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* This is a charity donation service for the BHF. Texts cost £3 + 1 standard rate message. The BHF will receive 100% of your donation to fund our life saving research. To opt out of calls, text 'NOCALL BHF', or to opt out of SMS, text 'NOSMS BHF' to 70060. If you have any questions about your gift, call 0203 282 7863.© British Heart Foundation 2015, a registered charity in England and Wales (225971) and Scotland (SC039426)

The week started like any other for the Smith family. Mum Sally got the children off to school, and dad Jake left for work as usual. He finished work early that day, so called to say he’d pop into the supermarket for food on the way home. Except he never came home.

Sally called him. And called again. And searched for him at his gym. And at the supermarket. By 9pm she was panicking. She called the police.

The next day the police came around to say Jake had been found dead in his car in the supermarket car park. He’d had a cardiac arrest. Just half an hour after Sally had spoken to him that Monday, he was gone. She hadn’t even said a proper goodbye.

Sally had to pick the children up from school and tell them their dad was dead. It was the hardest thing she’d ever had to do.

Every day in the UK heart disease strikes suddenly, tearing families apart.

But it’s not hopeless. We can and will beat it through our life saving research. By supporting us, you’re helping in the fight to end heart disease.

Text FIGHT to 85080 to donate £3.*

That Monday began just like any other.But no Monday would ever be the same again.

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Take a hike One man's inspiring story

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ENJOYED READING THIS MAGAZINE?Receive your own copy and much more…Join Heart Matters – the FREE programme that can change your life.

• Kick-start your healthy lifestyle: your membership pack includes the latest issues of Heart Matters magazine, an introduction to the BHF, a tape measure and a recipe folder.

• Be inspired: our bi-monthly Heart Matters magazine contains real-life stories, the latest research and tips for keeping healthy.

• Collect healthy recipes: in your recipe folder.• Stay up to date: fortnightly e-newsletters.• Get online: take advantage of our online

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*Lines are open 9am–5pm, Monday to Friday. Costs are similar to 01 and 02 numbers.

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We’ve all experienced life-changing moments. One of mine was joining Heart Matters. As Editor of the magazine, I hear inspirational stories and meet amazing people every day.

This issue, we hear how three people, despite their heart disease, are pursuing active hobbies. Our cover star discovered a passion for trial biking, while inside we meet a woman who, inspired by Heart Matters’ gardening column, has vowed to

keep tending plants for the rest of her life (page 10). It’s great to see the magazine makes a difference.

The same is true of BHF research, which is turning science fiction into science fact (page 14), thanks to generous donations from our readers and beyond. Thank you. Find out how we’re fighting to secure the future of research funding (page 8), and how a BHF-funded project is changing the lives of the next generation (page 26).

While our research hasn’t yet led to a cure for cardiovascular diseaseD, treatments can make a huge difference to people’s quality of life, as we discover in a ‘Focus on’ special (page 18).

Do you have a life-changing story you’d like to share? Email me at [email protected], and you could feature in a future issue.

Sarah Kidner, Editor

Turn to page 10 to meet three people who adapted their hobbies after a heart diagnosis.

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* This is a charity donation service for the BHF. Texts cost £3 + 1 standard rate message. The BHF will receive 100% of your donation to fund our life saving research. To opt out of calls, text 'NOCALL BHF', or to opt out of SMS, text 'NOSMS BHF' to 70060. If you have any questions about your gift, call 0203 282 7863.© British Heart Foundation 2015, a registered charity in England and Wales (225971) and Scotland (SC039426)

The week started like any other for the Smith family. Mum Sally got the children off to school, and dad Jake left for work as usual. He finished work early that day, so called to say he’d pop into the supermarket for food on the way home. Except he never came home.

Sally called him. And called again. And searched for him at his gym. And at the supermarket. By 9pm she was panicking. She called the police.

The next day the police came around to say Jake had been found dead in his car in the supermarket car park. He’d had a cardiac arrest. Just half an hour after Sally had spoken to him that Monday, he was gone. She hadn’t even said a proper goodbye.

Sally had to pick the children up from school and tell them their dad was dead. It was the hardest thing she’d ever had to do.

Every day in the UK heart disease strikes suddenly, tearing families apart.

But it’s not hopeless. We can and will beat it through our life saving research. By supporting us, you’re helping in the fight to end heart disease.

Text FIGHT to 85080 to donate £3.*

That Monday began just like any other.But no Monday would ever be the same again.

DE_1026_Heart Matters_Standard AWv2.indd 1 21/05/2015 11:52


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July/August 2015


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MORE THAN A MAGAZINE

FREE

Visit bhf.org.uk/heartmatters to discover what your Heart Matters membership gives you.

• An online version of Heart Matters magazine packed full of extras such as extended interviews, picture galleries and videos.

• Online tools, including a recipe search, eatwell plate and a fruit and vegetable portion guide.

• Our online community where you can chat to others about your experiences. Visit community.bhf.org.uk.

Kirsty Munn, Derby

Change of details? Let us know by completing the form opposite

And don’t forget, our Heart Matters Helpline can offer help understanding your heart condition, plus healthy lifestyle support on 0300 330 3300 (lines are open 9am–5pm, Monday to Friday; costs are similar to 01 and 02 numbers).

Reading Heart Matters allows me to concentrate on looking after my heart”

Help us spread the wordIf you’re a healthcare professional, you can get multiple copies of Heart Matters magazine to distribute to your patients. Log in to your account at bhf.org.uk/heartmatters and go to the ‘My Account’ page to tell us you’re a healthcare professional and choose how many copies of each issue you’d like.

Heart Matters

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We’ve all experienced life-changing moments. One of mine was joining Heart Matters. As Editor of the magazine, I hear inspirational stories and meet amazing people every day.

This issue, we hear how three people, despite their heart disease, are pursuing active hobbies. Our cover star discovered a passion for trial biking, while inside we meet a woman who, inspired by Heart Matters’ gardening column, has vowed to

keep tending plants for the rest of her life (page 10). It’s great to see the magazine makes a difference.

The same is true of BHF research, which is turning science fiction into science fact (page 14), thanks to generous donations from our readers and beyond. Thank you. Find out how we’re fighting to secure the future of research funding (page 8), and how a BHF-funded project is changing the lives of the next generation (page 26).

While our research hasn’t yet led to a cure for cardiovascular diseaseD, treatments can make a huge difference to people’s quality of life, as we discover in a ‘Focus on’ special (page 18).

Do you have a life-changing story you’d like to share? Email me at [email protected], and you could feature in a future issue.

Sarah Kidner, Editor

Turn to page 10 to meet three people who adapted their hobbies after a heart diagnosis.

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bhf.org.uk 3

YOUR BHF4 Your letters6 News

Heart repair research and find your heart age

8 Spotlight Why government research funding is vital

33 Join the fight Keep fit and raise funds – whatever your age

36 Big interview How GPs’ roles have changed and why we need more of them

49 Dictionary Medical terms explained

50 Information and support A guide to our free resources

MY STORY10 Shifting gear

How three people adapted their hobbies after a heart diagnosis

MEDICAL18 Cardiac treatments

We answer some questions about common procedures

22 Ask the experts Rotablation and internet rumours

34 Drug cabinet: antibiotics The facts about antibiotic resistance

NUTRITION28 Healthy holidays

Easy ways to uncover the nutritious taste of summer

30 Say cheese Busting myths about this dairy delicacy

32 Ask the expert Healthy weight loss and vitamin advice Plus Recipe cards

RESEARCH14 Science fiction

Discover how BHF-funded research is turning science fiction into reality

24 Bright future How the BHF is supporting young medical researchers

26 Inside the LifeLab Changing the habits of the next generation for a healthier future

WELLBEING38 Caring for the future

Three innovative projects driven to improve patient care

ACTIVITY41 Marching on

John fulfilled his dream of walking Offa’s Dyke – after a heart attack

46 Lisa’s workout How to get active this summer

47 Paul Peacock Keeping plants perky and perfect tomatoes

Heart Matters is published by Wardour on behalf of the British Heart Foundation, Greater London House, 180 Hampstead Road, London NW1 7AW.

The British Heart Foundation 2015 is a registered charity in England and Wales (225971) and in Scotland (SC039426). ISSN 1745-9753

Views expressed in this magazine are not necessarily those of the British Heart Foundation or Wardour. The BHF does not endorse third-party products and services featured in Heart Matters. Information correct at time of going to press. © BHF 2015. Heart Matters is printed on paper from sustainable forests. G204/0715

For BHFEditor: Sarah KidnerDeputy Editor: Sarah BrealeyProduction Editor: Amily ChangMedical Editor: Maureen Talbot; Christopher AllenHead of Heart Matters: Judy O’SullivanPrint: Pindar, part of the YM Group

For WardourManaging Editor: Rachael HealyArt Director: Daniel CoupeHead of Editorial: Molly BennettPicture Editor: Johanna WardCreative Director: Ben BarrettProduction Director: John FaulknerProduction Artworker: Jack MorganAccount Director: Georgina BeachManaging Director: Claire Oldfield Chief Executive: Martin MacConnol

Inside the magazine of the British Heart FoundationJuly/August 2015

Online exclusivesbhf.org.uk/heartmattersmag

Our expert team

BHF Associate Medical DirectorDr Mike Knaptonhas been a GP for more than 30 years and is a director at Addenbrooke’s Hospital, Cambridge.

Physical Activity SpecialistLisa Youngis a BHF Project Manager with a focus on workplace health and physical activity advice.

Senior DietitianVictoria Tayloradvises on nutrition and is a spokesperson for the BHF. She used to work on public health campaigns.

Gardening ExpertPaul Peacockstudied botany and has written many books on gardening. He is a regular on BBC Gardeners’ Question Time.

Senior Cardiac NurseMaureen Talbothas worked in the NHS and the private sector in general and cardiac nursing, for more than 25 years.

Senior Cardiac NurseChristopher Allenhelps manage BHF genetic information service and has specialist experience in cardiology and cardiac surgery.

≠ Interactive film: Videos, photos and maps of some of the UK’s most exciting long-distance paths

≠ Healthy cheese choices: The good, the bad and the ugly of cheese

≠ Just say no: Seven meals where you really don’t need to add cheese

≠ Inside the LifeLab: Watch our video about the research project changing teenagers lives one day at a time

≠ More of your letters: A reader explains how Star Trek can help your heart live long and prosper

≠ Healthy snacks: Enjoyed our sci-fi article (page 14)? Learn which snacks you need for a healthy movie night

54 Heart Matters bhf.org.uk

The BHF says: The findings of this study are interesting, but don’t explain why a person’s maximum grip strength (which is what the study looked at) would be related to cardiovascular disease. More research is needed to understand any possible link.

We already know of several established risk factors for cardiovascular disease and an NHS Health Check can assess your risk. If you’re over 40, ask your GP or practice nurse about getting this done.

“Handshake strength ‘could predict’ heart attack risk”New research suggests the strength of a person’s grip could predict the risk of heart attacks and strokes – and is a stronger predictor of death than blood pressure checks.

“Popular heart pill raises death risk by a third”A drug taken by hundreds of thousands of Britons with heart conditions dramatically increases risk of death, experts warned today.

The alert comes after a forensic examination of studies on the drug digoxin – used to treat some of the most severe types of heart disease.

Evidence of its potentially catastrophic effects, that could raise the chances of dying by almost a third, prompted experts to warn the tablet should be used with great caution.

The BHF says: We already know digoxin, a drug to treat heart failureD and atrial fibrillationD, can be problematic, so it is only prescribed after consideration.

New alternatives and in-depth safety studies, like this one, have led to a decrease in the use of digoxin but it can still be a useful drug.

If you take digoxin and are worried, speak to your doctor and make sure you are being monitored adequately.≠ Look out for an in-depth feature on digoxin in our Nov/Dec 2015 issue.

Express headline, “A glass of water a day ‘can cut diabetes risk by a quarter’”, suggests water alone lowered diabetes risk, when reducing sugary drinks was the key factor.

The study looked at nearly 25,000 people aged 40 to 79 who were followed up for nearly 11 years, from the 1990s to 2006. Participants recorded food and drink intake in daily diaries – a fairly accurate method. The study’s main weakness is the difficulty of knowing if drinks caused the effects seen. Study authors adjusted results to account for weight, social class, exercise and diet, but other factors could have affected outcomes.

BHF Senior Dietitian Victoria Taylor said: “In the UK, our intakes of sugar have exceeded dietary recommendations for some time. Sugar-sweetened drinks in our diet can mean we consume excess calories, which is linked to being overweight, a risk factor for cardiovascular diseaseD and type 2 diabetes.

“While we can’t say from this study that sugary drinks cause diabetes, we must not forget how much sugar can come from these. Replacing sugary drinks with sugar-free options is a simple swap we can make to help improve our diets.”

“Cutting down by a can a day of fizzy drink could slash risk of contracting diabetes.”

Just our cup of tea

Telegraph 14 May 2015

The Sun 1 May 2015

Express 5 May 2015

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This large study showed cutting back on sugary drinks can reduce your risk of type 2 diabetesD. Swapping just one sugary drink a day for water or unsweetened tea or coffee could make a difference.

University of Cambridge researchers looked at effects of sugar-sweetened drinks (fizzy drinks, hot chocolate, milkshakes), fruit juice, artificially sweetened drinks (‘diet’ or ‘low-calorie’ drinks) and unsweetened drinks.

Drinking sugar-sweetened drinks was linked to heightened risk of type 2 diabetes. The risk increased with the number of sugary drinks consumed. (The study did not look at type 1 diabetes, which is not related to diet.)

Drinking unsweetened tea and coffee was linked to a lower risk of diabetes. Drinking sweetened tea or coffee, fruit juice, artificially sweetened drinks or water didn’t appear to affect the risk of diabetes either way. However, swapping a sugary drink for water or unsweetened tea or coffee reduced risk of diabetes. We already knew of a link between diabetes and sugar-sweetened fizzy drinks or squash, but this is the first time a link with sweetened milk drinks has been established.

This study is also the first to estimate population-wide effects of sugary drinks on diabetes. If everyone swapped one sugary drink a day for an unsweetened one, new cases of type 2 diabetes could fall by 14–25 per cent. The study authors said: “Our findings suggest that reducing consumption of sweet beverages, in particular soft drinks and sweetened milk beverages, and promoting drinking water and unsweetened tea or coffee as alternatives may help curb the escalating diabetes epidemic.”

This research was reported in the Express, Guardian, Daily Mail, Sun and Telegraph. Coverage was fairly accurate, although the

YOUR LETTERSWe love to read your emails, letters and tips, so keep writing: [email protected] or Heart Matters, British Heart Foundation, Greater London House, 180 Hampstead Road, London NW1 7AW

If you’d like to share your story with Heart Matters, email [email protected] or write to Sarah Brealey, Heart Matters, British Heart Foundation, Greater London House, 180 Hampstead Road, London NW1 7AW.

Share your story

We make great strides in our medical care but appear to be standing still, even going backwards, when it comes to our national diet. Heart Matters needs to be sent to those who have any influence over catering in the NHS.John Marshall, Auchtermuchty, Fife ≠ See how some hospitals are getting food feedback from patients (page 38).

Objective and accurateFor me, the most significant page of Heart Matters is Behind the Headlines.

All too often, national media reporting is sensationalist or

I enjoyed reading Paul Peacock’s Perfect Patios in Heart Matters (May/Jun 2015), with its good advice for things like no-bend gardening and having a nearby seat to rest if needed.

Gardening in the fresh air is certainly therapeutic and you feel so much better and more relaxed sitting in the garden on a sunny day or evening.

Many childhood memories are of my father, Charles Hiscox, digging in the garden, planting flowers or potting in his greenhouse. He passed away 22 years ago, aged 72, and I still miss him. As the saying goes: “You are nearer to God’s heart in a garden than anywhere else on earth.” I couldn’t agree more!

Readers might like to know that an organisation called Gardening for Disabled Trust can give grants to help people with disability or illness continue to garden.

Their website is gardeningfordisabledtrust.org.uk or write to Gardening for Disabled Trust, PO Box 285, Tunbridge Wells TN2 9JD. I hope this may help others.Catherine Hiscox, Hemel Hempstead

Next issue Returning to work after a heart event.Plus: How cardiac rehabilitation could benefit you.

The writer of our star letter each issue can win a gorgeous

Radley Matinée purse worth £75, with ample room for all

your essentials. Or, if you prefer, choose this red heart-shaped

rug (about 1.5m long).

Food for thoughtHeart Matters keeps me bang up to date. The articles are a good reminder of my condition, the advances in heart surgery technology never cease to amaze, and the mouth-watering healthy meals inspire.

It’s 11 years since my double heart bypass. Today, I appreciate life more; it seems fuller. The day job continues and in ‘my’ time, gardening, walking, travel, caravanning and grandchildren activities are squeezed in.

Recently, an unexpected admission to hospital for a hernia operation brought back memories. Not only were there advances in technology since my previous stay, but equally important advances in nursing and patient engagement.

However, I was dismayed at the lack of progress on the cuisine. There were healthy options on the menu, but these were less appealing. It seems a wasted opportunity when you have a receptive audience.

STAR LETTER

sloppy and misleading. Behind the Headlines is an objective and accurate counterbalance.

