“Failure is not an option… how about we think of it like this: success is an option,” says Nick Hartshorne-Evans, the founder and CEO of the Pumping Marvellous Foundation, the UK’s Heart Failure charity.

Training our mind to see and experience success is an essential component of winning. In 2017, I uttered the bold words that this was heart failure’s decade. I always build margins of error into whatever I do.

For many years, there has been a lack of investment in heart-failure services; not just in the UK, but across Europe and the Globe. This is not a reflection on the thousands of dedicated heart failure specialists; this is a reflection on “who shouts loudest” which then prioritises certain conditions for people in power. If you look at it from an outsider’s point of view, why would you invest in heart failure? Have you ever invested in failure? You are brave if you have.

Highlighting ‘failure’ doesn’t facilitate optimism

Let’s look at it from a different angle. Company names are essential; they generally shout your brand and how you want the outside world to see you. How many companies are registered in the UK at Companies House with the word ‘failure’ in their registered title? There are nine listed. Now let’s look at how many companies at Companies House have the word ‘success’ in their registered title. There are 279 listed. The word failure is not widespread. It’s meaning alone doesn’t facilitate buy-in or demonstrate optimism or good outcomes.

Positive change needs to happen for the 1 million people in the UK.

Do people really know what heart failure is?

Heart failure is a debilitating condition that has a significant burden on people’s lives. It impacts nearly 1 million people across the UK and has a worse prognosis than most forms of common cancer. However, people don’t know what it is and what the symptoms are.

Heart failure is still not on the agenda and only occupies one paragraph in the 136-page NHS Long Term Plan published earlier this year.

Progress for 1 million people in the UK

Change needs to happen. Positive change needs to happen for the 1 million people in the UK; you probably know one or more.

We have many successes to shout about. We are seeing the green shoots of real positive change. We are all working together, working to beat heart failure, and we need you to support us. We want to reset attitudes towards heart failure and bring it to the forefront of the health agenda. 

Having been inserted into this conversation at 39 (with a diagnosis of heart failure, nearly dying, being cared for and treated back to some form of normality by people doing the right things); I know this is the time to strike. This is the time to work as a team and change the paradigm and move the needle to success. Never have we had a better opportunity.

As a friend of mine said, “We know what good looks like; we just need to do it.”

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Your body holds a 60,000 mile network of blood vessels, with your heart at its centre. But if anything goes wrong with this system, there can be devastating consequences.

There are around 7.4 million people living with heart and circulatory diseases in the UK

170,000 deaths from heart and circulatory diseases each year – an average of 460 people each day or one death every three minutes.

Heart

Coronary Heart Disease (CHD)

• CHD is responsible for around 64,000 deaths in the UK each year, an average of 180 people each day, or one death around every eight minutes.
• 2.3 million people in the UK living with CHD
• People with heart diseases are 2x more likely to develop vascular dementia

Heart attack

• In the UK more than 100,000 hospital admissions each year are due to heart attacks; that’s 280 admissions each day, or 1 every 5minutes

Heart failure

• People with heart failure are 2-3 times more likely to have a stroke
• Around 920,000 people are living with heart failure

Stroke

• Every 5 minutes someone is admitted to UK hospital due to a stroke
• There are 1.3 million stroke survivors in the UK
• Cause around 36,000 deaths in UK each year

Vascular dementia

• Around 150,000 people in the UK have vascular dementia
• Vascular dementia accounts for three quarters of dementia in stroke survivors

Risk factors

Diabetes

• Nearly 3.8 million adults in the UK have been diagnosed with diabetes.
• Can cause damage to blood vessels
• People with diabetes twice as likely to have a stroke
• One third of adults with diabetes die from a heart or circulatory disease
• People with diabetes are 2-3 times more likely to develop vascular dementia

High blood pressure

• More than 1 in 4 adults have high blood pressure in the UK
• Around 50% of heart attacks and strokes are associated with high blood pressure

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Most people have heard of heart failure, but it is frequently misunderstood and often confused with a heart attack, a cardiac arrest or other heart disease.

Heart failure is the inability of the heart to pump blood around the body. This leads to symptoms of breathlessness (either on exertion or at rest), extreme tiredness and swollen feet and legs.

Common causes are ischaemic heart disease, myocardial infarction (heart attack) and hypertension (high blood pressure).

Despite the prevalence being similar to the four commonest cancers combined, it doesn’t get the recognition or funding it deserves. Heart failure costs the NHS £2.3 billion a year (2% of the total budget).

