinical effectiveness and current UK practice (2025)

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Type of publication:

Journal article

Author(s):

Ingram A.; Boldovjakova D.; Wilson H.; Noble J.; Prentice J.E.B.; Brasnic L.; Papala P.; Waite R.; Hatem S.M.K.; Hamad H.H.M.A.; Lilani M.J.; Hardwick S.; Pritchard W.; Cairns D.; Lamuren E.; Thomas J.; Eve M.; Gabiana P.; Matias S.; Harris S.; Christmas E.; Brockbank J.; Mackinnon L.; Chrysikopoulou M.; Vo O.K.; George R.J.; Alsaarti R.; Mohrsen S.; Macleod C.; Grossi I.; Feetham J.; Almousa O.; Lyle A.; Victoria A.; Fox C.; Mitchell C.; Kara C.; Catley C.; Shea D.; Cranmer K.; Sach L.; Willsher L.; Vitaglione M.; Forsey M.; Fox N.; Arnold R.; Reid S.; Cotterell S.; Smolen S.; Lester Y.; Dean A.; Fitchett J.; Hoyle R.; Duberley S.; Goddard W.; Lunney C.; Ogbeide C.; Mcsorland D.; Gibson M.; Riley M.R.; Bradley P.; Thomas Z.; Giles E.; Patel H.; Pathirana J.; Chappel P.; Balasingam S.; Webb S.; Elshobaky E.; Challen K.; Ibrahim M.; Connor S.; Aprjanto A.; Ghosh A.; Amer E.; Sinclair J.; Smith T.; Freitas T.D.; Smith J.; Peachey J.; Clymer J.; Squire R.; Lee A.R.; Szekeres C.; Jessup-Dunton E.; Irvine G.; Brookman I.; Grant I.; Abbas K.; Wanigabadu L.; Futcher M.; Awadalkarim M.; Parker M.; Thammaiah Y.; Blows G.R.; Evans L.; Rebolledo M.; Macfarlane R.; Felix R.B.; Baker E.; Clarke J.; Dinglasan M.; Aldridge P.; Marshall S.; Helyar S.; Kunnath T.; Baldwin G.; Lowdell J.; Vallotton N.; Dasilva R.; Sharaf T.; Awe A.; Kerr-Winter B.; Anomelechi E.; Emond F.; Sennitt H.; Khan I.; Aderounmu I.; Bath J.; Woods J.; Dudden K.; Rupchandani K.; Mccafferty L.; Aaron L.; Al-Mousa M.; Okere N.; Scott O.; Edwards R.; Copson S.; Burke S.A.; Nawaz S.; Muhammad Y.; Noor A.; Tizon A.; Passalacqua C.; Qureshi E.F.; Malik F.I.; Jaafaru H.I.; Raees H.; Khaliq M.A.; Layawen N.; Shah R.; Torres S.L.G.; Guglani S.; Ramraj S.; Sharma S.; Hassan T.M.; Betos V.; Drexel A.; Sakutombo D.; Mendes F.; Furreed H.; Morris M.G.; James M.; Fong T.; Hartin D.; Lloyd G.; Sundarraj S.T.; Rivers V.; Kelly C.; Sutherland H.; Boast M.; Kisakye E.; Britton H.; Sebastian J.; Puscas M.R.; George S.; Olawale-Fasua W.; Wood D.; Kaur J.; King S.; Heeley C.; Davy G.; Wilson G.; Bennett K.; Allsop L.; Gill M.; Thorpe N.; Turner S.; Whitworth V.; Prendergast A.D.; Jones A.; Sheppard C.; Jones K.A.; Mcgregor K.; Sekar P.; Aeman S.; O'donnell S.P.; Griffin S.; Sheikh A.; Chintamani A.; Shrestha B.; Bisht D.; Saliu E.J.; Fadhlillah F.; Mahmoud M.Y.; Wasil M.; Ragupathy R.; Moghal Z.S.; John A.; Lockett C.; Tomkinson J.; Rose K.; Aziz M.; Keenan N.; Sandhu B.; Bentley C.; Phiri E.; Adams L.; Page M.; Seaman R.; Asnani S.; Taylor C.; Butt M.; Doherty W.J.; Da'costa A.; Adedeji A.D.; Ibeh C.O.; Oduware E.O.; Dolan H.; Ofori L.; Brassington L.; Olusoga O.; Nkala P.; Gurung S.; Williams S.; Ndlovu T.; Akhuemokhan Z.B.; Gulati D.; Akande M.; Oshiotse S.; Chilcott G.; Battishill W.; Wood J.M.; Hendry R.; Pottelbergh T.M.V.; T-Michael H.; Rothwell J.; Connolly K.; Cooper L.; Quli A.; Corr H.; Orourke L.; Pettet A.; Kariyadil B.; Pile J.; Gallamoza K.; Foo M.; O'connell P.; Kirkup A.; Hall J.; Hudson L.; Waddell G.; Mckie H.; Beck J.; Harrison M.; Ternent M.; Crispin P.; Aladesanmi A.; Ahmed A.; Thomson D.; Moth G.; Haslam J.; Killeen J.; Philbin J.; Howard-Sandy L.; Warran S.; Munt S.; Humphrey C.; Langridge E.; Otoole K.; Pule P.; Miln R.; Death Y.; Davies A.; Dunn E.; Brittain E.; Kohler G.; Stacey J.; Bloch M.; Murphy M.; Griffiths O.; Awbery H.; Oyindamola O.; Aor S.S.; Gribbin A.; Edwards C.; Vorwerk C.; Jackman