I no longer read or listen to the media on heart issues. Instead, I read Heart Matters’ Behind the Headlines. That saves me time and saves me from being misled. Equally important, it shows that the BHF takes an objective and scientific approach to all health, diet and social issues related to our hearts. Thank you.Martin Scherer, Folkestone

Deputy Editor Sarah Brealey replies: It’s great to hear you find Behind the Headlines useful. See page 5, or read past stories online at bhf.org.uk/headlines.

I thought I was on my own, enduring these conditions and frightened to say I am suffering all these things because of the stigma of having mental issues. I am at long last getting the help and medication I need. – Michael Webster

This is such a fascinating subject. I had a heart attack and a bypass five years ago – no symptoms – and I feel that I always have to appear upbeat as a survivor. It’s not always that easy and I think it’s underlined just what an impact heart disease has on people who have to live with it for the rest of their lives. – Jill Wakeford

I had heart and lungs transplanted at 13, I’m 40 in two weeks. Yes, it messes with your head and I recognise a lot of the concepts in the survey, but wow... I’m still here! – Eve Miller

COMMENTS ONLINE… During Mental Health Awareness Week, you shared thoughts on our mental health survey on Facebook

76 Heart Matters 7

NEWS

2 August Victoria Park Run. 5K or 10K on a paved flat route through a leafy east London park. Ideal for all ages and fitness levels. Visit bhf.org.uk/victoriaparkrun or call 0845 130 8663.

15 August Loch Ness Bike Ride. Choose from a challenging 50- or 70-mile on-road route from Inverness and back, via the quiet southern shores of Loch Ness. Sign up at bhf.org.uk/lochness or call 0845 130 8663.

12 September London to Eastbourne Bike Ride. Our new 60-mile route, on a mix of roads, rough tracks and cycle paths, is an exciting challenge. Visit bhf.org.uk/l2eastbourne or call 0845 130 8663.

13 September Kent Cycling Festival. Starting from Canterbury, choose from an on-road challenge over 50 or 65 miles, or take on a 26- or 40-mile off-road adventure through beautiful countryside. Visit bhf.org.uk/kentcycling or call 0845 130 8663.

13 September Pete Hayes Handsworth 10K Fun Run. Raise funds for our Mending Broken Hearts Appeal in Handsworth Park, Birmingham. Visit bhf.org.uk/handsworth10k or call 0300 330 3322.

14 September Medicine and Me: Living With Heart Failure. A half-day interactive forum, held jointly with the BHF and Royal Society of Medicine. Patients learn about the latest treatment and research, and professionals hear patients’ experiences and concerns first-hand. Find out more at www.rsm.ac.uk/medandme/heartfailure or call 020 7290 3919 to find out more.

4 October Blenheim Palace Half Marathon and 10K. A 2K family fun run is also available. Visit bhf.org.uk/blenheim or call 0845 130 8663.

11 November Tunnel of Love. The BHF’s extraordinary fashion and art party is back with even more glamour at the V&A Museum in London, raising funds for our vital work. For more details, visit bhf.org.uk/tolove or call 020 7554 0257.

Dates for your diary

BHF-funded research has identified a new way to

regenerate the heart after a heart attackD.

The findings, published in the journal Nature, show that the body’s lymphatic system (see page 14) – which transports white blood cells around the body to fight infection and injury – plays a vital role in helping the heart repair itself.

The Oxford University research, funded by the BHF, Wellcome Trust and Marie Curie Actions, showed mice hearts start growing more lymphatic vessels after a heart attack. Researchers believe this allows the body to transport immune cells away from the heart muscle after it becomes damaged, reducing inflammation and helping the heart repair itself.

Further growth of lymphatic vessels can be stimulated using a protein called VEGF-C. This had a number of positive effects: it amplified the healing process, reduced damage and

improved the heart’s ability to pump blood around the body.

BHF Professor of Regenerative Medicine Paul Riley led the research. “This has never been documented before and the

implications of these findings, in mice, could be huge,” he said. “By unravelling the mystery of how the lymphatic system develops and its role in heart repair, we hope to find new ways to reduce the devastating impact of a heart attack.”

Previous research, dating back to 1902, suggested all lymphatic vessels sprout from existing veins. Professor Riley’s team discovered that specialist cells, which are essential for the growth of blood vessels in developing embryos, also contribute to new lymphatic vessels in the heart.≠ Find out about the Mending Broken Hearts Appeal and make a donation at bhf.org.uk/findthecure, or send a cheque to the address on page 4. Watch our animation of lymph vessels forming at bhf.org.uk/news.

bhf.org.uk

Our new online tool allows you to discover the true age of your heart

in just a few clicks.You can input information, including

your weight, height and smoking habits, to see how your real age compares with the predicted age of your heart. Developed by Public Health England, the BHF, Joint British Societies and NHS Choices, it allows over-30s to better understand their risk of serious conditions such as coronary heart diseaseD and strokeD. They can then take positive action.

The tool works best, giving a more accurate result, if you know your cholesterol and blood pressure measurements. So, if you are over 40 and have not been diagnosed with one of these conditions

Discover your heart age

already, ask your GP for an NHS Health Check and find out.

BHF-funded Professor John Deanfield was a key adviser in the development of the tool. “Understanding your heart age can be a real wake-up call for people who might be at risk,” he said. “It can be that all-important nudge to take action and make lifestyle changes to improve your heart health.” ≠ Visit bhf.org.uk/heartage to get started.

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Scientists get closer to mending broken hearts

Lymphatic vessels transport immune cells away from the

heart, helping to mend it

Our right to breathe clean air has been upheld in the UK Supreme Court. In the last issue of Heart Matters (May/Jun 2015), we told you how the UK government’s failure to comply with EU regulations on nitrogen dioxide levels by the 2010 deadline had resulted in a lengthy court battle. Some regions were not expected to meet targets until 2030.

On 29 April, judges delivered a unanimous decision that the UK government must draft and consult on a new air-quality plan by the end of the year.

This is fantastic news for the seven million people living with cardiovascular diseaseD in the UK. BHF-funded research shows exposure to air pollution can cause or exacerbate existing cardiovascular conditions, such as heart attackD, strokeD and heart failureD. The UK’s continued failure to comply has been putting hearts at risk. ≠ Get our free air pollution leaflet at bhf.org.uk/airpollution or call 0300 330 3300.

Courts force government to clear the air

We’re now halfway through our year-long partnership with Santander, and colleagues across the country have been helping with our vital fundraising. The partnership began with nationwide heart health roadshows, and in February Santander colleagues showed commitment by raising over £30,000 turning offices and branches red for Wear it. Beat it.

Their 50 Million Steps Challenge, a sponsored pedometer event in May, was a massive success,

We team up with David Lloyd Leisure The BHF is launching a two-year partnership with David Lloyd Leisure. Caring for the heart health of British families is one of our core aims, so we’re proud to team up with Europe’s leading health, sports and leisure group. We want to build a fun partnership, raising £200,000 for our work and improving families’ health. Clubs will hold a fundraising friends and family weekend this summer, take part in Wear it. Beat it. next February, and do our famous London to Brighton Bike Ride.

We’ve been named the official charity of a top European eventing championship, part of the famous Blair Castle International Horse Trials.

Eventing fans will descend on Atholl Estates in Perthshire for the

Longines FEI European Eventing Championship, 10–13 September. BHF Scotland volunteers and staff have a stall in the shopping village and will raise funds with a ‘shop and drop’ service, looking after your purchases while you enjoy the day. To volunteer, contact Barbara Osborne by emailing [email protected] or calling 0131 561 3362.≠ For tickets and information, visit blair2015.com or call 01796 481543.

Horse event helps hearts

Raising funds with Santander

raising over £100,000, and keeping everyone active. Santander colleagues will take on an international challenge in India this

autumn to raise further funds. We’re looking forward to more fantastic fundraising from Santander over the rest of the year.

98 bhf.org.uk

With the new government focused on reducing public spending, we explain why it’s vital to maintain levels of research funding

SPOTLIGHT ON…

NEWS

research funding We’re pressing the UK

government to support the research sector.

Research has saved many lives and with proper investment will save countless more.

From discovery research in the lab, to population studies and clinical trials in patient volunteers, doing world-class research is expensive. At the BHF, thanks to those who make donations, including Heart Matters readers, we can afford to invest an average of £100m a year in research.

But that won’t be enough if the government fails to maintain levels of spending on science. Organisations like the BHF work within the university sector, so we are dependent on the government to fund world-leading universities.

In 2015/16 the government is spending £5.8bn on science. Of this, £4.7bn is for day-to-day funding and has been ringfenced – this means the government has pledged to not reduce the amount before 2016.

The rest is for capital spending on investment and projects to create growth. Most of this (£859m) is also ringfenced.

The day-to-day funding goes mainly to the seven UK research councils and the four UK higher education funding bodies. It also includes the Charity Research Support Fund, which covers overheads so that money from charities like the BHF can be spent directly on the best scientists, groundbreaking research and clinical trials. This is worth £198m a year in England and proportional amounts are available in Scotland, Wales and Northern Ireland, where funding comes via different bodies.

Cutting-edge researchWorld-leading scientists such as Andrew Newby, BHF Professor of Vascular Cell Biology at the University of Bristol, depend on research funding at every stage of their careers. Professor Newby’s team is at the forefront of work to identify people at

Research funding is the lifeblood of everything we do”Professor Andrew Newby

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risk of heart attackD, and is developing new treatments to prevent stentsD and bypassD grafts becoming re-blocked following angioplastyD and bypass surgery.

“Research funding is the lifeblood of everything we do,” he says. “Without this generous research funding environment in the UK, my career would have been completely different. I would probably just be teaching students – and not particularly well, as without research you can’t teach students the cutting edge.”

During his career, Professor Newby has been funded not just by the BHF, but by

government-funded research councils, specifically the Medical Research Council (MRC) and the Biotechnology and Biosciences Research Council (BBSRC).

Michael Schneider, BHF Simon Marks Professor of Regenerative Cardiology at Imperial College London, says while BHF funding is vital to UK universities – supporting more than half of cardiovascular research – it is not enough. “I’m acutely aware that the BHF cannot support the entirety of cardiovascular research in this country, though its contribution is immense and irreplaceable,” he says.

“Medical research in the UK is made possible by a robust

Professor Newby’s research career spans 42 years. He celebrated his 40th anniversary by cycling around the Isle of Wight to raise money for the BHF. Last year, he raised further funds on the London to Brighton Bike Ride.

Professor Newby’s many achievements include discovering the role that metalloproteinases, a group of enzymes, play in the smooth muscle cells that create blood vessel walls. These cells have an important role in healthy blood vessels but are also involved in stent restenosis and bypass graft

disease. His group is now studying the effects of different metalloproteinases, so that new drugs can be developed.

It is also exploring why some stents block (restenosis) in the months or years after an angioplasty, and why some bypass grafts re-block after surgery. The team helped create drug-releasing stents to reduce rates of restenosis, and developed a new type of stent that sits outside blood vessel walls. This unique concept has been taken up commercially and is currently going through clinical trials.

World-leading research: Professor Andrew Newby’s career

partnership among all the potential funding sources. In my own case, a collaboration with Imperial’s drug discovery unit was partially made possible by the MRC. We’re finding new compounds that protect human heart muscle, grown in the lab, from death and damage. This could lead to drugs that reduce the size of heart attacks in people. Government funding for science is clearly vital.”

Long-term viewDuring his career, Professor Newby has seen the importance of long-term research. “It is easy to over simplify the process of developing a new therapy,” he says. “Most people don’t realise it is based on a long period of growing understanding.”

Funding research is expensive because of the many disciplines involved, and because it is impossible to predict which lines of investigation will be successful. “If you take the

example of statins to treat heart disease, it is based on a century of research across many different disciplines.” Professor Newby explains. “If you tried to restrict funding, no new treatments like this would ever happen.”

Some of the most important discoveries in cardiovascular research have come from unlikely places. “The moral is, if you are trying to be prescriptive about which projects you fund, you would always get it wrong,” he says.

Britain has proved itself the most cost-effective country in the world for science research. This is thanks to the long standing Haldane principle, where the government identifies overall priorities then the scientific community selects specific projects to be funded based on scientific merit, through a robust peer-review process.

Funding science benefits Britain as a whole, Professor Newby says. “I think everybody realises we need to be competitive in the world. To do that you need high-end technology and you need to support discovery science.”

≠ We want to see funding not just maintained but increased. Research is our best weapon in fighting cardiovascular disease, helping us understand why it occurs, how to prevent it and how to treat it. Find out more and email your MP at bhf.org.uk/protectresearch.

£5.8bn Government science spending in 2015/16

£100m Average amount spent by the BHF on research each year

The government covers indirect costs of research, like heating and lighting in labs, so charity money is spent directly on the science

11

COVER STORY

ShiftingGEAR

Spending time doing something you love can enrich your life, but when you have a heart condition, you may wonder if you can keep doing the same hobbies. If your health declines,

you might need to make adaptations, but that doesn’t mean missing out on what gives you pleasure. We meet a gardener and a runner who have discovered this for themselves, plus a man who’s taken up an exciting new hobby since his heart surgery.

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Hobbies are a source of strength for many people with heart conditions, even if they have to adapt to suit changing health, finds Rachael Healy

Change of pace: Sean’s story

It’s my way of escaping”Sean Doyle, 47, from Huddersfield, was a

keen marathon runner, but since his heart attackD, he’s had to make some changes.

Back in May 2013, Sean collapsed on the way to a 5km Parkrun in nearby Greenhead Park. A blocked artery caused a heart attack, which led to a sudden cardiac arrestD. By chance, Sean’s GP, Dr Emma Spencer, was running that morning, as was

nurse Dinah Cooper. They performed CPRD until paramedics arrived to take him to Huddersfield Royal Infirmary.

In the ambulance, Sean suffered a second cardiac arrest and was put into an induced coma when he arrived at the hospital. He had a stentD fitted too, but within a week he was allowed to go home. “If I hadn’t been at that park on that day, with those people, I wouldn’t be here,” says Sean. “Things are meant to be for a reason.”

Back at home, Sean didn’t want to give up running but realised he might have to scale down his expectations. “I remember looking at Heart Matters and there was the guy who was a football referee on the front cover. I thought: ‘He’s not giving up what he used to do’, and neither am I,” says Sean. “Running is my way of escaping, but obviously you’ve got to listen to the advice you’re given. I was walking within a week and tried to do as much as I could, maybe a four or five-mile route every day.”

He was helped back to fitness by cardiac rehabD. At first, his activities were restricted to those that kept his heart rate low, such as gentle step-ups. Running was not permitted. Twelve weeks later, Sean had a stress test (also known as an exercise ECGD). His doctor was pleased with the results.

“The consultant said there was no reason why I shouldn’t go back to running,” says Sean. “But he said no more marathons, no more personal bests, no more than 40 miles a week and don’t get your heart rate above 135bpm. I bargained him up to 140bpm.”

Sean with Emma and Dinah, the doctor and nurse who saved his life

Parkrun Founded in 2004, Parkrun arranges 5km runs in parks around the UK. They are free, weekly and timed. There are almost 3,000 Parkrun clubs, with nearly 650,000 runners taking part. The aim is to get people outdoors and active, so all ages and abilities are welcome. Do it for fun or challenge yourself to improve on your personal time each week. Find out more at parkrun.org.uk.

Sean rejoined his running club, the Holmfirth Harriers, and is back doing Parkruns (see below). “I’ve been doing the Parkrun religiously, but my wife made me walk the first one,” he says. “That got my worst time ever, but we did a collection and raised £700.” The money helped buy a defibrillator for Greenhead Park.

Sean has done a few 10km runs too, including one to raise money for the local air ambulance service and another for Kirkwood Hospice. But mostly, he’s just running for fun. “It’s a form of escapism,” he says. “It’s keeping you fit and you can forget about all of your worries as you plod along. Although I can’t do half marathons anymore – about 10 miles is the most I can do at once – I can still do a fair old pace, especially with the medication I’m on.

“My trainers tend to last about 600 miles, and I’m now on the fourth pair since my heart attack.”

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Back on track: James’ story

Digging deep: Ruth’s story

In February 2014, James Cadman had surgery to treat a mitral valve prolapse. When he’d recovered, James, 52, knew he had to stay active and was keen to try something new.

“I’d done coarse fishing and match fishing, loads of dog walking and I work on the railway, but I wanted to do something different,” he explains. “Because I’m into my military history, my wife suggested going on a Roman or Viking re-enactment day. I said: ‘No thank you! I’m not running around in my underpants in November.’”

While browsing the internet for more ideas, James stumbled upon the site of Inch Perfect Trials, a trial bike training centre in Clitheroe, Lancashire. Trial bikers ride motorbikes, standing on pegs rather than sitting, as the bikes have no seats. It requires great balance and involves climbing hills, navigating obstacles and hopping from rocks to logs.

“The whole idea of trial biking is not to get the fastest time. It’s a bit like show jumping,” says James. “If you put your foot down or clip an obstacle, you’re penalised, so you can just take your time.”

Although he’d never tried the sport, James was curious. “I rang up Matt, who owns the company, and he said they cater for absolute beginners, like me,” says James. “I went and did an hour, getting used to the clutch control and the throttle. I fell in love with it; it was absolutely brilliant.”

Motorbiking may not sound very physical, but James explains it’s a great

workout. “It helps with your hand–eye co-ordination and you don’t realise how much energy you’re burning off and what muscles you’re using,” he says. “When you get off, you know you’ve had a good session.”