Heart failure is a modern day epidemic

Heart failure affects around 920,000 people in the UK, with this number is likely to rise due to an ageing population, more effective treatments, and improved survival rates after a heart attack.

Over the past 30 years there have been huge advances in available treatments. Many people with heart failure now live a normal life providing they have the right support from their specialist healthcare team.

There are almost 200,000 new cases diagnosed each year, with the number increasing year on year. However, a lack of understanding about the condition and the lack of awareness of heart failure symptoms can delay early diagnosis and referral to a specialist team, which can lead to a delay in effective treatments being given.

Heart failure affects around 920,000 people in the UK, with this number is likely to rise due to an ageing population.

Many people with heart failure are not receiving adequate care following diagnosis and there is considerable national variation in the level of service provision.

Heart failure is a large burden on the NHS: It accounts for one million bed days per year and 5% of all emergency admissions to hospital. Improving heart failure service provision can prevent costly re-admissions and provide efficiencies in the NHS.

We can do more

We have made astonishing progress in the fight against heart failure and are winning, but we could do even better and bring more hope to heart failure patients and their carers.

By increasing public awareness of the signs and symptoms of heart failure, an early diagnosis can be made in primary care with a simple blood test called Brain Natriuretic Peptide (NT-pro BNP).

Suspected cases can be quickly referred to a specialist heart failure team who can confirm the diagnosis and offer early treatment with effective therapies. With these therapies, we have seen prognosis improve considerably over the past 10 years. However, we need to do more.

Be aware of the symptoms. If you think you have them, talk to your GP. Ask for the NT-pro BNP blood test. It is time to act fast. Early diagnosis leads to quicker referral to a specialist team and treatment with life-saving therapies.

Fighting heart failure with public support

The British Society for Heart Failure needs the support of the public, patients and policy makers to support health care professionals to build on these green shoots of success to ensure all heart failure patients, no matter where they live in the UK, receive equitable access to specialist heart failure care.

www.bsh.org.uk

References:Temporal trends an patterns in heart failure incidence: a population-based study of 4 million individuals. Conrad et al. Lancet 2018;391:572-90 | Chronic heart failure in adults: diagnosis and management. www.nice.org.uk/guidance/ng106 | National heart failure Audit. www.nicor.org.uk/wp-content/uploads/2018/11/Heart-Failure-Summary-Report-2016-17.pdf

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Almost seven years ago, MP, Steve McCabe had open heart surgery to repair his mitral valve.

The surgery was intense; hours in the operating theatre, vast volumes of anaesthetic and time spent on a ventilator. “When I eventually came round, I wasn’t actually sure if I’d survived,” he says.

After the major surgery, he was in intensive care for three days and on a recovery ward for another two weeks. “It was a long and arduous process, and, despite being quite a determined character, I have to confess there were periods when I began to doubt that I’d ever be OK again.”

Even though Steve lives a full and active life now, he says: “After my treatment, I had a long recovery time, which meant I had to be off work for six months. I wish I had been more aware of the treatment options available and chosen a less invasive procedure.”

Early diagnosis and patient education is key

Steve stresses the importance of early diagnosis of heart valve disease, which can be achieved simply by listening to the heart with a stethoscope.

Untreated, heart valve disease can progress to heart failure and ultimately death but, identified early enough, it is treatable, and a less-invasive treatment procedures may be appropriate.

I am living proof that, with early diagnosis and proper treatment, these conditions needn’t be debilitating.

“As someone who has experienced heart valve disease, I know first-hand the importance of receiving timely treatment and how this can return people to a good quality of life, so it is important that this can be provided across the whole country.”

But do people know enough about the need for diagnosis or the options available to them? Steve feels more must be done. “I believe we must continue to work together to ensure that people living with these conditions have access to the care and support they need,” says Steve.

“It is vital that people are better educated on the condition, are aware of the symptoms and know what treatments options are available to ensure more lives are saved.”

Innovations in treatment

“I am living proof that, with early diagnosis and proper treatment, these conditions needn’t be debilitating. My advice to patients would be to speak to your clinician about the treatment options available so that you can make an informed choice.”

To find out more about heart valve disease, read more on Heart Valve Voice

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Innovations in heart valve technology and implantation systems are set to transform the lives of more people with heart valve disease.

Heart valve disease is a common condition that can turn into a killer

Half of UK over-65s have some level of disease related to heart structure. Over one in 10 – around 1.5 million people – have moderate or severe disease. By 2040, this is expected to reach 2.7 million.

Statistics show that, of those with the most common heart valve disease, severe aortic stenosis, half will die within two years and only 3% survive five years.