D.; Brown G.; Daly Z.; Naiyeju A.A.; Arrayeh A.; Giubileo A.; Sarvesh B.; Jafferji D.; Thornton H.; Mckenzie I.; Okwori I.; Rudnicka J.; Nasr M.; Hassan M.; Aliu M.; Osunsanya O.; Abdulsalam S.; Mbaekwe S.; Shedwell S.; Wickramanayake U.; Abdullahi Y.; Mcclelland B.; Willshire K.; Knight A.; Beranova E.; Tutt G.; Ramos H.; Mcarthur C.; Khoo E.; Hughes E.; Austin K.; Doran K.; Gordon M.W.G.; Oshaughnessy O.; Worgan R.; Matthews A.; Baddeley A.; Morris A.; Ndungu A.; Peters C.; Walker L.; Tilbury N.; Lubbock S.; Mapatuna C.; Kehlenbeck E.; Curtis K.; Tonkins M.; King P.; Walker R.; Gabriel Z.; Titu H.; Coyle J.; Waddington N.; Chotai C.; Ward C.; Elliott L.; Henshall A.; Pogorodnaja A.; Knowles C.; Mascia G.; Rai S.G.; Bartley S.; Ko S.T.S.; Perera Y.; Conroy E.; Nicholson J.; Taylor J.; Flanagan R.; Wilce A.; Lindsay C.; Bascombe C.; Osey C.; Tiller H.; Rogers L.; Agius N.; Barratt N.; Pitts S.; Mohammed A.; Eihebholo A.; Olaifa A.; Bowyer C.; Sutcliffe E.; Bishop O.J.; Jenkins O.; Kyriakides O.; Thomas S.; Ali S.; Mason S.; Ripsher W.; Cousins E.; Dhande K.S.; Wright L.; Bolus A.; Sykes D.; Faronbi G.O.; Slade L.; Page R.; Maiti M.; Hekal M.; Khadka S.; Border T.; Wilson W.; Lowe A.; Evans C.; Moceivei C.; Mcavoy D.; Hay F.; Homyer K.; Dunne M.; Goldmann N.; Mitchell R.; Geoghegan A.; Entwistle J.; *Marsh A.; *Stephens A.; *O'connell G.; *Gibson H.; *Stickley J.; *Witt J.; *Beekes M.; *Sowailam M.; *Ali N.A.; Stan A.; Boalch A.; Demetriou C.; Flitney C.; Munday C.; Khoory C.; Carter D.; Gould E.; Evans G.; Elghonemy H.; Latham J.; Zamari K.; Ramos L.; Howie L.; Gunning S.; Haskins W.; Ayodeji Y.S.; Potts A.; Kay D.; Perez J.; Holden J.; Pendlebury J.; Cawley K.; Shahedy N.; Doonan R.; Blevings R.; Anthony A.; Trim F.; Hadebe B.; Pherson A.M.; Mphansi E.; Tysoe S.; Masunda B.; Galliford J.; Pestell S.; Patel S.; Pickard A.; Hoare B.; Cox C.; Hart D.; Amarnani D.; Fay E.; Khedarun F.M.; Collins F.; Sysum K.; Fung M.; Corbin N.; Patel N.; Moss P.; Marques R.; Johnson R.; Parmar S.; Sarker S.; Lawrence G.; Romero M.R.; Felix R.M.B.; Raju T.; Clarson S.; Clarke B.D.; Philp E.; Wren G.; Gallacher S.; Sharir A.; Andrews B.; Faint C.; Caines C.; Everett C.; Newman D.; Cruz G.D.L.; Hughes G.; Carey H.; Reavley H.; Ayre J.; Quan J.; Caines L.; Wedge-Bull M.; Alzaatreh M.; Chong N.; Anthony N.; Chandler S.; Walford S.; Sharir T.; White T.; Heslop-Harrison W.; Dunphy A.; Trenwith B.; Coelho B.; Hunter L.; Moran R.; Pemberton A.; Suggitt B.; Pimlott B.; Bates C.; Tibke C.; Pegler D.; Daniel D.; Lamond D.; Pureti G.; Baxter H.; Melville J.; Zai K.F.T.; Mullane K.; Phyu M.P.; Gabriels N.; Mills R.; Bennett S.; Blenkinsop S.; Vikramadhithyan S.; Barnes S.; Hopkins S.; Doherty-Walls T.; Coughlan T.; Kinder J.; Clark M.; Islam M.N.; Gray R.; Ford A.; Florey L.; O'neill M.; Aspa P.; Mercer P.; Ackerley A.; Ironside J.; Haynes L.; Garcia B.; Elkhodair S.; Enegela A.; Leech C.; Hassanali F.; Rashid H.; Lalji J.; Akpoghene M.; Enegela O.A.; Hafeez-Bore O.; Oluwaseun O.; Pelasur R.; Ayres R.; Tariq R.; Mchenry R.D.; Bains B.; Jones B.; Tarant E.; Mundy M.; Pearse R.; Sibtain S.; Day A.; Campbell B.; Stagg C.; Jones D.; Atwal I.; Tompkins K.; Parsons P.; Dancer R.; Balaican A.M.; Ellis C.; Ede C.H.; Joseph J.; Hardaker O.; Ridwan R.; Khan S.; Zhao X.; Wood L.; Tampsett R.; Rao S.; Castillo W.P.H.; Ticehurst F.; Rocha J.G.D.; Chivers K.; Vecchione N.; Kader N.; Wilson S.; Adhikari S.; Ramsundar S.; Felix F.; Johnston R.; Jin Y.; Ingall E.; Rand J.; Solly R.; Naeem S.; Stirrup S.; Priestley V.; Pun A.; Olosho O.Z.; Board S.;