James likes that trial biking lets you go at your own pace and that riders are always ready to help one another improve their skills. “If you come across a section that’s too hard, you can just skip it and go on to the next one,” he says. “It’s all good camaraderie; everybody is willing to help

everybody else. It’s about getting out and meeting new people.”

Sue, James’ wife, surprised him at Christmas with his very own trial bike. Now he’s training to do his first beginners’ competition, known as a ‘Wobbler’.

James says staying active through trial biking, plus the support of new friends he’s made, has aided his recovery. “I went back to the cardiology department and they did an ECG and said the repair I’d had done was holding up no problem,” he says. “I was fortunate. My dad died at 50 of a massive heart attack and for me to be told, younger than that, that I had heart problems, you’re thinking: ‘Oh my God.’

“But I’m back at work and I’m doing a new hobby. It’s good to exercise – as long as you’re doing something and not just sat watching television all day.”

It’s all good camaraderie”

Don’t just plant for how you are today”

For more than 15 years, Ruth Rogers has been a prolific gardener, caring for three full-size allotments as well as a large garden at her home in Suffolk. “It is my refuge. I love being down at the allotment,” says Ruth, 70.

Two years ago, she thought she’d have to give up her hobby, after discovering a suspected long-running virus was in fact a combination of health problems, including a diagnosis of heart failureD. Ruth made a good recovery at the time, but says: “In the last few months, I’ve started going downhill more rapidly than I would like. I get very tired and breathless, so heavy lifting or digging is out. I got very low as I couldn’t see a way to continue doing what I love.”

As Ruth’s heart failure symptoms worsened, she found Paul Peacock’s column in Heart Matters (page 47). Paul has heart failure too, and has devised solutions to help him keep gardening. His ingenuity inspired Ruth.

“Paul’s words really spoke to me,” she says. “If he could do it with his problems, so could I. His words came when I was feeling quite

unwell, thinking that I would have to give it all up. It was the encouragement I needed, at exactly the right time.”

Ruth downsized to one five-rod allotment (half the size of a standard allotment) and still looks after her garden, with its vegetable patch and greenhouse full of tomatoes, peppers and salad leaves. She’s adapted the way she gardens, too. A path has been laid across the vegetable patch and non-slip tiles through the allotment. She plants crops further apart for ease of harvesting.

“I have two sets of gardening tools, one at one end of the allotment and one at the other end, because it saves me quite a lot of walking,” Ruth says. “I only plant what is easy to grow and what the rabbits don’t eat so there is no covering to do.

“I cleared my allotment in the autumn on my hands and knees, using only a trowel. It took forever, but I enjoyed doing it. My wonderful family did all of the composting.”

Over at the allotments, Ruth’s fellow gardeners support her, too. “Everyone is absolutely lovely,” she says. “They are kind and thoughtful and cheerful and helpful.”

Ruth is determined to keep gardening for as long as she can and is planning ahead to make that possible. “Don’t just plant for how you are today,” she says. “You have to look to the future, when your health may not be as good as it is now. I have learned that life can change very abruptly and unexpectedly, so I plan ahead. It will mean that I can carry on doing what I find so rewarding.”

Get inspired Read Paul Peacock’s story and his regular column at bhf.org.uk/gardening.

Matt (left) gave James his first taste of trial biking in 2014

London to Brighton Off-Road26 September 2015This 75-mile bike ride mixes cycle, single track and forest paths. Sign up to be part of the UK’s largest charity off-road bike ride: bhf.org.uk/L2Boffroad.Ph

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RESEARCH

Face/Off: transplantsIn Face/Off, FBI agent Sean Archer (John Travolta) undergoes a face transplant to swap identities with super-criminal Castor Troy (Nicolas Cage). Archer believes Troy was responsible for his son’s death, so seeing the criminal’s face in the mirror repulses him.

The BHF-funded realityOrgan rejection is a common and potentially fatal complication of transplants and the most common cause of a donor heart failing. Helped by a BHF grant, Dr Wilson Wong is studying the lymphatic system, a key part of the immune system, to discover why donor hearts may be rejected. Speaking to Heart Matters in January 2014, he said: “The better we understand the rejection process, the better we will be able to design new treatments to help prevent it.”

Dr Wong, a Reader in Transplant Immunology at King’s College London, is using an adapted CT scan to study the lymphatic system in mice, post heart transplant. If the research is successful and Dr Wong receives additional funding, it could “help to reveal new ways in which the lymphatic system can be modified to help combat rejection and reduce the need for current long-term immunosuppressant drugs”.

Gattaca: geneticsGattaca tells the story of Vincent Freeman (Ethan Hawke), born with a genetic heart condition that consigns him to an ‘underclass’ of humans, deemed useful only for menial jobs. To move ahead, he assumes the identity of Jerome Morrow (Jude Law), a genetically perfect man who, due to a car accident, is paraplegic.

The BHF-funded realityGenetics holds great potential for predicting who is at risk of cardiovascular and related diseases, then treating them either at an earlier stage or more effectively.

The BHF and the Welsh Assembly jointly created a genetic testing service for familial hypercholesterolaemia (FH)D, a genetic condition that causes very high cholesterol levels. The service focuses on finding ‘index cases’ – people with FH who can undergo genetic testing. People that have FH can be successfully treated with cholesterol-

Welcome to a world where time is the ultimate currency. In the film In Time, everybody stops ageing when they reach 25, but they are genetically engineered to live only one more year, unless they can buy their way out of it. The rich ‘earn’ decades at a time, while the rest beg, borrow or steal enough hours to make it through the day.

The BHF-funded realityEight out of 10 babies born with a congenital heart condition now grow up to be adults, largely thanks to research we helped to fund. Before the BHF was set up, only one in five babies born with heart disease saw their first birthdays.

Former BHF professors Robert Anderson and Sir Magdi Yacoub have both been influential in the field of congenital research. Early in his career, Professor Anderson specialised in cardiac morphology (studying the anatomy of the heart). While helping a Liverpool colleague investigate potential

lowering statins alongside making lifestyle changes.

A 2008 study, part-funded by the BHF, found that people with FH who are diagnosed and treated before they develop coronary heart diseaseD generally live as long as people who don’t have FH.

complications to the heart’s electrical system during surgery, he made a discovery that led to a crucial change in heart surgery procedures on children.

Sir Magdi pioneered ‘the switch’ operation, which has transformed the lives of babies

born with transposition of the great arteries.

We also provide support for children living with congenital heart conditions. In 2007, we launched Yheart (yheart.net), an online hub where 13- to 19-year-olds can share advice, stories, news, ideas and support. BHF Professor John Deanfield and Dr Jane Somerville are also working to establish the new cardiology specialty of grown-up congenital heart disease.

80% of babies born with heart conditions now survive to adulthood

The BHF spent

£115m on research in 2014

In Time: living longer

Help the BHF. Donate now. 0300 330 3322* or bhf.org.uk/donate*Cost similar to 01 or 02 numbers

Futuristic films contain mind-boggling ideas, but thanks to research we’re funding, some of them aren’t as far from reality

as you’d think, as Lauren Tedaldi and Sarah Kidner discover

SCIENCE FACTScience fiction becomes

HHHHH “We will be able to design new treatments”– Dr Wilson Wong

HHHHH “We used

to tell surgeons

what they were going

to find. Now we just give

them a 3D model”

– Dr Tarique Hussain

HHHHH “We saw we could prevent disease”– Professor Magdi Yacoub

STARRING: STEM CELLS FROZEN IN TIME, SPACE-AGE IMAGING MACHINES, 3D-PRINTED BODY PARTS AND MORE!

VISIT bhf.org.uk/sciencefiction


Earth is over populated and decimated by pollution and disease, so the wealthy have relocated to a space colony called Elysium. Special body scanners find and treat every potential health threat. The poor try smuggling themselves to Elysium to be healed by the scanners.

The BHF-funded realityHigh-tech imaging equipment we’ve funded is advancing understanding of cardiovascular diseaseD and how to diagnose and treat it.

We’ve contributed over £1.8m to help fund the Centre for Translational Cardiovascular Imaging at the University of Leeds, which is led by BHF Senior Research Fellow Professor Sven Plein.

In 2012, Professor Plein and his research team published the results of a BHF-funded study demonstrating that magnetic resonance imaging (MRI) is an accurate and reliable method for detecting coronary heart diseaseD.

Policeman John Spartan (Sylvester Stallone) is frozen into CryoPrison with crime lord Simon Phoenix (Wesley Snipes). After 22 years, Phoenix is released in a utopian society that can’t deal with violence. Spartan is defrosted to save the day.

The BHF-funded realityWhile we’re not deep-freezing

Meanwhile, in Edinburgh, BHF Clinical Lecturer Dr Marc Dweck has developed a test that may identify patients at high risk of heart attackD using an imaging technology called PET/CT.

Cambridge-based BHF Professor Martin Bennett and his colleagues have pioneered an imaging technique called

virtual histology intravascular ultrasound (VH-IVUS), which looks at the specific components of plaques.

The technique is currently only used in research, but eventually VH-IVUS may identify not just the presence of disease, but specific plaques at higher risk of rupture. Treating these patients with medications might then prevent heart attacks.

heroes for the future, scientists at one of our three BHF Centres of Regenerative Medicine are investigating whether stem cells, derived from defrosted blood cells, can grow heart muscle that could be grafted onto a damaged heart, such as after a heart attackD.

Stem cells are immature cells that have the potential to grow into any kind of cell.

In the 23rd century, the future of mankind depends on The Fifth Element. She only comes to Earth every 5,000 years to protect the human race and this time, the spacecraft bringing her back to Earth is destroyed. A team of scientists uses DNA remains to rebuild her. She is recreated using a machine that seems to ‘print’ a three-dimensional person.

The BHF-funded realityWe’re not suggesting that we can ‘print’ a person or a new heart (yet) but the use of 3D printers is already making great leaps forward in planning surgery. Using complex and detailed MRID imaging, BHF-funded scientist Dr Tarique

£2.5m invested into imaging studies

-196˚C The temperature blood cells can be kept frozen at for 50 years

Elysium: imaging technologies

The Six Million Dollar Man: what we’ve spent

Demolition Man: frozen cellsIn The Six Million Dollar Man, astronaut Steve Austin is ‘rebuilt’ after his spaceship crashes. Using cutting-edge research, scientists spend a total of $6m (£2.4m) bringing him back to health.

The BHF-funded realityIn 1973, the year The Six Million Dollar Man was made, we were spending the

equivalent of £5m. Last year, we spent £115m on research. Over our 50-year history, generous donations from the public have funded life saving projects, from gene therapy to population studies.

In today’s money, Steve Austin’s rejuvenation would cost £28m. How many research projects could we fund with that?≠ £10m on regenerative medicineLast year, we put around £10m into regenerative medicine projects in the UK, including three £2.5m Centres of Regenerative Medicine. This involves finding ways to repair damaged hearts and

Hussain and his team at King’s College London are able to create exact replicas of a patient’s heart. These models can be used to work out where a hole lies in a child’s heart, allowing surgeons to precisely plan what repairs to make and where before the operation.

BHF-funded scientists want to know more about these potentially life saving cells. But stem cells are fragile, not to mention expensive to obtain and maintain, making them difficult to work with.

Dr Amer Rana and his colleagues at the University of Cambridge are developing a way to generate stem cells from defrosted blood cells. Researchers can freeze and store blood cells (at -196˚C for longer than 50 years), then turn them into stem cells when they need them, rather than having to use them as soon as they are made. This will have huge practical value, prolonging the ‘use by date’ of patient samples.

Go online For even more examples of the BHF turning science fiction into reality, including self-mending hearts, at bhf.org.uk/sciencefiction.

blood vessels using stem cells, enhancing the body’s own repair mechanism and engineering heart ‘patches’ to mend broken hearts.≠ £3m on genetics, genomics and biomarkersSome diseases of the heart and circulatory system occur because of a person’s genetics – the building blocks in our DNA that make us who we are. We invested £3m last year to better understand which genes are important in these conditions, and which we could target for treatment or prevention.≠ £2.5m on imaging studiesImproved technology means heart scientists have a better idea than ever what’s going on inside our bodies and what happens when things go wrong. ≠ £6.5m on population studiesResearching large populations can help us find the causes of heart and circulatory diseases. ≠ £4m on intervention trialsIntervention trials are when researchers intervene in a way that could affect the outcome they are measuring – for example, they could give people a medication or a scan that may affect their diagnosis and then observe the effects of this intervention. We spent £4m on this sort of research in 2014. ≠ £2m on infrastructureLast year, we gave around £2m towards the cost of essential infrastructure like buildings and major pieces of cutting-edge equipment.

The Fifth Element: printing a person

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19Heart Matters

MEDICAL

bhf.org.uk

cardiac treatments

Focus on…

Treatments for cardiovascular disease can alleviate symptoms and improve quality of life, but for how long? Senior Cardiac Nurse Christopher Allen enlists a panel of experts to find out

Abnormal heart rhythms (often called arrhythmiasD) are when your

heart beats very slowly, very quickly or irregularly. They can cause symptoms like dizziness and palpitations. The most common arrhythmia in the UK is atrial fibrillation (AF)D, and we discuss treating it with ablationD, below. While medications play a vital role in helping to treat arrhythmias, sometimes a procedure is necessary. This could be an ablation for AF, or insertion of a pacemakerD or implantable cardioverter defibrillator (ICD)D.

Ablation for atrial fibrillationDuring a cardiac ablation, a thin, hollow catheter is passed into your heart through an artery in your groin or wrist. Your doctor pinpoints the tissue where the abnormal signal originates and destroys it with radiofrequency waves (radiofrequency ablation) or by freezing (cryoablation). Hopefully this will resolve your AF.

Immediately afterwards, you may still have symptoms, usually palpitations, but these should stop. It will be clearer whether the ablation has worked eight to 10 weeks later. Some people experience short-term chest pain because of inflammation, but this usually settles after seven to 10 days.

If the ablation is successful, your doctor will discuss stopping some of your medications. You’ll be monitored for a year and if your symptoms stay under control, you won’t require further follow-up.

Some people with AF will only have one ablation; others may have multiple

Am I better now?

Abnormal heart rhythms

Patients often want to know how quickly a treatment will take effect

ablations, which may or may not work but may help improve their symptoms. “This is unusual, but if AF gives you symptoms and affects your quality of life, we can repeat the procedure,” says Dr Ben Brown.

For other people, where an ablation has not been effective, medications can help to alleviate the symptoms.

PacemakersMost pacemaker recipients have either a very slow heart rate, long pauses between heartbeats or AF. In heart failureD patients, a special ‘biventricular pacemaker’ can help your heart pump more efficiently.

Your pacemaker starts functioning as soon as it is inserted. Some people feel the benefit straight away as their heart rate is increased to a normal rate.

All pacemakers have an internal battery, connected to the heart by one or more leads. It is not unusual to need new batteries, known as a ‘box change’, as leads remain in place but the box is swapped.

Batteries last for eight to 10 years and sometimes longer, depending on how

often the device is used. Your pacemaker clinic closely monitors your battery. When it starts to run low, they arrange for you to have a new pacemaker box implanted. This is a routine procedure.

If the insulation on the leads is wearing, you will need a lead change too. This is also easily detected during pacemaker clinic checks. Pacemaker leads last for 20 to 30 years.

When your battery is low, the pacemaker functions just as effectively. However, it’s important to let your GP or pacemaker clinic know if you experience symptoms that concern you.

Overall, little can go wrong, as long as you attend your regular pacemaker clinic appointments. Your underlying abnormal heart rhythm or condition will always be there, but your pacemaker will aim to help improve any symptoms.

CV Dr Ben BrownConsultant Cardiologist, University Hospital of South Manchester≠ Expert in cardiac

electrophysiology and treatment of heart rhythm disorders

≠ Performs ablation procedures; implants pacemakers and ICDs

Medications and surgery can help relieve symptoms of cardiovascular disease (CVD)D and sometimes slow its progression. However, in most cases we

can’t reverse CVD, so patients often want to know how quickly a treatment will take effect, the extent to which it will improve their quality of life, and how long it will remain effective. Unfortunately, there is no simple answer.

We’ve explored some common procedures and surgical treatments for abnormal heart rhythms, coronary heart disease (CHD)D and heart valve disease and enlisted the help of experts to give you the best idea of what to expect.

How long will the battery last?

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Coronary heart disease (CHD) is where the arteries that supply your

heart muscle with oxygen-rich blood become narrowed due to a build-up of fatty plaque. This can reduce blood flow, resulting in anginaD symptoms. Sometimes a piece of plaque breaks off and a blood clot forms around it, blocking blood flow to part of your heart muscle. This is a heart attackD.

CHD is a progressive disease and there is currently no way to reverse plaque build-up, but the process can be slowed down by medications and lifestyle changes, and treatment can manage symptoms.

If your plaque build-up is severe or causing symptoms, or if you’ve already had a heart attack, you may be referred for an angioplastyD and stentD, or a coronary artery bypass grafting (CABG).

Coronary artery bypass grafting (CABG)This procedure is normally carried out on people with a very severe narrowing in one or more arteries, especially if the narrowing is too tight to accommodate a stent or you have several narrowings in the arteries that supply your heart muscle with blood. An artery or vein is taken from another part of your body and used to divert blood around the narrowing or blockage.