Part of the problem is detection. Chris Young, the heart surgeon and chair of the charity, Heart Valve Voice (HVV), says: “The main symptoms are breathlessness and feeling tired, but many people attribute this to age.”

Once suspected, heart valve disease can be diagnosed by listening to the heart through a stethoscope – but only 7% of UK GP consultations include this (compared to 79% in France).

Treatment in less severe conditions usually starts with monitoring. “Monitoring means we can predict when valve repair is needed,” says Young. Traditionally, this required open heart surgery, but new techniques are making this faster, easier and safer.

Treatment innovations use tissue from cow or pig hearts

Innovative heart valves have recently been tested in the UK TAVI Trial. The valves, made of tissue taken from cow or pig hearts, are used to repair the patient’s damaged aortic valve, using transcatheter aortic valve implantation (TAVI).

The valve is threaded into the body, usually via the femoral artery, until it reaches the patient’s own aortic valve, where it takes over the task of pumping blood.

Catheterisation typically takes one to two hours and the typical hospital stay is three to five days. Procedure time, days in hospital and the risk of complications are lower than with traditional open heart surgery.

Young says: “The TAVI trial will deliver more information about valve performance and patient outcomes. TAVI is underused in the NHS at present but I expect it to become mainstream in the next few years.”

A new lease of life

Heart valve repairs can deliver dramatic new energy and lengthen patients’ lives.

“Typically, those who have successful surgery go on to live longer than their peers who have had no heart valve problems,” says Young. The effort of pushing blood through an abnormal valve makes the heart stronger, so once the problem is corrected the heart is more efficient than average, he explains.

I’ve seen people who, before surgery, were only able to walk slowly, transformed into people who can achieve more than they ever could before.

More and better treatment

Inequalities of diagnosis and under-treatment of heart valve disease has spurred HVV to work with valve care specialists and patients to create Gold Standard of Care Guidelines. “These will help optimise patient care, improve access and influence policy makers on behalf of heart valve disease patients,” says Young.

HVV is now helping develop the 2019 NICE heart valve disease guidelines, and the issue will be debated in Parliament soon.

Meanwhile, Young counsels: “Ask for a stethoscope check. Undetected heart valve disease can kill.”

To find out more about heart valve disease, read more on Heart Valve Voice

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Alison Banayoti has a new lease of life after treatment for an unsuspected heart condition. Now, she’s urging everyone to get a simple stethoscope check for the disease.

In May, Alison Banayoti, 59, abseiled down St Thomas’ Hospital in London to raise awareness of heart valve disease. Six months earlier Alison had surgery there for the condition. She now says: “I feel fitter than ever. I’ve been given a second chance at life and nothing phases me.”

She is not alone: heart valve diseases can mean the heart has to work harder.  If the heart valve can be repaired or replaced, the heart functions more efficiently than normal.

Early diagnosis is vital for the best treatment

Alison considers herself lucky that her heart valve disease was diagnosed at an early stage.

Aged 45, she experienced a rubbery feeling down one arm and leg. A mini stroke was suspected, but a stethoscope check found a heart murmur, and she was diagnosed with bicuspid aortic heart valve disease. This can reduce or block the blood flow to the body, and can be present, undetected, from birth.

Alison had an annual echocardiogram to check the valve and, after 15 years, a replacement valve operation was recommended.

“I researched the replacement procedure, choice of valves and surgeons. I chose a new variety of valve that has been treated to extend its life to 25 years. If necessary, later on, a new valve can be inserted into it using transcatheter aortic valve implantation (TAVI), where the replacement valve is fed in through an artery.”

She also chose a surgeon who specialised in the mini-sternotomy – a less invasive procedure than traditional open-heart surgery.

It was only in the last two months before surgery in October 2018, that Alison got symptoms. “I got breathless more easily and was tired in the afternoons. At 58, many people would have put it down to ageing, she says.”

Life after diagnosis and raising awareness

After surgery and six weeks of cardiac rehabilitation, Alison now attends weekly cardiac exercise classes, goes to the gym twice a week, and walks her dog daily.

“Now, I want to raise awareness of the disease and urge everyone to ask their doctor to listen to their heart. A quick stethoscope check takes so little time, but it could save your life.”

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A pulse check is an effective way of detecting atrial fibrillation, the most common heart rhythm disorder and the leading cause of stroke. It’s time more of us learned how to do it.

Many of us are aware of our heart rate, says Trudie Lobban MBE, Founder & CEO of Arrythmia Alliance, a coalition of charities, patient groups, patients, carers, healthcare professionals, medical groups and allied professionals working to promote timely and effective diagnosis and treatment of arrhythmias.