Citation:

Emergency Medicine Journal. (no pagination), 2025. Article Number: 214616. Date of Publication: 2025. [epub ahead of print]

Abstract:

Background: Numerous strategies have been developed to rapidly rule-out acute coronary syndrome (ACS) using high-sensitivity troponin. We aimed to establish their performance in terms of emergency care length of stay (LOS) in real-world practice. Method(s): A multicentre observational cohort study in 94 UK sites between March and April 2023. Recruitment was preferably prospective, with retrospective recruitment also allowed. Adults presenting to the ED with chest pain triggering assessment for possible ACS were eligible. Primary outcome was emergency care LOS. Secondary outcomes were index rate of acute myocardial infarction (MI), time to be seen (TTBS), disposition and discharge diagnosis. Details of ACS rule-out strategies in use were collected from local guidelines. Mixed effects linear regression models tested the association between rule-out strategy and LOS. Result(s): 8563 eligible patients were recruited, representing 5.3% of all ED attendances. Median LOS for all patients was 333 min (IQR 225, 510.5), for admitted patients was 460 min (IQR 239.75, 776.25) and for discharged patients was 313 min (IQR 221, 451). Heterogeneity was seen in the rule-out strategies with regard to recommended troponin timing. There was no significant difference in LOS in discharged patients between rule-out strategies defined by single and serial troponin timing (p=0.23 and p=0.41). The index rate of acute MI was 15.2% (1301/8563). Median TTBS was 120 min (IQR 57, 212). 24.4% (2087/8563) of patients were partly managed in a same day emergency care unit and 70% (5934/8563) of patients were discharged from emergency care. Conclusion(s): Despite heterogeneity in the ACS rule-out strategies in use and widespread adoption of rapid rule-out approaches, this study saw little effect on LOS in real-world practice. Suspected cardiac chest pain still accounts for a significant proportion of UK ED attendances. ED system pressures are likely to be explanatory, but further research is needed to understand the reasons for the unrealised potential of these strategies.