Following successful bypassD surgery, around 75 per cent of patients will be free from the symptoms of angina, such

Your heart valves make sure blood flows through your heart in the right

direction. As you get older, valves can become diseased or damaged, making them very stiff or causing them to leak. This forces your heart to work much harder to pump enough blood to meet your body’s demand for oxygen. Mild to moderate valve problems are usually managed with lifestyle changes and medications, but if a valve becomes severely affected or you suffer with symptoms such as light-headedness and tiredness, you may be considered for valve replacement surgery.

The replacement will be a donated tissue valve from a human or an animal (such as a pig or cow), or a mechanical valve made from carbon fibre. “The main difference is that a tissue valve is prone

Will I need another procedure soon?

Implantable cardioverter defibrillator (ICD)The main aim of an ICD insertion is to treat rapid abnormal heart rhythms that can lead to cardiac arrestD. This is achieved by rapid pacing or by the device giving your heart a direct shock via a special lead.

If you have an ICD to treat only rapid, life-threatening heart rhythms, you won’t feel any difference in your overall condition. However, if your ICD also uses pacing functions to bring a very slow heart rate into the normal range, you should immediately feel better.

An ICD will not cure your underlying heart condition, but it does give

immediate treatment if you ever have a life-threatening abnormal rhythm.

ICD batteries run down over time but usually last six to eight years, depending on how much pacing or how many shocks you receive. ICD leads are more complicated and less durable than pacemaker leads. After five years, around one in 10 people will need to have their lead replaced.

Coronary heart disease

Heart valve disease

as chest pain and shortness of breath. However, the benefit may be masked by soreness from the wound for a few weeks after surgery.

Plaque can build up in your bypass graft, so some people will later require angioplasty and stents or even further surgery, but eating a balanced diet, taking regular exercise and not smoking help to prevent this. You will need to take medications after the procedure, too.

Angioplasty and stents“This treatment should resolve the symptoms of angina, such as chest pain, straight away,” says BHF Professor David Newby. “It’s very unusual for a stent to cause any other problems, but in about

one in 20 cases, symptoms may return because of in-stent restenosis. This is where the inside of the stent becomes furred up with scar tissue. It usually develops over three to six months.”

A small balloon is inflated in the narrowing to push plaque to the sides of the artery, then the stent is put in to reinforce this. As with other treatments, a stent won’t fix the underlying disease, but it will reduce or resolve your symptoms.

“For this reason, it’s important to make positive lifestyle changes to slow down further plaque build-up, as this could mean further stents or even bypass surgery,” says Professor Newby. “Future problems are particularly likely if you continue to smoke.

“Stents can last your whole lifetime and you may not need any further treatment to the narrowed artery. However, if plaque builds up at different places in the stented artery or any other coronary arteries, you may need further stents fitted.

“Recovery time following a stent is usually very short. For a planned procedure, you normally go home the same day. Full recovery depends on the success of the procedure and your pre-operative fitness.”

to general wear and tear, and over time can start to leak and need replacing,” says Professor David Taggart.

A mechanical valve will almost always last for life, but you must take an anticoagulant such as warfarin to stop blood clots forming around it. Tissue valves should eliminate or alleviate your symptoms for 10 to 15 years.

CV BHF Professor David Newby

University of Edinburgh≠ Leads the Scottish Centre

of Regenerative Medicine (funded by our Mending Broken Hearts Appeal)

Always talk to your GPif you’re concerned

about any symptoms

Which treatment is best for me?

Stents can last your whole lifetime”

CV Professor David Taggart Professor of Cardiovascular Surgery, University of Oxford ≠ Specialist in coronary

revascularisation, arterial grafts and off-pump surgery

≠ Former President of the Society for Cardiothoracic Surgery in Great Britain and Ireland

≠ Lead for cardiothoracic research in the UK, Royal College of Surgeons of England

Talk to us

0300 330 3300Heart Matters Helpline

MEDICAL

Our panel of experts answer your health questions

ASK THE EXPERTS

Internet rumoursQ I’ve recently read

on the internet about something called ‘cough CPR’. The article claimed that if I have a heart attackD and then do this, it could save my life. Is it true?

Senior Cardiac Nurse Christopher Allen says: The absolute priority when you think you or someone else is having a heart attack is to call 999. This way, paramedics can assess and aid you, and you’ll

get to hospital as fast as possible. There is no medical evidence to support ‘cough

CPR’, which suggests you can help yourself by coughing vigorously

if you think you’re having a heart attack

and are alone.A heart attack is when

the blood supply to your heart muscle is interrupted;

this is most commonly due to a blood clot. A heart attack can lead to a cardiac arrestD, when your heart

stops pumping blood around your body. You

would become unconscious, and without immediate CPRD (chest compressions and rescue breaths), you would die. If you are still conscious (and you would have to be to do ‘cough CPR’), then you are not in cardiac arrest and therefore

Need more information? Learn about CPR at bhf.org.uk/cpr and find out about the role of GPs in the community on page 36.

Call the Heart Matters Helpline on 0300 330 3300 for more information. To suggest a question, email [email protected].

How to get in touch

CPR is not needed, but urgent medical help is vital.

The ‘cough CPR’ myth has been circulating the internet for a while now, especially on social media sites such as Facebook. If you come across it, please avoid spreading it any further and consider letting the person who posted it know that there’s no truth in it.

Explaining rotablationQ I recently had an

angiogramD and was told that I need a rotablation. Please can you explain what this is?

Professor Peter Weissberg says: An angioplastyD procedure is used to help relieve symptoms

of anginaD. This is where a guide wire is passed into an artery in your heart that has become narrowed by a build-up of plaque. A tiny balloon is inserted along the wire and then inflated to squash the plaque to the sides and improve the flow of blood through this section of the

narrowed artery. This is often followed by the insertion of a metal mesh, called a stentD, which holds the artery open after the balloon is withdrawn.

Sometimes, when the plaque is particularly hard, or is so narrow that the balloon can’t pass through it, rotablation may be used. Again, a very

49

bhf.org.uk

A Ablation Procedure to correct or control certain types of

arrhythmias. Involves using radiofrequency waves to destroy abnormal electrical pathways. Angina An uncomfortable feeling, tightness or pain in your chest that may also be felt in your arms, neck, jaw, back or stomach. The symptoms of angina are usually caused by coronary heart disease.Angiogram X-ray pictures that show whether the arteries are narrowed and, if so, how narrow they have become. A coronary angiogram examines the coronary arteries.Angioplasty Procedure to widen a narrowed artery. It involves temporarily inserting a catheter and infl ating a tiny balloon at the narrowing to widen it and improve blood fl ow.Arrhythmia An abnormal heart rhythm. Atrial fi brillation (AF) An abnormal heart rhythm in which the atria (the upper chambers of the heart) beat in an irregular pattern. People with AF have an irregular, sometimes fast, pulse.

B Bypass See coronary artery bypass surgery.

C Cardiac arrest The ultimate medical emergency, when

a person’s heart stops pumping blood round their body and they stop breathing normally. Cardiac arrests in adults can be caused by a heart attack.Cardiac rehabilitation Also called ‘cardiac rehab’, this is an education and exercise programme to help you

recover from a cardiac event and get back to as full a life as possible.Cardiopulmonary resuscitation (CPR) Actions performed to keep blood circulating around a person’s body when they are in cardiac arrest. CPR consists of chest compressions (pumping the heart) and rescue breaths (infl ating the lungs). Cardiovascular disease (CVD) Includes all diseases of the heart and circulation, such as coronary heart disease and stroke.

Carotid arteries Blood vessels positioned in the neck that carry blood to the brain.Coronary artery bypass surgery An operation to treat coronary heart disease. Arteries from your chest wall and arm, or veins from your leg, are used to bypass the blocked or narrowed coronary arteries, improving blood fl ow to the heart muscle.Coronary heart disease (CHD) When the walls of the coronary arteries (the arteries that supply blood to the heart muscle) become narrowed due to a gradual build-up of atheroma.

DDiabetes A condition in which glucose (sugar)

levels in the blood are too high. There are two main types of diabetes; type 1, where your body stops producing insulin, and type 2, where your body can’t use the insulin it produces, usually because excess fat in organs prevents the insulin from working eff ectively. Diabetes increases your risk of developing cardiovascular disease.

EElectrocardiogram (ECG) A simple, painless test

to record the heart’s electrical activity. Small sticky patches (electrodes) are put onto your arms, legs and chest. These are connected to a machine that picks up and records the electrical signals of your heartbeat.

FFamilial hypercholesterolaemia (FH) A genetic condition

that results in high cholesterol levels. Having FH gives you a much higher risk of getting coronary heart disease.

H Heart attack Known medically as a ‘myocardial infarction’, or ‘MI’. This describes a sudden loss of blood fl ow to part of the heart muscle. Most heart attacks are caused by

atherosclerosis, the gradual build-up of atheroma within artery walls. If the atheroma becomes unstable, a piece may break off and lead to a blood clot forming. This can block a coronary artery, causing a heart attack and irreversible heart muscle damage. It is a medical emergency and can lead to a cardiac arrest.Heart failure Condition where the heart is less effi cient at pumping blood around the body.

High blood pressure Also called ‘hypertension’. High blood pressure is when the pressure required to pump blood is consistently higher than the recommended level. This puts extra strain on your heart and blood vessels, and over time can increase your risk of having

MEDICAL TERMS EXPLAINED

Call the Heart Matters Helpline on 0300 330 3300 if you want to know more

a heart attack or stroke.High cholesterol Cholesterol is a waxy substance that is mainly made in the body and plays a vital role in how every cell works. However, high cholesterol, when there is too much in the blood, can increase your risk of getting cardiovascular disease, which includes having a heart attack or a stroke.

I Implantable cardioverter defi brillator (ICD) A small

device implanted under the skin on your chest, connected to your heart by one or more wires (leads). It monitors your heart rhythm and can deliver a controlled electric shock if you have a life-threatening abnormal heart rhythm.

P Pacemaker A small device implanted under the skin

on the chest, connected to your heart by one or more wires (leads). Monitors the heart’s electrical signals and can stimulate it to contract and produce a heartbeat if required.

S Stent A short tube of expandable stainless-steel

mesh that is inserted into an artery to hold it open after an angioplasty, improving the fl ow of blood through the artery. Stroke An interruption of blood fl ow to part of the brain, causing brain cells to die or become damaged. This happens if an artery carrying blood to your brain becomes blocked, or if an artery bleeds into your brain. A stroke is a medical emergency.

DICTIONARYMedical words, identified by a small symbolD are explained in plain English in our dictionary on page 49.

Dictionary

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Please avoid spreading this myth any further”

fine wire is guided through the narrowing. After this, a special catheter (a thin tube) is inserted along the wire with a tiny drill at its tip, powered by compressed air. This drill is used to chip away at the plaque to gradually widen the narrowing. Once this has been done, a balloon can be inserted and the angioplasty can proceed as normal.

You’ll be awake for the procedure. Although the drill can be surprisingly noisy, it’s not painful, but as with an angioplasty, you may feel some minor chest discomfort. A local anaesthetic is used at the site in your groin or wrist where the catheter is inserted.

22 Heart Matters

0300 330 3300Call the Heart Matters Helpline

Talk to us

Heart health questions?Heart Matters Helpline

is here to help, with free information and

support about your heart health

Call rates are similar to 01 and 02 numbers. Lines are open 9am–5pm, Monday to Friday

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RESEARCH

24

“Everyone needs a mentor,” says Dr David Grieve. “When I started out as a postdoctoral researcher,

Ajay Shah, BHF Professor of Cardiology at King’s College London, helped me a huge amount.”

Fifteen years later, Dr Grieve is running his own lab at Queen’s University Belfast and has published 40 peer-reviewed papers in cardiovascular journals. His work focuses on cardiovascular remodelling – the specific changes that occur in the heart as a result of cardiovascular disease (CVD)D, including the influence of diabetesD – to find new forms of treatment.

Dr Grieve has been funded by the BHF throughout his career. He says this has been “essential”. He is still in touch with Professor Shah, who “supported me by developing my independence”.

“He encouraged me to write my own papers and make funding applications, and gave me opportunities to supervise postgraduate students,” says Dr Grieve. “He really helped me prepare for having my own lab. When I moved to Belfast, that support helped me to meet the challenge of setting up as an independent researcher. And that support is still there to this day – whether it is commenting on a funding application or sharing resources, such as tissue models.”

Sarah Brealey discovers how mentoring helped BHF-funded researcher David Grieve, who’s now passing on his expertise to PhD student Arya MoezBright future

Promising protégésDr Grieve is currently supervising four students at different stages of their PhDs. One of those students is Arya Moez, who hopes to make discoveries that could lead to new treatments for heart failureD and other diseases.

Arya is working with partial induced pluripotent stem (iPS) cells, which can be derived from blood or skin and turned into cells that can potentially create new blood vessels. This could treat critical limb ischaemia (loss of blood supply to the limbs, a possible complication of diabetes). If the technique is successful, it could be applied to other illnesses linked to blood-supply problems, such as heart failure following a heart attackD, and some diseases of the eyes and kidneys.

Partial iPS cells can be created from the patient’s skin or blood, so there are no issues of compatibility or rejection. Challenges include producing enough cells to treat patients and keeping cells alive once they are introduced into the body.

“I am hoping to find a new therapy – that is what motivates me,” says Arya. “Having David’s support means a lot, and so does the support of the BHF. Without both of those, I wouldn’t be here.”

Dr Grieve says his role is to “supervise, advise and mentor” while Arya does the hands-on project work. Despite being at an early stage in her PhD, she’s already displaying the traits for independent research. “When you see someone with potential, you want to support them,” says Dr Grieve. “Although she is at an early stage, she has plans for her future career.”

Arya’s long-term aim is to return to her native Afghanistan and set up a lab. “Research is non-existent there,” she says. “I want to be one of the first people setting

BHF PhD Studentships enable graduates to take a three-year PhD degree at a UK university. The award covers stipend, tuition fees and up to £10,000 in annual research consumables.

Applicants need a first class or 2:1 BSc, or an MSc at merit or distinction.

They must be supported by a named supervisor and a second supervisor.

Just over half of applications are funded and in 2014/15, the BHF funded 33 new PhD Studentships at approximately £110,000 each. In total, 141 PhD Studentships are currently being funded.

BHF support for students

£3.6mBHF funding for new PhD students in 2014/15

Dr Grieve knows the valueof mentoring and is sharing

his experience with Arya

up a research centre and motivating and encouraging students.”

Global movement and scientists working together across borders are beneficial for research, says Dr Grieve. “We encourage people to go away [to work]. Labs do things differently around the world; you can learn from that and it promotes collaboration.”

Even if Arya moves away, Dr Grieve hopes to continue offering support from a distance as her career develops.

Growing top talentArya, who is also an Austrian citizen, moved to Belfast to take up her BHF-funded studentship and work with Dr David Grieve. “Relocating has given me the chance to excel in my career and means I am surrounded by expertise.”

Dr Grieve says it is vital to fund scientists at this early stage in their careers. “These are the next generation. The PhD students are part of the research programme and are just as likely to make impactful and exciting discoveries as anyone else.

“One of the good things about the BHF PhD programme is that it tries to give a

generous stipend, and that definitely helps to attract the best students.”

Arya says: “I am thankful to the BHF for funding my project. Having the funding makes this possible, both in terms of my time – and we work long hours in the lab – and the money to buy the equipment that we need. I hope the BHF’s work to support young researchers will continue.”


Professor Mark Hanson’s innovative project is aiming to change habits passed down through generations with the help of funding from you. He tells Sarah Kidner how he’s planning to do it

We all have stories of life-changing moments, and it’s this idea that underpins an innovative BHF-funded research project at the University

of Southampton. LifeLab is a purpose-built educational laboratory

showing young teenagers how their lifestyle may affect their future heart health. Its aim is to educate children before they become parents themselves, because research has shown that an unhealthy lifestyle negatively affects parental DNA.

“We think we can change their attitudes and behaviours to affect their health,” says Professor Mark Hanson. “It’s important, because they will be the parents of tomorrow. By helping to educate them, we hope we can encourage them to live a healthier lifestyle and to pass that on to future generations.”

A team of educators works with schools before they visit the centre, providing training and resources. “We give teachers booklets and lesson plans. It helps them to prepare the kids and engage them with the LifeLab concept, taking the burden off their shoulders,” explains Professor Hanson, who is a former teacher.

After an initial four lessons, the children come for a day visit to the LifeLab, where they’re encouraged to be hands-on. “They observe the blood flow in their carotid arteriesD using an ultrasound machine, they measure muscle function and grip strength, and they

RESEARCH

At the end of the day, the children are encouraged to make pledges about how they’ll live a healthier lifestyle. When they return to school, there is a series of follow-up lessons.

Life-changing behaviourMore than 4,000 children aged 13 and 14 have visited the lab and, says Professor Hanson, the results are positive. “Even six months after a visit to the LifeLab, we find that children’s attitudes show a sustained change. We don’t know yet whether that translates into healthier behaviour or lives or reduced risk of cardiovascular disease (CVD)D.”

The BHF has awarded LifeLab a grant of £226,165 to evaluate the success of the programme by examining the 2,500 children who visited the lab during a three-year period of its operations.