But to make sure we are not at risk of atrial fibrillation (AF) — the most common arrhythmia (or heart rhythm disorder) and the leading cause of stroke — it’s also crucial we are aware of our heart rhythm.

No expensive equipment or complicated technology is needed to do this (although medically approved apps are available). In fact, it can be done with a simple pulse check.

Get to know the rhythm of your pulse

“Many people don’t connect their pulse with their heart,” says Lobban. “Yet, by taking our pulse we can check our heart rhythm, which can detect AF. That’s why our message is: ‘Know your pulse to know your heart rhythm’.”

Some people say AF feels as though they have a bag of worms in their chest — or drums beating in their chest.

Lobban advises feeling your pulse when you’re sitting down and relaxed (“not after drinking a cup of coffee or running a marathon”) and getting to know its normal rhythm (not to be confused with the beat).

If you feel that it’s jumping around, going too slow, too fast or is irregular, then see your doctor. This is important because, when the heart rhythm is irregular, clots can form in the blood, which may break off and cause heart failure, or travel to the brain and cause an AF-related stroke.

Recognise the symptoms of atrial fibrillation

“If you have AF, you are five times more likely to have an AF-related stroke, which can often prove to be fatal — or they can be more disabling and debilitating than any other type of stroke,” says Lobban.

AF is a more prevalent condition than previously suspected. Worryingly, a quarter of people over the age of 40 will develop AF at some time in their lives; and at least one-third of those with AF are yet to be diagnosed.

Obesity, alcohol, smoking and stress all increase risk of atrial fibrillation, the symptoms of which may include breathlessness and/or palpitations.

“Some people say AF feels as though they have a bag of worms in their chest — or drums beating in their chest,” says Lobban. “But it is possible to have AF and experience no symptoms at all.”

Detect, protect, correct and perfect

If your GP diagnoses AF, you will be given anti-coagulation therapy. “There are several types available, which will help reduce the risk of a clot forming,” explains Lobban. “This type of therapy does not treat AF, however, so you should also discuss treatment options with your doctor.

“There are lots of treatments available to reduce symptoms of AF, and potentially cure it.” These include drug therapy or ablation therapy (where a catheter is placed into the heart to detect and ablate the area causing the abnormal rhythm).

Lobban also asks those at risk of AF to remember a simple slogan: ‘Detect, protect, correct and perfect’. “Detect AF with a simple pulse check; protect against AF-related stroke with anti-coagulation therapy; correct an irregular heart rhythm with access to appropriate treatment,” she says. “Finally, perfect the patient care pathway, restoring the patient back to a person leading as active a life as possible.”

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Know the symptoms – if you are feeling dizzy, breathless, fatigued and have chest pains, it could be a sign of heart valve disease.

Across the UK, approximately 1.5 million people aged over 65 are affected by heart valve disease.

According to the OxVALVE Study, this will increase by 122% to as many as 3.3 million by 2056, yet many are not aware they are have a condition that can be effectively treated if diagnosed early.

Despite its prevalence, knowledge of heart valve disease is limited. According to a Heart Valve Voice survey of 1,411 people over the age of 60, 94% did not know what aortic stenosis was and only 3% were concerned about valve disease in comparison with other illnesses.

Don’t ignore the symptoms

“Many over 65s mistakenly believe that symptoms of valve disease – such as breathlessness, fatigue and chest pains – are merely a sign of ageing,” says Wil Woan, Heart Valve Voice CEO.

“We are campaigning to highlight the importance of recognising symptoms, improve diagnosis through regular heart checks, and streamlining the patient treatment pathway.”

The 10-year plan

The NHS recently revealed their 10 Year Plan with a focus for the first time on heart valve disease. This announcement came just ahead of the launch of our own Gold Standard of Care Report. Working with leading UK valve disease care specialists, the report sets out the ideal process to achieve the perfect valve disease patient pathway.

For patients with heart valve disease, a consistent patient pathway is key to ensuring that they receive the correct treatment at the right time. If heart valve disease is caught early enough, more severe complications such as heart attack or heart failure can be avoided. Moreover, patients can get back to living, being active and ageing healthily, contributing positively to their communities.

“We believe the recommendations found in the NHS 10 Year Plan can really help to remedy the problem of under diagnosis and treatment,” says Wil. “By delivering optimal treatment of heart valve disease, you ensure that patients can get back to their lives and reduce the burden on the NHS.