DOI: 10.1136/emermed-2024-214616

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Exploring the Association Between Myocardial Infarction and Cognitive Decline: A Narrative Review (2025)

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Type of publication:

Journal article

Author(s):

Issimdar, Iqrah A; Mudegowdar, Rohit; *Gupta, Anchal R; Patel, Keval B; Elshoura, Anas; Bhanushali, Vidhi Mahendra; Joseph, Joshua R; Meiyalagan Varalakshmi, Aishwarrya; Sahotra, Monika; Kashif, Mazin; Binny, Vivasvat; Pathan, Nahila A; Siddiqui, Humza F.

Citation:

Cureus. 17(5):e84957, 2025 May.

Abstract:

The association between cognitive impairment (CI) and myocardial infarction (MI) has been highlighted in recent years. Several studies have reported an increased incidence of cognitive decline (CD) following MI, emphasizing the need for early identification and intervention in such patients. Previous research findings have been inconsistent due to the presence of various unaccounted factors potentially contributing to CD and disparities in the methods utilized to assess cognition such as the Mini-Mental State Examination, Mini-Cog and self-evaluation questionnaires. This emphasizes the potential for a more standardized tool of assessment to investigate the onset of CD amongst MI patients in a reliable manner. This literature review delineates the correlation between MI and CI, exploring the pathogenesis, risk factors, management and preventive strategies. Cerebral hypoperfusion, underlying atherosclerosis and neuroinflammation are crucial in the development of CD after MI. Hence, it is important to consider the 'heart-brain axis' for targeted therapy of CD in MI patients. Old age is a common risk factor for CD and MI. However, the impact of variables including gender and comorbidities is underreported, which can potentially alter the relationship between cognitive outcomes and MI. The implementation of multidisciplinary-oriented cardiac rehabilitation programs and a universal screening tool to follow up on patients with established CI post-MI has shown favorable outcomes and has reduced the risk of adverse health consequences. Optimizing medical management and regular monitoring of serum brain natriuretic peptide (BNP) and hemoglobin levels are essential in preventing CD after MI. Psychological evaluation and counselling also help attenuate CD. Additionally, preventive strategies addressing modifiable risk factors and implementing anti-inflammatory diets have proven beneficial. Ongoing research is focused on the study of novel interventions targeting the neuroinflammatory process. Recently a new member of the C-reactive protein family, pentraxin 3, has been identified as a specific vascular inflammatory biomarker produced by cells in atherosclerotic lesions that can potentially aid in recognizing CD. It is imperative to establish uniform guidelines to recognize and manage CI among patients following MI to improve quality of life among the elderly population.

DOI: 10.7759/cureus.84957

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Cardiovascular disease morbidity is associated with social deprivation in  subjects with familial hypercholesterolaemia (FH): A retrospective cohort  study of individuals with FH in UK primary care and the UK Simon Broome  register, linked with national hospital records (2025)

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Type of publication:

Journal article

Author(s):

Iyen, B; Qureshi, N; Kai, J; *Capps, N; Durrington, P N; Cegla, J; Soran, H; Schofield, J; Neil, H A W; Humphries, S E.

Citation:

Atherosclerosis. 403:119142, 2025 Feb 18.

Abstract:

BACKGROUND: Social deprivation is associated with higher cardiovascular disease (CVD) morbidity and mortality. We examined whether this is also observed in people with Familial Hypercholesterolaemia (FH).