In 2013, the lab moved to a new location within Southampton General Hospital. Since then, it has welcomed 1,500 children from 20 Southampton schools and has trained 60 teachers. “It is an idea that’s gaining enormous momentum,” says Professor

Hanson. “We feel this is the beginning of an important new social movement, and we hope it’s a step towards reducing the risk of cardiovascular disease.”

Longer term, Professor Hanson has ambitions to create a virtual version of the LifeLab on the internet, and using interactive apps. “We hope we will be able to develop a national or international programme that combines internet-based activities with physical visits, using science learning centres, medical schools and hospitals,” he says.

“When you hear kids saying it’s the first time they’re learning about science, it’s fantastic,” says Professor Hanson. “Of all the things I’ve been involved in over the years, this is the one where everyone tells me what a great idea they think it is. We’ve had nothing but praise from the parents and teachers, and even the bus driver who brings them to and from the lab. He asked me: ‘What have you done to these children? When they get back on the bus they talk about nothing but LifeLab’.”

≠ Turn over for our guide to a healthier summer holiday for every generation.

Welcome to the

LifeLab

Watch now For a behind-the-scenes look at the LifeLab, watch our exclusive video at bhf.org.uk/lifelab.

extract their DNA and look at how their diet may alter DNA function,” says Professor Hanson. “We have an exercise bike and we test lung function and talk about the risks of smoking.

“There’s a whole range of activities that are exciting and fun and which they’d never have the opportunity to do in school. We are very clear to them that we’re not testing their health, but giving them a chance to explore how they might measure and improve health.”

CV BHF Professor Mark HansonDirector, Academic Unit of Human Development and Health, University of Southampton≠ BHF Professor of Cardiovascular Science≠ Previously at University of Reading≠ His work combines epidemiology (population

studies) and epigenetics (study of cellular and physiological trait variations that can’t be explained by changes in the DNA sequence)

£226,165funded by our supporters

School groups visitingLifeLab are shown how to monitor their health

BHF

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Heart Matters28

sugar and calories. Try carrot or bread sticks instead of crisps, or chopped watermelon to prevent demands for ice cream. Under-fives will need more substantial snacks. These should be combinations of fruit and vegetables with starchy carbohydrate (bread, bread sticks, rice cakes, currant buns) or protein (yoghurt or pulses). Hand out snacks that must be kept cool in the morning and save hardier options (dried fruit or currant buns) for the afternoon. Freeze tap water in plastic bottles for cold drinks all day.

Restaurant mealsMost restaurants have menus online, so consider the healthiest choices in advance. If there aren’t healthy options, enquire about grilled rather than battered foods or jacket potatoes in place of chips. Sharing a main, such as pizza, and a side salad between children can also be healthier and cheaper.

Many children’s meals are high in salt, which could contribute to them developing a taste for it from an early age. Read labels or nutrition information on menus, and watch out for salty ingredients like processed meat, cheese, pickles, olives, soup and soy or fish sauce. Don’t add salt to children’s food.

≠ Chompy’s ten tasty mealtime tips: a quick-read leaflet including tips to help you tackle fussy eaters aged two to four.≠ Understanding food labels: helps you make healthy choices for the whole family. Includes a useful card to use while shopping for food.≠ BHF nutrition information for the under-12s: bhf.org.uk/kidseatwell.

Free help from the BHF

sugar. Pure, unsweetened juices are healthier as they contain vitamin C, but can be acidic and high in calories. Diluting fruit juice with water reduces the sugar content in each glass, but stick to a maximum of 150ml of juice per day. Water is the healthiest choice. Coloured straws and novelty ice cube moulds can make it more interesting, or add chopped cucumber, strawberries and lemon.

Something for everyoneCook one dish for everyone. Fussy eaters might resist at first, but will eat if they are hungry. If children are used to having a separate dish, ease them into the new approach with an adaptable meal. Simple tomato sauce with pasta can have chicken, chickpeas or vegetables added. Children can try some of yours to see if they like it.

Going outNutritious nibblesBuying snacks when you’re out can be expensive, and they’re often high in fat,

Looking after children this summer? You’ve probably thought about how to fill the time, but spare a thought for

what you’re going to eat too. During the summer holidays, your routine changes and healthy eating and regular activities can slip off the radar. It’s common for children – and adults – to gain excess weight, but these tips could keep you on track.

Staying inAdapting treatsThere’s room for treats during the holidays, but six weeks is a long time, so don’t overdo it. With a bit of imagination, you can make summer snacks healthier. Blitz low-fat Greek yoghurt and frozen berries in a blender for an alternative to ice cream, or freeze diluted fruit juice or puréed fruit to make ice lollies.

bhf.org.uk

Treats are part of any holiday, but a bit of planning can stop you (and any children you’re looking after) putting on excess weight. Dietitian Annemarie Aburrow tells us how

Healthyholidays

develops vital skills. Younger children enjoy mixing and shaping, so make salads, oven-baked fishcakes from fish such as salmon or tuna tinned in water, or homemade pizzas using pitta breads. Older children can be more involved, chopping vegetables and cooking meals from scratch with supervision. Soups, tomato sauces for pasta, and chicken or fish traybakes with new potatoes and vegetables are good starter recipes.

Substantial snacksIf children have been active or are having a growth spurt, they may get hungry between meals. Low-fat yoghurt with banana, toasted wholegrain pitta with tomato salsa, tzatziki or reduced-fat hummus, or a bowl of low-sugar wholegrain cereal with semi-skimmed milk are all nutritious and filling choices.

Sugary drinksFizzy drinks are the biggest source of sugar in teenagers’ diets. A can of sugar-sweetened cola can contain over eight teaspoons of

Frozen yoghurt-coated strawberriesGreat for a refreshing sweet treat, these are easy to make and delicious to eat.Preparation time: 25 minutes, plus freezingCooking time: N/AMakes 16/serves 4Line a baking sheet (that fits in your freezer) with non-stick baking paper; set aside. Put 150g (5½oz) thick Greek-style natural yoghurt (5% fat), 2 teaspoons clear honey and a few drops of vanilla extract into a bowl; stir well to combine. Hull 16 medium, fresh, ripe strawberries (about 275g/9½oz hulled weight). One at a time, drop each strawberry into yoghurt mixture; use 2 forks to turn and thickly coat each strawberry in yoghurt. Lift out each coated strawberry; place on prepared baking sheet. Repeat until all strawberries are thickly coated in yoghurt. Freeze uncovered for 1–2 hours, until yoghurt coating is frozen. Remove coated strawberries from baking sheet; serve immediately.

Cook’s tipsBe careful not to freeze the strawberries for too long, otherwise the fruit will become too hard. Just freeze them until the yoghurt coating is frozen (the fruit inside will be semi-frozen, but still soft enough and not too cold to eat). You can also try this with fresh raspberries or blueberries.

These baked apple rings are easy to prepare and make a healthy snack.Preparation time: 20 minutesCooking time: 45 minutesServes 2–4Preheat oven to 150°C/fan 130°C/gas mark 2. Line 2 baking sheets with non-stick baking paper; set aside. Remove cores from 2 crisp eating apples (such as Braeburn or Granny Smith), keeping apples whole; cut apples crossways into very thin slices (about 1–2mm thick). Lightly

Plan aheadWeekly meal plans keep costs and waste down and ensure a healthy daily balance. Find recipe planners online or just write out a list of meals. Remember to include vegetables or salad with every meal. Choose quick dishes like baked chicken or fish with jacket potatoes and salad for days when you’re out, and get the children to lend a hand on days in.

Encourage independenceChildren can fetch their own snacks, help make sandwiches for picnics and pick which vegetables to have with dinner. A fruit bowl on the side and a box of berries or chopped fruit in the fridge at the children’s eye level will help encourage healthier habits. Cooking with children can be fun, and

brush apple slices all over with lemon juice; lightly dust all over with ground cinnamon. Arrange in a single layer on prepared baking sheets. Bake in oven for about 45 minutes or until dried out (they’ll crisp up as they cool), turning once halfway through. Transfer to a wire rack; leave to cool, then serve.

Cinnamon-spiced apple rings

23%

Each portion contains:

Sugars11g

High

Energy227kJ54kcal

Fat0.1gLow

Saturates0g

Low

Salt0g

Low0%0% 0%12%3%

% = an adult’s reference intake

23%


Sugars8.1gMed

Energy289kJ69kcal

Fat1.9gLow

Saturates1.3gLow

Salt0g

Low0%3% 7%9%3%


Cooking with children develops vital skills”

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Go online Get a guide to the healthiest cheeses and meals where you don’t need cheese at all, at bhf.org.uk/cheese.

30

Are all cheeses packed with calories, saturated fat and salt? DietitianAnnemarie Aburrow gives us the facts about this tempting dairy product

30gof cheese contains 7% of your daily calorie intake

CHEESEMyths about

Cheese is a great source of protein and calcium but is often high in saturated fat and salt. This means eating too much could lead to high cholesterolD and high blood

pressureD, increasing your risk of cardiovascular disease (CVD)D. In the UK, the standard portion size is 30g (the size of a small matchbox or two-and-a-half dominoes).

Your daily diet should feature three 30g portions of dairy products, and cheese alone won’t do. It’s fine to enjoy it sensibly though. Here’s how:

MYTH: I should give up cheese completelyREALITY: You don’t have to cut cheese out of your diet, but if you have high cholesterol or blood pressure, use high-fat cheeses sparingly. A 30g portion of cheese provides seven per cent of your daily calories and there can be more salt in a portion of cheddar than in a packet of crisps. Some types of roquefort, halloumi, feta and cheese singles are saltier than seawater. Cheese contains calcium and protein, so it can be OK in moderation, but remember: low-fat yoghurt, tinned fish, tofu, lentils and beans are good sources of calcium and protein too.

Keep cheese portions small and weigh them to reduce temptation. Using naturally lower-fat cheeses – such as edam, brie, camembert, goat’s

cheese, mozzarella, feta, paneer or reduced-fat versions – will provide less saturated fat. Cooking from scratch helps too, as convenience foods often contain higher-fat cheeses. Take time to stop and ask if your dish really needs cheese at all.

MYTH: Reduced-fat cheese is rubbishREALITY: It’s a common misconception that reduced fat equals reduced flavour. Experiment with different brands to find one you like.

Remember: ‘reduced fat’ isn’t necessarily ‘low fat’, it just means 25 per cent less fat than the original. Check the label to see whether the fat content is high (more than 17.5g/100g), medium (3.1–17.5g/100g) or low (3g or less/100g).

You can also cook and bake with reduced-fat cheese, although reduced-fat varieties of hard cheeses may take longer to melt. Grate it finely and melt over a low heat. Sometimes these cheeses produce a skin when baked or grilled, so add them near the end of the baking time.

MYTH: I’m addicted to cheeseREALITY: Research suggests that casein – a protein found in dairy products and highly concentrated in cheese – releases opiates called casomorphins as it digests. These opiates can signal comfort to the brain indirectly via hormones. However, a review by the European Food Safety Authority questioned whether casomorphins can be transferred through the intestine to the bloodstream or brain. If you eat a lot of cheese, you may become accustomed to the salty flavour or the habit

of having it at a certain time of day, so be aware of patterns in your eating and reduce your intake gradually.

MYTH: I need cheese to keep my bones strongREALITY: Cheese is a good source of calcium: a 30g portion of cheddar provides over a quarter of an adult’s daily requirements. However, other dairy products, such as yoghurt and milk, are just as good for the bones and much lower in fat and salt.

Cheese also contains a small amount of vitamin D, the fat-soluble vitamin that helps us absorb calcium from food. Lower-fat dairy products such as semi-skimmed milk do not contain as much vitamin D as fuller-fat cheese, but eggs, oily fish and fortified cereals (providing they’re low in sugar) are better sources anyway.

MYTH: Goat’s cheese is better for me than cow’s cheeseREALITY: Soft goat’s cheese contains about 26g of fat per 100g, on a par with brie and edam, and about as much salt as camembert. Goat’s cheese is considered a ‘high-fat’ product – feta, mozzarella

and ricotta are much lower in fat. Goat’s cheese is touted as being better for people with lactose intolerance than soft cheeses made from cow’s milk. It actually has a similar lactose content to other semi-soft cheeses such as feta and brie, but is lower in lactose than wetter cheeses like ricotta and cottage cheese.

MYTH: Cheese on spaghetti bolognaise doesn’t countREALITY: Grating cheese on

your spaghetti bolognaise adds extra calories, saturated fat and salt. A generous handful of cheddar could easily weigh 50g, adding 230kcal (more than 10 per cent of your daily requirement). Two level tablespoons of grated cheddar is about 20g. Avoid using your hands to grab a large sprinkling, as you may add too much. To get that tasty cheese flavour while avoiding excess calories, use a smaller serving of a vintage or mature cheddar.

MYTH: Grating or slicing? REALITY: Most people use less cheese when they grate it. A pre-cut slice of cheese usually weighs 20–30g and most people use many slices in a sandwich. Even if you’re grating cheese into sauces, toasties or jacket potatoes, watch your portion size, as it’s easy to have too much.

Once cheese is grated, it’s difficult to equate it to a healthy matchbox-size portion. Weigh it out next time to check how

good your guess is. Another common habit is to eat the knob of cheese that’s too small to grate. If this knob weighs 5g and you eat one twice a week, you will consume a whole day’s extra calories each year.

A standard portion of cheese is 30g (the size

of a small matchbox)

3332 bhf.org.uk

NUTRITION

Heart Matters

Our Senior Dietitian Victoria Taylor shares nutrition advice

ASK THE EXPERT

Do I need supplements? Q I have read that

vitamin and mineral supplements can help me keep my heart healthy. Is this true and do I need them?

Victoria Taylor says: There may be a place for supplements in the diets of specific groups of people, such as young children, pregnant women and the elderly, but for most of us, vitamin and mineral tablets are not necessary unless they have been prescribed by a health professional.

A wide range of supplements are available

in shops and on the internet, some of which make claims about improving general health, as well as more specific conditions like coronary heart

disease (CHD)D. However, a report from NHS Choices in 2011 highlighted that many of the

claims made about the benefits of supplements

have not been backed up by robust evidence. None of the most recent

UK official guidance for the prevention

and management of

Enjoyed this article? For further advice on the fat content of different foods, read our list of 12 surprisingly fatty foods at bhf.org.uk/fattyfoods. Find all of our nutrition information at bhf.org.uk/nutrition.

Call the Heart Matters Helpline on 0300 330 3300 for more information. To suggest a question, email [email protected].

How to get in touch

CHD recommends the use of dietary supplements.

It’s also worth remembering that, while taking extra vitamins and minerals can seem like a harmless addition to your diet, it’s possible to have too much of a good thing. In tablet form, vitamins and minerals are more concentrated than in food, and more is not always better. High intakes of some vitamin and mineral supplements can come with adverse effects. The antioxidant vitamins A, E and beta-carotene, for example, should definitely be avoided. Research has shown that these may actually have a harmful effect on health when consumed as supplements.

Safer summer slimmingQ I’m taking a holiday next

month and I really want to lose some weight before I go. I have read about diets that promise I can lose a stone in a month. Are these diets a good way to lose weight?

Victoria Taylor says: With the summer holiday season almost upon us, we all want to feel our best before we head off, so this is a time when more people than usual look for a quick fix for excess weight. If you are

overweight, then losing some weight is good for your overall health and wellbeing and can help to lower your risk of cardiovascular diseaseD.

But restrictive and short-term weight loss plans are not the way to go. Although they may help you to achieve a rapid weight loss – if you can stick to them – as soon as you go back to eating normally, it’s likely you’ll regain that weight, often with a bit more on top.

Losing weight steadily and gradually is the safest

approach and the weight is much more likely to stay off. It’s also a more sustainable approach, enabling you to make permanent changes to your diet and lifestyle. Gradual weight loss of 1–2 pounds (0.5–1kg) a week is achievable.

≠ Check out our booklet Facts not fads – your simple guide to healthy weight loss for more information. You can download or order it for free from bhf.org.uk/HMpublications or by calling 0870 600 6566.

49

bhf.org.uk

A Angina An uncomfortable feeling, tightness or pain in your chest that may also be felt in your arms, neck, jaw, back

or stomach. The symptoms of angina are usually caused by coronary heart disease. Angioplasty A procedure used to widen a narrow artery. It involves temporarily inserting and infl ating a tiny balloon where the artery is narrowed in order to widen it and improve the blood fl ow.Atheroma Fatty material that can build up on artery walls. Sometimes called ‘plaques’.Atrial Fibrillation (AF) A common heart rhythm in which the atria (the upper chambers of the heart) beat in an irregular pattern. People with AF have an irregular, sometimes fast, pulse.

B Bypass See coronary artery bypass surgery

C Cardiac arrest The ultimate medical

emergency, when a person’s heart stops pumping blood round their body and they stop breathing normally. Cardiac arrests in adults can be caused by a heart attack.Cardiac rehabilitation Sometimes called ‘cardiac rehab’, this is an education and exercise programme to help you recover from a cardiac event and get back to as full a life as possible.Cardiomyopathy Disease of the heart muscle in which it becomes weakened. It may become thickened, enlarged and/or stiff , depending on the type of cardiomyopathy. It aff ects people of all ages and is usually inherited.

Cardiopulmonary resuscitation (CPR) Actions performed to keep a person’s blood circulating around their body when they are in cardiac arrest. CPR consists of chest compressions (pumping the heart) and rescue breaths (infl ating the person’s lungs). Information on the Call Push Rescue programme can be found at bhf.org.uk/cpr. Cardiovascular disease (CVD) Includes all diseases of the heart and circulation, such as coronary heart disease and stroke.