To find out more about heart valve disease, read more on Heart Valve Voice

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Dr Simon Davies spends his days as a cardiologist performing operations on hearts. Yet, as he tells us, effective screening with sophisticated imaging techniques is helping to make the process of diagnosing the UK’s most dangerous disease a less invasive process for the patient.

We all know that our lifestyles are likely to have a direct effect on our health. Heart health is one area in particular that is likely to be negatively affected by us smoking, having an unhealthy diet or not getting enough exercise.

Lifestyle plays a huge impact on likelihood of coronary heart disease

However, the most common type of heart disease is hereditary, with family links increasing someone’s chances of developing it. Coronary heart disease is the biggest killer of both men and women, killing one third of men and 25-28% of women, making it a bigger killer of women than breast cancer.

Dr Simon Davies, Consultant Interventional Cardiologist at the internationally renowned cardiology department at Royal Brompton Hospital, still sees lifestyle as a hugely important factor.

“Yes, someone may have coronary heart disease in their family, but their lifestyle could either bring forward its development by 20 years or put it off for 20 years.”

Knowing the symptoms of the disease

Warning signs of coronary heart disease can be breathlessness during exercise, chest pain or simply the feeling of having a weight on your chest that feels uncomfortable.

Knowing your family history of the disease is vital.

Even now, in an age where education around the effects of poor lifestyle choices is as good as its ever been, coronary heart disease continues to affect both those who do the right things and those who do the wrong things to their bodies.

This is why Dr Davies argues that screening is absolutely key in spotting problems quickly and ensuring that patients aren’t incorrectly diagnosed with the disease.

Screening involves a variety of tests for your heart health

“If you notice pain or breathlessness, I would always advise going to a GP first. They’ll know more about your history and they can then refer you on to a cardiologist if your symptoms indicate that you may require some form of investigation.”

The screening process for coronary heart disease can involve several different types of test. These might include testing a patient’s cholesterol levels, non-invasive tests showing how effectively the heart is pumping blood around the body and new, sophisticated imaging techniques that will give cardiologists incredibly detailed pictures of a patient’s individual arterial health.

A modern CT scan of the coronary arteries:

The use of non-invasive tests reduce complications

An angiogram, one of the imaging techniques currently used to screen coronary heart disease, involves an invasive element where a fine, flexible tube is threaded along the arteries to reach the heart in order for the pictures to be taken.

Through that same tube, a stent can be fitted to open up a damaged artery to fix the problem as soon as it is seen. However, Dr Davies believes the ‘gold standard’ in terms of screening should involve new non-invasive imaging tests taking place first.

“Putting a tube into the heart does come with complications. Through the new non-invasive imaging techniques we are now able to perform at a specialist centre, we as cardiologists can build a picture of someone’s heart health and then decide if they need an invasive angiogram. This helps achieve the best outcomes for the patient.”

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Every year, 17.9 million people die from cardiovascular disease (CVD), including heart disease and stroke.

Cardiovascular disease has many causes: from smoking, diabetes and high blood pressure – which are very common and affect a wide range of age groups and geographical regions – to less-common causes, such as Chagas and Kawasaki disease, and rare conditions such as cardiac amyloidosis. These tend to affect mainly certain populations due to factors such as where they’re from, their age and their genetic background.

But, whatever the cause, we believe that every heartbeat matters and that means that every single person has the fundamental right to heart health.

This year, on World Heart Day, our objective is to create a global community of ‘Heart Heroes’, inspiring people from all walks of life who are acting now to live longer, better, heart-healthy lives by making a promise…

As individuals: a promise to our families to cook and eat a more healthy, balanced diet including plenty of fruit and vegetables… A promise to our children to do more exercise every day and help them to be more active; to say no to smoking and help our loved ones to stop.

As healthcare professionals: a promise to help our patients give up smoking or lower their cholesterol, and to understand their risks of CVD.

As employers: to invest in heart-healthy workplaces, making time during the working day for exercise and offering healthy meal options.

CVD is the leading cause of death and disability in the world, causing a third of all deaths on the planet and half of all non-communicable-disease-related deaths. Around 85% of these deaths are due to heart disease and stroke.

The good news is that at least 80% of premature deaths (between the ages of 30 and 70) from heart disease and stroke could be avoided.

World Heart Day plays a crucial role in this with 1,000s of individuals and organisations around the world organising events and taking to social media to help spread the word. It is a vital global platform that we can all use to raise awareness and encourage individuals, families, communities, and governments to take action now.

Together, we have the power to reduce the burden of heart disease and stroke, helping people everywhere to live longer, better, heart-healthy lives. Because every heartbeat matters.

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