METHODS: Subjects with FH and linked secondary care records in Hospital Episode Statistics (HES) were identified from UK Clinical Practice Research Datalink (CPRD) and the Simon Broome (SB) adult FH register. Cox proportional hazards regression estimated hazard ratios (HR) for composite CVD outcomes (first HES outcome of coronary heart disease, myocardial infarction, angina, stroke, transient ischaemic attack, peripheral vascular disease, heart failure, coronary revascularisation interventions (PCI and CABG)) in Index of Multiple Deprivation (IMD) quintiles.

RESULTS: We identified 4309 patients with FH in CPRD (1988-2020) and 2956 in the SB register. Both cohorts had considerably fewer subjects in the most deprived compared to the least deprived quintile (60 % lower in CPRD and 52 % lower in SB). In CPRD, the most deprived individuals had higher unadjusted HRs for composite CVD (HR 1.71 [CI 1.22-2.40]), coronary heart disease (HR 1.63 [1.11-2.40]) and mortality (HR 1.58 [1.02-2.47]) compared to the least deprived but these became insignificant after adjusting for age, sex, smoking and alcohol consumption. In the SB register, hazard ratios for composite CVD increased with increasing deprivation quintiles and remained significant after adjustment for age, sex, smoking and
alcohol consumption (adjusted HR in quintile 5 vs quintile 1 = 1.83 [1.54-2.17]).

CONCLUSIONS: Strikingly fewer individuals with FH are identified from lower socioeconomic groups, though the most deprived FH patients have the highest risk of CVD and mortality. In CPRD, this risk was largely explained by smoking and alcohol consumption, but not in the SB register. More effective strategies to detect FH and optimise risk factor management, are needed in lower socioeconomic groups.

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Ethnic disparity in the care and management of non-ST-segment elevation myocardial infarction and its impact on short-term and long-term survival: a long-term study of a national registry (2024)

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Type of publication:

Conference abstract

Author(s):

Yera H.; Weight N.; Moledina S.M.; Mamas M.A.;

Citation:

European Heart Journal. Conference: European Society of Cardiology Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no pagination), 2024. Date of Publication: 01 Oct 2024.

Abstract:

Background: Previous examination of data from the United Kingdom indicates no apparent ethnic disparity in the treatment of patients hospitalised with non-ST-segment elevation myocardial infarction (NSTEMI). However, it remains uncertain whether this lack of disparity results in similar long-term survival outcomes among ethnic minority groups, particularly those with multiple underlying risk factors for coronary artery disease, when compared to White patients.

Purpose(s): To assess the impact of quality of care on short-term and long-term survival among NSTEMI patients while examining disparities based on ethnicity.

Method(s): We analysed records of 252,964 individuals diagnosed with NSTEMI from the Myocardial Ischaemia National Audit Project database spanning 2005 to 2019, alongside Office of National Statistics data for mortality. Among them, 233,158 were identified as White patients, while 19,806 were categorised as belonging to ethnic minority groups (Asian, Black, and mixed ethnicity). Propensity score matching was used to compare average treatment effects between cohorts while survival was compared using Cox regression model.

Result(s): Ethnic minorities were younger (median age in years) (66 vs. 73, P < 0.001), predominantly male (70% vs. 63%, P < 0.001), and exhibited a higher prevalence of cardiovascular risk factors such as diabetes (52% vs. 24%, P < 0.001), hypertension (67% vs. 54%, P < 0.001), hypercholesterolemia (49% vs. 34%, P < 0.001), and chronic renal dysfunction (13% vs. 8%, P < 0.001). Ethnic minorities more frequently underwent invasive coronary angiography (80% vs. 68%, P < 0.001), percutaneous coronary intervention (53% vs. 44%, P < 0.001), and coronary artery bypass grafting (5% vs. 4%, P < 0.001). After conducting propensity score matching, both cohorts had no significant differences in in-hospital all-cause mortality [odds ratio (OR) 1.13, confidence interval (CI) 0.89 – 1.43; P = 0.268], cardiac mortality (OR 1.20, CI 0.89 – 1.54; P = 0.209), one-year mortality (OR 1.01, CI 0.89 – 1.13; P = 0.893) and major adverse cardiovascular events (OR 1.21, CI 0.95 – 1.48; P = 0.108). However, upon conducting a five-year survival analysis, ethnic minorities had better survival rates than their White counterparts (Hazard ratio (HR) 0.89, CI 0.86-0.92; P < 0.001).