Coronary artery bypass surgery An operation to treat coronary heart disease. Arteries from your chest wall and arm, or veins from your leg, can be used to bypass the blocked or narrowed coronary arteries. This helps to improve the fl ow of blood to your heart muscle.Coronary heart disease (CHD) When the walls of the coronary arteries (the arteries that supply blood to the heart muscle) become narrowed due to a gradual build-up of atheroma.

D Defi brillator A life saving machine that can give the

heart a controlled electrical shock during a cardiac arrest.Diabetes A condition in which glucose (sugar) levels in the blood are too high. There are two main types of diabetes; type 1, where your body stops producing insulin, and type 2, where your body can’t use the insulin it produces, usually because excess fat in organs prevents the insulin from working eff ectively. Having diabetes increases your risk of developing cardiovascular disease.

F Familial hypercholesterolaemia (FH) A genetic condition

that results in high cholesterol levels. Having FH gives you a higher risk of getting CHD.

H Heart attack The medical term for a heart attack is

a ‘myocardial infarction’, or ‘MI’ for short. This is when there is a sudden loss of blood fl ow to a part of the heart muscle. Most heart attacks are caused by atherosclerosis, which is the gradual build-up of atheroma within the artery walls. If the atheroma becomes unstable, a piece of it may break off and lead to a blood clot forming. This can block one of your coronary arteries, causing a heart attack and possibly irreversible damage to the heart muscle. A heart attack is a medical emergency and can lead to a cardiac arrest.Heart failure An inherited condition where the heart becomes less effi cient at pumping blood around. High blood pressure Also called hypertension. High blood pressure is when the pressure required to pump blood is consistently higher than the recommended level. This puts extra strain on your heart and blood vessels, and over time can increase your risk of having a heart attack or stroke.High cholesterol Cholesterol is a waxy substance that is mainly made in the body and plays a vital role in how every cell works. However, high cholesterol, when there is too much in the blood, can increase your risk of getting cardiovascular disease – which



includes having a heart attack or a stroke.Hypertension The medical term for high blood pressure.




on the chest, connected to your heart by one or more wires (leads). Monitors the heart’s electric signals and can stimulate heart to contract and produce a heartbeat if required.


mesh that is inserted into an artery to hold it open after an angioplasty, improving the fl ow of blood through the artery.Stroke An interruption of blood fl ow to part of the brain, causing brain cells to die or become damaged. This happens if an artery carrying blood to your brain becomes blocked, or if an artery bleeds into your brain. A stroke is a medical emergency.

V Ventricular fi brillation (VF) A life-threatening heart

rhythm that starts in the ventricles. This causes the heart to quiver or ‘fi brillate’ in a disordered way and the heart stops pumping blood around the body. This is a cardiac arrest.

DICTIONARYMedical words, identified by a small symbolD, are explained in plain English in our dictionary on page 49.

Dictionary

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Joseph Jennings is only six, but he’s already contributing to our life saving work.

After both of his grandfathers, Clive Brooks and Ralph Jennings, survived heart attacksD, Joseph realised the importance of funding research into new treatments.

He wanted to raise money for the BHF and, with the help of family members, set up an Easter shop. Joseph’s mum Helen Jennings,

aunt Charmaine Brooks and grandmother Sue Brooks made things to sell, such as cupcakes, Easter nests, bookmarks and knitted chicks with Easter eggs. They also organised a raffle, and raised £170 in total. Joseph, who lives in Chorley, Lancashire, was the shopkeeper and enjoyed manning the stall at Sue’s home in Huddersfield.

“I think Joseph is a real champion and someone who, despite his young age, can

already see the value of the work that the BHF does and how much his two granddads have benefited,” says Sue, 63. “Well done Joseph!”

Mark, 62, from Cheshire, took up hillwalking in his 50s, after discovering he had high blood

pressureD and high cholesterolD. “This was a wake-up call,” he says. “As a scientist, I know the importance of exercise for the heart and blood vessels, and for reducing the risk of many other conditions, such as dementia.”

Mark started walking regularly, as well as taking medication for blood pressure and cholesterol. Four years ago, he bought a bike via the national Cycle to Work scheme, and has been cycling regularly ever since.

Mark has been training for his Mont Blanc trek for the past three years, and says it’s helped him lose weight and increase his fitness. “As well as doing a lot of hillwalking, I have been going to the gym four times a week, and I try to leave the car at home,” he says. “I eat a healthier diet now too. I think looking after your fitness is particularly important at my age.”

Raising money for the BHF means a lot to Mark, who is Professor of Cardiac Electrophysiology at the University of Manchester. “Throughout my long career, my research on the heart has been generously supported by the BHF – I have received 53 research grants from the BHF,

JOIN THE FIGHT

totalling nearly £13m,” he says. “I thought it would be fun, but also important, to use this opportunity to give something back.”

Mark, who is married with two adult children, will soon head to the French Alps for a week, to train and acclimatise to the high altitude. At the end of the week, he will set off for the summit of Mont Blanc.

“I am a bit nervous, because I am not young, but then, I am not the oldest person to have done it by any means,” says Mark.

“We’ll set off at midnight, as that’s when the glaciers are frozen solid, using crampons and ice axes and using head torches for light. We have to pass through a valley of falling rocks and boulders and, roped together, we will be traversing steep snow-covered slopes with 2km drops on either side.

“Although I am a bit frightened, I am really looking forward to it.”

≠ You can sponsor Mark online at justgiving.com/mark-boyett

Blanc cheque

● Set yourself a fundraising challenge● Get friends and family involved● Raise funds for our life saving work

Climbing the highest mountain in Western Europe will be the culmination of a 10-year dream for Mark Boyett

Starting young

To help us fund more crucial research, call 0300 330 3322 or go online at bhf.org.uk/fundraise

Inspired to raise funds?

Mark will trekacross gorges and

frozen glaciers

If you’re thinking about taking a supplement that hasn’t been prescribed, talk to your doctor before spending your money and make sure that you do not exceed your daily requirement. In most cases, sticking to a healthy, varied and balanced diet will provide your body with all of the energy, vitamins and minerals you need.

0300 330 3300

Talk to us

Heart Matters Helpline

Antibiotics treat a range of bacterial infections. They work in one of two ways: killing bacteria by disrupting functions they need to survive, or preventing bacteria from multiplying by disrupting processes they use to make cells. It’s vital you only take antibiotics when you need them.

Q Why have I been given an antibiotic?

A Your doctor has prescribed antibiotics because they suspect or have confirmed you have a bacterial infection. GPs are most likely to prescribe them for respiratory infections (such as pneumonia), a urine infection or a skin or soft tissue infection (such as a cut or other wound). Most bacterial infections clear up quickly. Severe infections are more likely in hospital, where existing illness makes people more vulnerable. There is also a higher risk of infection

following surgery or if you have a device such as a drip, catheter or drain inserted. Sometimes, antibiotics are given through an injection or drip, rather than in tablet form.

Q What type of antibiotic will I be given?

A This depends on the infection location and type of bacteria involved. You need a high concentration of antibiotic at the infection site. So, for a urine infection, you’ll be given an antibiotic that passes through the kidneys and gets to the urine. The most common tablet antibiotics are the penicillin family of drugs (such as amoxicillin and flucloxacillin). Antibiotics may also be given as cream, ointment or drops.

Q My GP won’t give me an antibiotic even though I am unwell. Why?

A Antibiotics are only active against bacteria; viral illnesses

Heart Matters bhf.org.uk 3534

AntibioticsDRUG CABINET

MEDICAL

Antibiotics save lives, but resistance to them is increasing. Dr Nicholas Brown, Consultant Medical Microbiologist at Addenbrooke’s Hospital, Cambridge, tells Christopher Allen when you need them and when you don’t

49

bhf.org.uk

A Ablation Procedure to correct or control certain types of

arrhythmias. Involves using radiofrequency waves to destroy abnormal electrical pathways. Angina An uncomfortable feeling, tightness or pain in your chest that may also be felt in your arms, neck, jaw, back or stomach. The symptoms of angina are usually caused by coronary heart disease.Angiogram X-ray pictures that show whether the arteries are narrowed and, if so, how narrow they have become. A coronary angiogram examines the coronary arteries.Angioplasty Procedure to widen a narrowed artery. It involves temporarily inserting a catheter and infl ating a tiny balloon at the narrowing to widen it and improve blood fl ow.Arrhythmia An abnormal heart rhythm. Atrial fi brillation (AF) An abnormal heart rhythm in which the atria (the upper chambers of the heart) beat in an irregular pattern. People with AF have an irregular, sometimes fast, pulse.




recover from a cardiac event and get back to as full a life as possible.Cardiopulmonary resuscitation (CPR) Actions performed to keep blood circulating around a person’s body when they are in cardiac arrest. CPR consists of chest compressions (pumping the heart) and rescue breaths (infl ating the lungs). Cardiovascular disease (CVD) Includes all diseases of the heart and circulation, such as coronary heart disease and stroke.

Carotid arteries Blood vessels positioned in the neck that carry blood to the brain.Coronary artery bypass surgery An operation to treat coronary heart disease. Arteries from your chest wall and arm, or veins from your leg, are used to bypass the blocked or narrowed coronary arteries, improving blood fl ow to the heart muscle.Coronary heart disease (CHD) When the walls of the coronary arteries (the arteries that supply blood to the heart muscle) become narrowed due to a gradual build-up of atheroma.


levels in the blood are too high. There are two main types of diabetes; type 1, where your body stops producing insulin, and type 2, where your body can’t use the insulin it produces, usually because excess fat in organs prevents the insulin from working eff ectively. Diabetes increases your risk of developing cardiovascular disease.





H Heart attack Known medically as a ‘myocardial infarction’, or ‘MI’. This describes a sudden loss of blood fl ow to part of the heart muscle. Most heart attacks are caused by

atherosclerosis, the gradual build-up of atheroma within artery walls. If the atheroma becomes unstable, a piece may break off and lead to a blood clot forming. This can block a coronary artery, causing a heart attack and irreversible heart muscle damage. It is a medical emergency and can lead to a cardiac arrest.Heart failure Condition where the heart is less effi cient at pumping blood around the body.

High blood pressure Also called ‘hypertension’. High blood pressure is when the pressure required to pump blood is consistently higher than the recommended level. This puts extra strain on your heart and blood vessels, and over time can increase your risk of having









mesh that is inserted into an artery to hold it open after an angioplasty, improving the fl ow of blood through the artery. Stroke An interruption of blood fl ow to part of the brain, causing brain cells to die or become damaged. This happens if an artery carrying blood to your brain becomes blocked, or if an artery bleeds into your brain. A stroke is a medical emergency.

DICTIONARYMedical words, identified by a small symbolD, are explained in plain English in our dictionary on page 49.

Dictionary

such as colds, flu and most coughs won’t respond to them. Many infections go away without antibiotics if you look after yourself with rest and paracetamol, or with help from your pharmacist. Taking antibiotics when you don’t need them can mean they lose their ability to kill bacteria.

There are times when you should seek medical help. These include: if you have a fever plus a rash that doesn’t fade when a glass is pressed against it; a hoarse voice or cough lasting more than three weeks; coughing up blood; and, if you have a wound, increased redness around it, or pus, blood or a smell coming from it.

Q I’ve had a lot of antibiotics before. Does this mean they won’t work?

A Bacteria can evolve in ways that allow them to resist the effects of antibiotics. If so, the cause of the infection Ill

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common in hospitals but is now being recommended in GP surgeries too, especially when an initial course of antibiotics isn’t effective.

Q What are the possible side effects?

A The most common side effects are stomach upset, feeling nauseous or diarrhoea. This is usually mild and doesn’t mean you should stop taking antibiotics. However, if your symptoms are severe or persistent, seek advice from your GP. Some people develop a rash, which should always be checked by your GP and

may mean that you will need a different antibiotic.

Q Can I take antibiotics with my heart medication?

A Yes you can. Some antibiotics can affect how warfarin and statins work but that can be monitored. Before your GP prescribes antibiotics, and before your pharmacist dispenses them, your other medications will be checked to make sure there aren’t any serious interactions.

Q Is there any food or drink I should avoid?

A For most antibiotics, this isn’t a problem, but your GP or pharmacist can give specific advice. Check the label of your medications to see if you should take them before, with or after food.

Q What about allergies?A Around one person in

15 has an allergic reaction to antibiotics, especially the

becomes more difficult to treat. To avoid this, it’s important that antibiotics are only prescribed when absolutely necessary.

Q How does my doctor know what type of bacteria is causing the infection?

A They might be able to tell from your symptoms, or they might prescribe a ‘broad-spectrum’ antibiotic. Sometimes a culture is taken to find which bacteria are causing your infection. The culture may be a sample of mucus, blood or urine, or a swab of a wound. This is more

penicillin family. In most cases, the allergic reaction is mild, causing an itchy rash, but you should see a doctor. A severe allergic reaction is very rare. If facial swelling and breathing difficulties occur, call 999.

Q How long should I take them for?

A It’s vital that you complete the full course prescribed by your GP, even if you begin to feel better. If you stop early, it’s more likely the infection will return and you’ll need a further course of antibiotics. This will increase your chances of developing antibiotic resistance.


FREE

July/August 2015


Shifting gear

HOLIDAY TREATS

PULL OUTAND KEEP

RECIPECARDS

7MYTHS ABOUT

CHEESE



Enjoyed this article?Read more:≠ Science fiction page 14≠ Focus on: cardiac treatments page 18≠ Explaining rotablation page 22

Visit bhf.org.uk/drugcabinet:≠ ACE inhibitors ≠ Angina medication explained≠ Calcium channel blockers

CV Dr Nicholas Brown Consultant Medical Microbiologist, Addenbrooke’s Hospital, Cambridge ≠ Associate Lecturer, University of Cambridge ≠ Former President of the British Society for

Antimicrobial Chemotherapy (BSAC) and is involved with its initiative to improve awareness about antibiotic resistance

≠ Member of groups overseeing implementation of the Department of Health strategy to combat antibiotic resistance

37Heart Matters bhf.org.uk

Dr Maureen Baker is Chair of the Royal College of GPs. She talks to Sarah

Kidner about the role of GPs in the community, and why we desperately need more of them

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THE BIG INTERVIEW

Q Why is it so hard for people to get an appointment with a GP?

A On a working day in England, over one million patients see their GP, but people are concerned about the difficulty of getting appointments, and rightly so. It’s really a question of supply and demand.

In 2008 in England, GPs conducted 300 million patient consultations. That’s already a lot. By 2012 that had increased to 340 million; in 2015, we estimate that number will have gone up to 370 million, but the overall headcount of GPs has stayed pretty much the same.

Q So, we need more doctors?A Yes. We haven’t grown the general

practice workforce for the past 10 years, and yet the number of consultations and what GPs are expected and required to do for patients has increased. There are fewer GPs per head of population, and we have a growing population with a significantly increased number of people in the old, and very old, category who have multiple complex problems that need the skills GPs, as expert medical generalists, can provide.

Q Is it possible to manage complex needs within a 10-minute appointment?

A There are different ways of doing it. Some surgeries are introducing care planning sessions involving different members of the practice team. Patients have an initial appointment that sets out how to support them with their long-term – and often complex – needs. They might also meet with a practice nurse who will take a detailed medical history. From there, multiple future appointments can be scheduled with their GP, who won’t need to start from scratch every time the patient visits and can really make the most of their 10-minute consultation. This is one way, but different practices deal with the constraints in different ways.

Q How can GPs help with the management of long-term conditions such as cardiovascular diseaseD?

A GPs treat the whole person, so we take an overview of what is going on for an individual. Often, we are the first port of call if a patient is having problems, or an appointment hasn’t come through, or they want to find the result of their test, or they need a form signing. We are naturally placed at the crossroads of care. Our first concern is to deal with the person in front of us as an individual who might be suffering with multiple issues.

Q Are we doing enough to support people with the emotional impact of long-term conditions?

A GPs are aware of the correlation

36

between acute episodes of physical illness or ongoing physical illness and depression and anxiety. Does it sometimes go undiagnosed? Yes – there are multiple reasons why that might be the case. Patients might think they will just not bother the doctor with it, or they might not really recognise themselves that something has gone wrong. I think for every person who is missed, we pick up a lot of others and work with them to resolve these issues.

Q Carers are another vulnerable group. How can GPs help them?

A The Royal College of GPs has been taking the lead on identifying and supporting carers. There are a number of resources that people can access through our website to help carers (rcgp.org.uk). We are working on a document at the moment about the need to invest in carers. It is not necessarily about the NHS and it’s not just about general practice – it’s a wider societal issue. Most of us through our lives will be carers at some point and we have a responsibility to each other to make it work.

Q How do you see the role of charities in terms of supporting people?

A Charities do a huge amount of work. They identify issues and support patients and carers. One of the things that I and lots of my colleagues in general practice do is flag up relevant charities and tell patients that they might, for example, find more information on the BHF website.

Q What made you want to become a GP?A For all the problems and pressures, I still

believe being a GP is the best job in the world. I went into general practice because I like people. I’m the eldest of a large family so I have always looked after people. That was, I suppose, one of the reasons why I went into medicine. I also love the variety. People who become GPs are almost by definition generalists and like lots of different things to do.