Conclusion(s): Despite ethnic minorities being at a higher risk for coronary artery disease, our findings indicate that they experience better five-year survival rates than White patients. This suggests equitable access to care and potentially a more aggressive treatment approach in this relatively young patient cohort.

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REPAIRS Delphi: A UK and Ireland Consensus Statement on the Management of Infected Arterial Pseudoaneurysms Secondary to Groin Injecting Drug Use (2024)

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Type of publication:
Journal article

Author(s):
MacLeod C.S.; Nagy J.; Radley A.; Khan F.; Rae N.; Wilson M.S.J.; Suttie S.A.; Munro E.N.; Flett M.M.; Hussey K.; Wolf B.; W R.; Wallace D.; Vesey A.T.; McCaslin J.; Wong P.; Tenna A.; Badger S.; Harrison G.; Ghosh J.; Al-Khaffaf H.; Torella F.; McBride R.; Drinkwater S.; Antoniou G.A.; Bhasin N.; Pradhan A.; Smith G.; Coughlin P.; Brar R.; Peach G.; Kulkarni S.; Brooks M.; Wijesinghe L.; McCune K.; Hopper N.; Cowan A.; Hunter I.; Mittapalli D.; Garnham A.; *Jones S.; Rajagopalan S.; Tiwari A.; Imray C.; Atwal A.; Bahia S.; Jones K.G.; Handa A.; Bowbrick G.; Nordon I.; Button M.; Rudarakanchana N.; D'Souza R.; Tai N.; Moxey P.; Bicknell C.; Gibbs R.; Zayed H.; Saratzis A.; Kannan R.; Batchelder A.; Chong P.L.; Rowlands T.; Hildebrand D.; Thapar A.; Chaudhuri A.; Howard A.; Metcalfe M.; Al-Jundi W.; Sayer G.; Lewis D.; Sohrabi S.; Woolgar J.; Fligelstone L.; Davies H.; Hill S.; Fulton G.; Moneley D.; McDonnell C.; Martin Z.; Dowdall J.; Tierney S.; Walsh S.; Medani M.; Gosi G.

Citation:
European Journal of Vascular and Endovascular Surgery. (no pagination), 2024 [epub ahead of print]

Abstract:
Objective: Consensus guidelines on the optimal management of infected arterial pseudoaneurysms secondary to groin injecting drug use are lacking. This pathology is a problem in the UK and globally, yet operative management options remain contentious. This study was designed to establish consensus to promote better management of these patients, drawing on the expert experience of those in a location with a high prevalence of illicit drug use. Method(s): A three round modified Delphi was undertaken, systematically surveying consultant vascular surgeons in the UK and Ireland using an online platform. Seventy five vascular surgery units were invited to participate, with one consultant providing the unit consensus practice. Round one responses were thematically analysed to generate statements for round two. These statements were evaluated by participants using a five point Likert scale. Consensus was achieved at a threshold of 70% or more agreement or disagreement. Those statements not reaching consensus were assessed and modified for round three. The results of the Delphi process constituted the consensus statement. Result(s): Round one received 64 (86%) responses, round two 59 (79%) responses, and round three 62 (83%) responses; 73 (97%) of 75 units contributed. Round two comprised 150 statements and round three 24 statements. Ninety one statements achieved consensus agreement and 15 consensus disagreement. The Delphi statements covered sequential management of these patients from diagnosis and imaging, antibiotics and microbiology, surgical approach, wound management, follow up, and additional considerations. Pre-operative imaging achieved consensus agreement (97%), with computerised tomography angiography being the modality of choice (97%). Ligation and debridement without arterial reconstruction was the preferred approach at initial surgical intervention (89%). Multidisciplinary management, ensuring holistic care and access to substance use services, also gained consensus agreement. Conclusion(s): This comprehensive consensus statement provides a strong insight into the standard of care for these patients.

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