DOCTORin the house

Dr Baker believes ourageing populationrequires more GPs

We are the first port of call if a patient is having problems”

CV Dr Maureen Baker2013–2016: RCGP Chair

1999–2009: Honorary Secretary RCGP

2007: Joined NHS Connecting for Health

She has also previously held appointments with the National Patient Safety Agency, NHS Direct and the University of Nottingham.

38 Heart Matters

WELLBEING

39

Breaking with convention can lead to better patient care. Sarah Brealey reports on three projects that are daring to be different

CARING for

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Imagine a hospital where loved ones can visit at any time of day or even spend

the night, and where relatives are actively encouraged to get involved with care. Is this a fictional utopia or just common sense? Either way, at Liverpool Heart and Chest Hospital, they’re making it a reality.

“Families are vital,” says Director of Nursing Sue Pemberton. “Patients feel more relaxed and have less anxiety when they have relatives with them.

“On the wards, we ask the main family member or carer if they would like to be involved in the care of their relative or friend and, if so, what elements of care. For example, it might be helping with meals or helping them to walk. It is about empowering families to be partners in care.”

The traditional practice of set visiting hours and having to ask or ring a bell to get families to leave was rejected because it “didn’t feel very welcoming”. The only restriction is in the critical care unit during the morning, so that doctors can spend time with seriously ill patients.

The hospital also takes a broader view of patient welfare. When one man expressed concerns about leaving his wife, who has dementia, while he had surgery, it was

arranged for her to spend each day in the hospital and meals were provided.

Relative comfortOffering accommodation for loved ones may sound expensive, but Sue says it helps patients recover faster. It can even improve safety: “We say to families, if you see anything you are not happy with, please tell us,” explains Sue.

Feedback from patients is positive. In the Care Quality Commission’s annual inpatient survey, the hospital was rated top in the country for quality of patient care for seven of the last eight years.

For people living with heart failureD, timely treatment can be the difference between a well-managed

condition and a hospital admission. That’s why a BHF-funded service is working to keep patients at home.

The BHF gave Betsi Cadwaladr University Health Board £90,000 over two years, to set up a community heart failure service in Conwy and Denbighshire. It assembled a team – a GP with a special interest in community cardiology, a heart failure specialist nurse, a clinical cardiac physiologist and a pharmacist – while rapid-access echocardiogram clinics helped increase diagnoses. Results are still being analysed but suggest a drop in hospital readmittance. Patient surveys have also reported an improvement in quality of life.

“This innovative service is all about identifying and managing heart failure patients in the community to prevent them going into hospital or becoming so sick that they end up in A&E,” says Catrin Hanks, North Wales Cardiac Network Manager. “It is certainly cost-effective; it helps take the pressure off unscheduled care. As a patient, it is better not to go into hospital if you don’t have to, and to have a small team of specialists caring for you. It is a win-win situation.”

Gordon Richardson, 77, from Rhos-on-Sea, was diagnosed with heart failure four years ago, after he started to feel ill on a flight home. When his condition

deteriorated, he had to spend a week in hospital. But since the integrated care service was set up in Llandudno, when his condition worsened again, the specialist team was able to see him. “I was starting to get breathless,” he says. “I actually thought it might be asthma, as I’ve had that in the past, but it turned out to be my heart. They gave me an echocardiogram and adjusted my medication and I have been fine ever since. It was a very pleasant experience. They were concerned to make sure I got the right treatment. I felt very lucky.”

Gordon, who also has a pacemakerD, is currently recovering from a broken leg, but has otherwise kept active and is able to enjoy trips abroad with his partner.

“The BHF funding has played a massive part in moving things forward,” explains Catrin. “The BHF gave us the opportunity to trial the service and to gather evidence and evaluate it.”

The service has now been fully funded by the local NHS Health Board, ensuring its long-term presence. It’s being rolled out across North Wales and is fully joined up with the hospital heart failure teams.

The project is one of nine we’re funding across Britain to improve quality of life through joined-up healthcare. The aims are to improve prevention, increase the skills of health professionals and help different services in the ways they work together.

Joined-up heart failure care

A family-centred hospital

A recent patient said: “During my admission, I found all the staff really listened to me and were responsive to my needs. I felt I was involved in the decision-making.”

A new initiative involves bedside signs encouraging people to tell nurses if they’re unhappy with something. In the critical care unit, the relatives’ area has been redesigned with their help. It’s now more comfortable and has somewhere to get food and drink.

“It is a long journey to truly embed patient- and family-centred care across the hospital,” says Sue. “We are changing the culture of how families are viewed. We want to empower people.”

Liverpool Heart andChest Hospital offers

beds for relatives

Llandudno’s integratedcare service saved Gordon a hospital stay

They were concerned to make sure I got the right treatment”

the FUTURE

40

E urope’s largest cardiovascular centre has set up a patient forum to monitor

performance. The forum was established when the former London Chest Hospital and the Heart Hospital were combined. To date, forum members have done everything from taste testing hospital food to visiting departments.

An average of 15 to 20 people, including members of staff, meet as the forum every six weeks. “The idea of the forum is to focus

on patient experience,” says Director of Nursing Louise Crosby. “For example, we were told that communication isn’t always as good as it could be. Some patients would have liked to know more about what was going to happen to them, so we’re reviewing information leaflets and encouraging nurses and doctors to explain in greater detail what to expect during a procedure.”

A good investmentLouise acknowledges that getting significant numbers of patients to attend and managing the impact on staff time can be difficult. “It has taken more time than I expected, but it is an exciting opportunity to have patients help us take our service forward,” she says.

Like Sue in Liverpool, Louise describes the new scheme as a “work in progress – this is the first step”.

The Deputy Chairman of the patient forum at Barts is Malcolm Billings, 79, a writer and broadcaster from north London. He had a pacemaker fitted last year. “I was grateful to them for sorting me out,” he says, “so when they asked me to get involved, I was happy to say yes. Food is a big issue in hospitals, so I was pleased that we got the opportunity to taste some and was surprised at how good it was.”

He says the patient forum is playing an important role in putting hospital communications in plain English rather than “gobbledygook”. Other small changes include putting books in waiting areas and the forum is setting up a scheme to offer support to new patients.

“I think it is a good idea for patients to be involved, especially as the nature of most heart conditions means you have it for the long term,” says Malcolm. “If we can make suggestions that make things better for others, then it is well worth it.”

1 Family members can help with your care, as Liverpool Heart and Chest Hospital shows.

2 Get health niggles checked out early; don’t wait until you’re really ill. This applies even if, like Gordon Richardson in Wales, you think it may be nothing to do with your heart.

3 If you’re not happy about something, speak up. Even the best health services can improve by listening to patients and carers, as both Barts and Liverpool hospitals have shown.

4 Take an active role in your own care to help you feel in control and lead to better care. You can ask questions to improve your understanding of your condition. Call the Heart Matters Helpline with your questions on 0300 330 3300, or email [email protected].

5 Your experiences can help improve care for others. The BHF’s Heart Voices is a network of people affected by heart disease who want to influence heart health services. Find out more at bhf.org.uk/heartvoices or call 020 7554 0194.

≠ Got a hospital stay soon? Find out how to prepare (from May/Jun 2015) at bhf.org.uk/packing and discover what standards you should expect (from Sep/Oct 2014) at bhf.org.uk/expect.≠ Order our free booklet Having heart surgery on 0870 600 6566 or from bhf.org.uk/HMpublications.

Free help from the BHF

ways to better patient care5

Patient involvement

Barts Heart Centre isusing patient feedbackto make improvements

I was pleased we got the opportunity to taste the hospital food”

Heart Matters

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Long-distance walking sounds intimidating, but John Roberts proves even a heart attack shouldn’t stop you trying. He tells Rachael Healy how he fulfilled a lifelong dream and conquered Offa’s Dyke

John stays active withwalks along local locks and canals

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John Roberts lives in the village of Pant, surrounded by the idyllic countryside of the Welsh Marches, where England meets Wales. He’s always explored his surroundings on foot, but it was

only after a heart attackD seven years ago that he decided to tackle Offa’s Dyke trail.

“It was something I’d been talking about for years, since I was much younger, but with work and everything else, you never seem to find the time,” says John. “And you need to find someone to walk with, don’t you? My son, Huw, said: ‘When I’ve got some time off, I’ll walk with you.’ We had the best part of a week, so we decided we’d walk as far as we could.”

John, 75, had long enjoyed walking in his spare time. He spent his career in the building trade, so he’d led an active life and

tried to follow a healthy diet. He certainly wasn’t expecting a heart attack. “We would always have at least two veg in the evening and a lot of fruit, I wasn’t really overweight and I’ve never smoked, so it was out of the blue,” he says. “You think you’re fit and healthy, but we just don’t know, do we?”

On the night of his heart attack in August 2008, John hadn’t been sleeping well. “I thought I’d get up. I only walked part way round the bed and I must’ve gone down, then I was on my knees trying to get back up. It happened so quickly.”

Thinking he’d simply stood up too suddenly, John went back to bed. “I had no pain,” he says. In the morning, his wife, Eiry, insisted he visit his GP. After an ECGD test, John was sent straight to hospital. “I went to the surgery and then my feet never touched the ground,” he says. “I was in Shrewsbury

It was something I’d been talking about for years”

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A worthy challengeIn the end, the adventurous father and son trekked 90 miles, from Chepstow at the southern end of Offa’s Dyke, to Knighton in Mid Wales. They decided to turn their hike into a fundraising challenge, collecting money for Wales Air Ambulance, the same organisation that had rushed John to hospital back in 2008. They succeeded in raising over £1,000.

Huw’s wife booked a series of bed and breakfasts in advance so the pair could recuperate after each day’s hike. “They were all very good,” says John. “On the first day, from Chepstow, it never stopped raining from the time we started until we went to bed that night. I was soaked by the time we got to the B&B, but the owner was wonderful. She dried out our clothes and told us it was just part of the job.”

John found this first, damp day the most challenging of the trip. “There wasn’t a shop or a pub or anything along the way – we couldn’t believe it. We saw a sign for a pub, but when we got there, it looked like it had been shut for a few years.”

The route itself had some tricky points too. “There were some quite steep bits, but I coped with them alright,” says John. “There are a lot of stiles and some parts are a bit muddy – there were a couple of ploughed fields we had to cross – but it was just really enjoyable.

“I think my favourite part was in the Black Mountains. It was a good climb to the top and honestly, the view… you could see the countryside for miles around you.”

This substantial walk through the Welsh Marches roughly follows the English/Welsh border, crossing it 20 times and taking you through eight counties. You’ll also walk across the Black Mountains and the Brecon Beacons National Park.Length 177 milesAverage time 12–16 days Difficulty Despite some flat sections, the ups and downs and number of stiles add difficulty. Walking south to north clocks up an ascent of 8,500m – the height of Mount Everest.Start Sedbury, EnglandEnd Prestatyn, WalesLandmarks Look out for Offa’s Dyke itself, which is a bank and ditch, hand-dug in the eighth century

at the command of King Offa. It probably acted as a barrier between his kingdom of Mercia and territories of rival leaders in what is now Wales.

≠ Further information:nationaltrail.co.uk/offas-dyke-path

1 John’s route: Offa’s Dyke path

Turn over for long-distance walks in every corner of the UK Read about five more routes in all four nations, taking you from forest to beach, via lochs, canals and a mountain range or two.

The British Isles is blessed with stunning terrain, much of it accessible on foot. There are 15 National Trails in England and Wales, 26 Great Trails in Scotland and many paths recommended by Walk Northern Ireland. You’ll need sturdy shoes, comfortable clothes, water and snacks and, for some routes, map-reading skills. Go at your own pace: a very fit walker might average 20–22 miles a day, whereas some people will be more comfortable doing 10–12 miles a day. And remember, these routes can all be broken down into smaller sections for a manageable day of hiking.

If you need an operation, our free booklet Having heart surgery may help. Find out what to expect afterwards in Cardiac rehabilitation – your quick guide. Order or download them at bhf.org.uk/HMpublications or call 0870 600 6566. For more information and support call our Heart Matters Helpline on 0300 330 3300 or visit bhf.org.uk/heartsupport.

Need more information?

exercises in the gym, then we did cooling-off exercises afterwards. I really enjoyed it.”

Having learnt a lot from cardiac rehab, and with Eiry looking out for him, John made a great recovery. “I keep busy, I do a few jobs,” he says. “I can’t sit still.” John started playing bowls, both indoors and outdoors, and returned to his favourite Oswestry walks. He loves to take his nine grandchildren out for hikes in the school holidays too.

When he and Huw decided to tackle Offa’s Dyke, John stepped up his activity levels in preparation (check with your GP before embarking on a long-distance walk of your own). “We walked along the local canal a lot and Llanymynech rocks – there’s a golf course up there too. I did a lot of nice walks; we’re not short of walks around here.”

We’re not short of walks around here”

John with four of his nine grandchildren on Offa’s Dyke

Hospital within 20 minutes of the doctor seeing me. The air ambulance took me.”

Steady recoveryJohn needed a triple bypass. After 17 days at Shrewsbury Hospital, he was transferred to Stoke Hospital for the surgery. He stayed there for a week to recover before returning home, where Eiry helped make him comfortable. “My wife’s been nursing all her life, so I had to do as I was told,” says John. “She’s still watching me now!”

His recovery continued with cardiac rehabilitationD classes at his local hospital. “It was really good,” he says. “We were in the gym for the most part and they just built us up quietly. It was hard, because you didn’t know how far you could push yourself to get back to doing things. We did a lot of

Whether you’re a seasoned long-distance walker or an enthusiastic first-timer, there’s a BHF walk to suit you. Here are a few of our upcoming hikes. To see the full list or register for an event, visit bhf.org.uk/walks or call 0845 130 8663.≠ 11–13 September, 24 Peaks Challenge – Snowdonia, Highlands or Lake District, 20 miles or 30 miles≠ 23–27 September, Trek Morocco – Mount Toubkal, 4,167m ascent≠ 17–25 October, Great Wall of China Trek, 28 miles≠ 15 November, High Peak Winter Hike, Derbyshire, 17 miles

Walking with the BHF

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The Ulster–Ireland section of the International Appalachian Trail was developed in 2014. It starts in the province of Ulster, crosses Donegal’s Blue Stack Mountains and then enters Northern Ireland, where the path takes you along the Giant’s Causeway, the north coast and the Glens of Antrim. The route is divided into 10 segments; doing one or a combination of two or three could be a good option if a 12-day trek is a bit intimidating.Length 280 milesAverage time 11–18 daysDifficulty Challenging: expect obstacles and there is not always a formal path, so map-reading skills are essential. There are also a number of steep slopes, some without steps, and peaty ground in places.Start Bunglas, Donegal, ROIEnd Glenarm, Antrim, NILandmarks There are amazing views from

Tim Kington and Jacob Thrall, experts at Cotswold Outdoor, advise us: “When choosing a pair of walking boots, the first thing to bear in mind is the terrain you expect to go into, as boots are made with a specific environment in mind. Everything from the stiffness of the sole or height of the ankle is designed for the demands you will face. Next, make sure they fit. Here, shape matters as much as size. While you’re getting fitted, check out socks, too. The right socks – with perfect padding, insulation, wicking and elasticity – make a big difference to the feel of your boots.”

Best boots

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bhf.org.uk

…and more of our favourite long walks

2 Ireland section of International Appalachian Trail

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Go online Get inspired by videos, photos and maps of the UK’s best long-distance paths at bhf.org.uk/walkingguide.

A variety of pace and views make this a real adventure. Starting by Ben Nevis, the highest peak in the British Isles, you’ll end up at Inverness Castle, where you can explore the manicured grounds. Spot illicit wooden whisky stills, manmade caves, waterfalls and the sole island of Loch Ness along the way.Length 79 milesAverage time 5–6 daysDifficulty Moderate: mostly low-level towpaths and woodland trails, but there are some challenging sections. If you’re feeling adventurous, you can choose to climb the Munros or Corbetts too.Start Fort WilliamEnd Inverness CastleLandmarks Inverlochy Castle, built in 1280, is one of Scotland’s first stone castles. During renovations, a walled-up human skeleton was uncovered here.Wildlife You may encounter red deer, wild boar and Scottish wildcats, as well as countless species of bird, including black grouse, buzzards, merlins, kestrels, woodpeckers and osprey.

≠ Further information:outdoorhighlands.co.uk/long-distance-trails/great-glen-way-2

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the Antrim Glens; on a clear day, you can see across the sea to Scotland.Wildlife Look out for brown trout, salmon, eels and lamprey in the streams of the Sperrin Mountains. Glenarm Nature Reserve is home to many birds, including the kingfisher, grasshopper warbler and spotted flycatcher.

≠ Further information:walkni.com/iat/

Spanning the far north of England with stunning views of Northumberland and Cumbria, Hadrian’s Wall is a historically interesting hike. The wall itself is a UNESCO World Heritage Site and there are chances to stop and examine Roman archaeology. Length 84 milesAverage time 5–8 daysDifficulty Moderate: there are many short climbs and descents on grassy paths, but the route is clearly marked and the first few miles are on tarmac.Start Wallsend, Newcastle-upon-TyneEnd Bowness-on-Solway, CumbriaLandmarks Roman forts, including Segedunum, Chesters, Housesteads and

Birdoswald. Look out for Sycamore Gap (made famous by Robin Hood: Prince of Thieves), where a large tree sits in a dip forged by the flow of ancient meltwater.Wildlife Deer, red squirrels and sparrowhawks. The route ends by the wildfowl-rich Solway salt marshes. Seals and dolphins frolic offshore here too.

≠ Further information:nationaltrail.co.uk/hadrians-wall-path

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You’ll pass an ancient submerged forest, Aberystwyth and, near New Quay, a former home of Dylan Thomas. This is actually a manageable segment of the much longer Wales Coast Path. If you want a bigger challenge, try the full 870-mile route (not necessarily all at once).Length 62 milesAverage time 3–5 daysDifficulty Easy: the route is mostly flat and not too challenging, but make sure you wear waterproof footwear, as part of the trail covers wetland.Start CardiganEnd YnyslasLandmarks Cardigan Castle has just reopened to the public following extensive renovations. Aberystwyth Cliff Railway, on top of Constitution Hill, is one of the longest funicular railways in Britain.Wildlife Dolphins and porpoises can

be spotted swimming in Cardigan Bay, which is also a breeding spot for Atlantic grey seals. Birds Rock in New Quay is a great place to spot birds and is home to oystercatchers, cormorants, guillemots and razorbills.

≠ Further information:ceredigioncoastpath.org.uk

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Created between 1894 and 1929 when existing canals were merged, the Grand Union passes west London, rural Slough and Warwickshire, ending in Birmingham’s suburbs. Stop at the Canal Museum in Stoke Bruerne to find out more.Length 147 milesAverage time 6–7 daysDifficulty Easy: the route is flat and mostly paved. It passes through many towns, providing refreshment options.Start Paddington, LondonEnd Gas Street Basin, BirminghamLandmarks Blisworth Tunnel, at 2.8km, is Britain’s third-longest canal tunnel. Wildlife Birds galore at Tring Reservoirs.

≠ Further information:canalrivertrust.org.uk/canals-and-rivers/grand-union-canal

5 Grand Union Canal


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Some sports are best played outdoors, preferably on a springy

lawn beneath a clear blue sky. Summer months provide the best conditions to go outside, enjoy some fresh air and get heart healthy. This applies even if you don’t have a regular sporting hobby, as many national governing bodies of sport work with local clubs to hold starter sessions that enable you to try something new. You don’t need previous experience and you won’t have to pay for any specialist kit – simply turn up and have a go.

There are lots of events, often free, throughout the year. The Lawn Tennis Association’s (LTA) mission is to get more people playing tennis more often. You can try tennis for free at its Great British Tennis Weekend Ph

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You don’t have to be an expert to enjoy a sport. With plenty of free taster sessions during the summer months, now’s the time to get involved

SUMMERACTIVITIES

on 1 and 2 August. There will be thousands of events across the country for the whole family, and rackets and balls are provided.

Active beginningsSome sports schemes have a particular focus, such as encouraging women to get involved. The This Girl Can campaign, developed by Sport England, aims to get women and girls moving regardless of shape, size or ability. Similarly, British Cycling launched its Breeze network in 2013, aiming to get one million more women riding bikes by 2020. Currently,

four times more men cycle than women. Breeze hopes to close the gap by providing a relaxed, supportive atmosphere in which women can ride together. Breeze organises fun, local rides for women, often starting and finishing at a café.

Other initiatives target beginners of any gender. Run England has over 2,500 beginners running groups across the country. These are

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The sun is shining, your plants are flowering and Paul Peacock has a few ideas to keep you and your garden in great summer shape

For a short stretch, the summer garden is more wistful than wearing, more tranquil than toilsome. But it’s not

all deckchair sleeping, wafting away the hoverflies and bees. There is some work to be done.

Many of you will already know that I like to pack my patio with pot plants that release wonderful fragrances. This forces me into two jobs straight away: deadheading and watering.

Recently, my son-in-law made me a table that means I can stand, or sit, and pot until my heart’s content. I’ll be starting off with posh little hyacinths, which will eventually make excellent Christmas presents. By the end of the summer, I will have moved on to dividing up the lilies that have finished flowering.

Paul’s tips for summer1 Water, water, everywhere

Pot plants lose a lot of water and it needs to be replaced. Carrying a watering can in the heat is out of the question for me, as

Give it a go

Paul Peacock’sUNDERTHE SUN

is standing with a hose, so I use ice cubes. I have found three ice cubes per pot in the late morning to be optimum for the health of the plant, four for a larger plant and five for a particularly big one.

As soon as the tomatoes have four flowering trusses (clusters of small stems that eventually yield fruit), snip off the tops of the plants to prevent any more. By the end of July, start to remove leaves, especially those emerging from between the vertical stem and the main branches of the plant, leaving tomatoes and nothing else. All of this pruning will reduce the amount of water your plants need and help them remain free of fungal infections too.

2 Off with its headDeadheading encourages new flowers to grow and will ensure your garden looks its best. This can be a really lovely task, just pottering about, snipping off spent flowers here and there. Tie a plastic bag to your secateurs to collect the dead flowers.

Wellies or boots?If you’d asked me this question a few years ago, I would have said boots every time, because they are warmer, they do not pick up as much mud as wellies and they are usually better-fitting. However, I’ve been experiencing water retention as a result of my heart failureD. I cannot get my boots on without pain now, so I am hanging them up and buying a pair of wellies that open out, making them easy to pull on. I will be wearing these with a couple of pairs of long socks that I still have from my rugby days.

You don’t need experience and you won’t have to pay for specialist kit”

All of the activities offer ways for beginners to get involved. Which one will you try this summer?

≠ Canoeing – Starter sessions, run by Canoe England, cater for absolute beginners and many of them are free (gocanoeing.org.uk/go).≠ Cycling – Get in touch with cyclists in your area via goskyride.com and goskyride.com/Breeze. ≠ Tennis – Find further details about the LTA’s free summer events at greatbritishtennis weekend.com. ≠ Rugby – Attend a rugby-related event (festivalofrugby2015.com) or have a go at the non-contact version of the sport (in2touch.com/uk or playtouchrugby league.co.uk).≠ Golf – Find free or low-cost taster sessions around England (getintogolf.org). ≠ Table tennis – Discover your nearest outdoor

table and play for free (tabletennisengland.co.uk). ≠ Cricket – Register a team or sign up solo at lastmanstands.com.≠ Football – Just Play provides regular kickabouts without the commitment of a league (thefa.com/my-football/justplay).≠ Rounders – Discover your nearest league, many of which are free, at roundersengland.co.uk.≠ Running – There are plenty of tips and ways to get involved in sociable running events at runengland.org or parkrun.org.uk.≠ Baseball and softball – Learn all about baseball, slowpitch softball and fastpitch softball at baseballsoftballuk.com.≠ Volleyball – 29–31 August is the Go Spike Big Weekend, when anyone can turn up and give it a go (gospike.net).Before taking up any new activity, check with your consultant or GP.

Pruning will reduce the amount of water your plants need”

3 Sowing saladsA refreshing salad makes a great accompaniment to a meal or can be a light lunch on its own. You can sow salads up until August, at waist height in containers and hanging baskets. I’ll also be ordering Japanese onion sets and ‘all-year-round’ cabbage, as well as a tub of carrots.

Ice cubes are the perfect alternative to a heavy watering can

ideal if you’re looking to add a social element to your running, and they offer advice and support from a group leader. You can walk, jog or run and benefit from the motivation and safety of a group of like-minded people.

Activities such as walking, running and cycling help lower

your risk of coronary heart diseaseD. Regular physical activity can also help you feel more relaxed, as well as giving you more energy and a sense of achievement. Before you know it, you’ll be building up to your minimum recommended 150 minutes of physical activity a week.

The digital version of our magazine offers extra articles, interviews, photographs and exclusive videos, at bhf.org.uk/heartmattersmag

Go online for a peek behind the scenes at the LifeLab in Southampton or take a virtual walk on long-distance paths. Our website is the perfect partner to the print magazine, and a great read in its own right. If you want to save paper and switch your Heart Matters membership to online-only, log in to your account at bhf.org.uk/heartmatters or call 0300 330 3300.

10 MOST POPULAR PAGES

1 Shockingly fatty foods

2 Lisa’s 10-minute workout video

onlineFocus on…

Useful pages ≠ Read about reaching and maintaining a healthy weight, including portion sizes, eight tips to stay slim for life, and more: bhf.org.uk/weight.≠ Find out how to eat more fruit and veg, including information on what counts as your 5-a-day: bhf.org.uk/5aday.≠ Cooking for yourself is a great step towards eating more healthily. We’ve got tips and ideas for healthy baking, cooking on a budget, perfect poached eggs and more: bhf.org.uk/cookingskills.≠ Log in for meal ideas: bhf.org.uk/recipesearch.

3 Video: easy swaps to get your 5-a-day

5 12 things that don’t count towards your

5-a-day

4 Drug cabinet: beta- blockers

6 Video: what to pack for a hospital stay


AAblation Procedure to correct or control certain types of

arrhythmias. Involves using radiofrequency waves to destroy abnormal electrical pathways. Angina An uncomfortable feeling, tightness or pain in your chest that may also be felt in your arms, neck, jaw, back or stomach. The symptoms of angina are usually caused by coronary heart disease.Angiogram X-ray pictures that show whether the arteries are narrowed and, if so, how narrow they have become. A coronary angiogram examines the coronary arteries.Angioplasty Procedure to widen a narrowed artery. It involves temporarily inserting a catheter and inflating a tiny balloon at the narrowing to widen it and improve blood flow.Arrhythmia An abnormal heart rhythm. Atrial fibrillation (AF) An abnormal heart rhythm in which the atria (the upper chambers of the heart) beat in an irregular pattern. People with AF have an irregular, sometimes fast, pulse.




recover from a cardiac event and get back to as full a life as possible.Cardiopulmonary resuscitation (CPR) Actions performed to keep blood circulating around a person’s body when they are in cardiac arrest. CPR consists of chest compressions (pumping the heart) and rescue breaths (inflating the lungs). Cardiovascular disease (CVD) Includes all diseases of the heart and circulation, such as coronary heart disease and stroke.Carotid arteries Blood vessels positioned in the neck that carry blood to the brain.Coronary artery bypass surgery An operation to treat coronary heart disease. Arteries from your chest wall and arm, or veins from your leg, are used to bypass the blocked or narrowed coronary arteries, improving blood flow to the heart muscle.Coronary heart disease (CHD) When the walls of the coronary arteries (the arteries that supply blood to the heart muscle) become narrowed due to a gradual build-up of atheroma.


levels in the blood are too high. There are two main types of diabetes; type 1, where your body stops producing insulin, and type 2, where your body can’t use the insulin it produces, usually because excess fat in organs prevents the insulin from working effectively. Diabetes increases your risk of developing cardiovascular disease.





H Heart attack Known medically as a ‘myocardial

infarction’, or ‘MI’. This describes a sudden loss of blood flow to part of the heart muscle. Most heart attacks are caused by atherosclerosis, the gradual build-up of atheroma within artery walls. If the atheroma becomes unstable, a piece may break off and lead to a blood clot forming. This can block a coronary artery, causing a heart attack and irreversible heart muscle damage. It is a medical emergency and can lead to a cardiac arrest.Heart failure Condition where the heart is less efficient at pumping blood around the body. High blood pressure Also called ‘hypertension’. High blood pressure is when the pressure required to pump blood is consistently higher than the recommended level. This puts extra strain on your heart and blood vessels, and over time can increase your risk of having




I Implantable cardioverter defibrillator (ICD) A small





mesh that is inserted into an artery to hold it open after an angioplasty, improving the flow of blood through the artery. Stroke An interruption of blood flow to part of the brain, causing brain cells to die or become damaged. This happens if an artery carrying blood to your brain becomes blocked, or if an artery bleeds into your brain. A stroke is a medical emergency.

DICTIONARY

Food, glorious foodWe know you love our articles about healthy eating, cooking tips and recipes. If you enjoyed reading about cheese (page 30), go online for ‘Cheese – the good the bad and the ugly’ and ‘Six times to say no to cheese’.

There’s also a fun video showing easy swaps to help you get your 5-a-day, and many more 5-a-day articles, from strawberries to salads.

Heart Matters members can access our full archive of more than 250 recipes. There’s something for everyone. Our recipe search lets you select by ingredient, dietary requirements (gluten free, nut free, vegetarian or vegan), cooking time, nationality and type of meal. You can search for specific recipes suitable for people with diabetesD, high blood pressureD and high cholesterolD. Just click on the ‘Advanced search’ link on the right of the recipe search page.

7 10 scenic pictures from around the UK

8 Drug cabinet: warfarin

9 Focus on familial hypercholesterolaemia

10 Surprisingly sugary foods

Find them all at bhf.org.uk/heartmattersmag.

Order your free guides by calling 0870 600 6566 or visiting bhf.org.uk/HMpublications

Healthy eating and lifestyleBe active for life (physical activity information for over-65s) G364Coping with stress G187Cut down on salt G160Cut the saturated fat M4Eating well G186Everyday triumphs (for mental health service users) G972Facts not fads – your simple guide to healthy weight loss M2Get active, stay active G12Healthy living, healthy heart (information for African Caribbean communities) G532Keep your heart healthy HIS25Put your heart into walking G26Risking it – short films designed to help you tackle risk factors bhf.org.uk/riskingit or DVD21Stop smoking G118This label could change your life G54Taste of South Asia (South Asian recipes) G606Taste of the Caribbean (African Caribbean recipes) G503Women and heart disease M37Your heart, our help G598 Living with a heart conditionAn everyday guide to living with heart failure G275UAngina HIS6Atrial fibrillation – your quick guide G963Blood pressure HIS4Cardiac rehabilitation – your quick guide G964Caring for someone with a heart condition HIS20Coronary angioplasty HIS10Diabetes and your heart HIS22Electrocardiogram – your quick guide G965Having heart surgery HIS12Heart attack – your quick guide G966Heart rhythms HIS14Heart to heart: heart disease and your emotional wellbeing G954Heart transplantation HIS13Heart valve disease HIS11Implantable cardioverter defibrillators (ICDs) HIS19

Use our booklets, DVDs and information sheets to help you improve your heart health and get support on living with a heart condition. To see the whole range of guides, order the Take heart (G5) catalogue

50 Heart Matters

ORDER YOUR FREE GUIDES

Want to measure your blood pressure at home? Watch our short film on how to do it at bhf.org.uk/

pressure.

Lifelines: heart surgery and after (DVD) DVD10Living with heart failure HIS8Medicines for your heart HIS17My progress record (a manual to keep important information about your medication, test dates and results) M92MOne step at a time – living with heart failure (DVD) DVD5Pacemaker – your quick guide G968Peripheral arterial disease HIS16Physical activity and your heart HIS1Primary angioplasty for a heart attack HIS26Reducing your blood cholesterol HIS3Returning to work HIS21Stroke – your quick guide G969Tests helped me understand my heart HIS9The road ahead – your guide to heart tests and treatments DVD30

BHF SUPPORT

This beautifully illustrated book helps children and their families understand what a heart attack is and why someone has had one. It tells the story of Megan and her brother Alfie, who are worried when their dad goes into hospital. It shows his steady recovery and the healthy changes the family make to ensure they all take care of their health.Order code G1016

My dad’s heart attackA book for children whose family member has had a heart attack.

My dad’s heart attack

150g (5½oz) self-raising wholemeal flour¼ tsp baking powder40g (1½oz) sunflower spread½ tsp dried herbes de Provence85g (3oz) courgettes, coarsely grated2 spring onions, very finely chopped

40g (1½oz) half-fat mature cheddar-style cheese, finely gratedFreshly ground black pepper, to taste1 large egg, beaten125ml (4fl oz) skimmed milk6 small cherry tomatoes, halved

Courgette & tomato muffins

Preparation time: 25 minutesCooking time: 25–30 minutesMakes 6 large muffins

1 Preheat oven to 190°C/ fan 170°C/gas mark 5. Line 6 cups of a muffin tin with paper muffin cases; set aside. Combine flour and baking powder in a bowl; lightly rub in sunflower spread until mixture resembles fine breadcrumbs.

2 Stir in dried herbs, courgettes, spring onions, cheese and a couple or so grinds of black pepper. Add egg and milk, stirring gently to mix well – don’t over-mix as this may result in heavy muffins.

3 Spoon mixture into prepared muffin cups, dividing it evenly between each one. Top each muffin with 2 tomato halves, cut-side up, pressing them in lightly. Bake in oven for 25–30 minutes or until risen, golden brown and firm to the touch. Transfer to a wire rack. Serve warm or cold.

Ingredients

Method

“Muffins are best eaten freshly cooked on the day they are made. Once cooled, store any leftover muffins in an airtight container and use within 1–2 days. They are best reheated and served warm.

“Freeze cold muffins in a sealed freezer bag or individually wrapped for up to 1 month; defrost and serve warm.”

Anne SheasbyOur resident food writer Anne has had more than 26 cookery books published covering bread, soup, vegetarian meals and more.

Anne’s tips

23%


Sugars1.9gLow

Energy701kJ

167kcal

Fat5.8gMed

Saturates1.7gMed

Salt0.56gMed

9%8% 9%2%8%% = an adult’s reference intake

HOLIDAY TREATS

Got the baking bug? Try our tea loaf (Mar/Apr 2015). Call 0870 600 6566 or go to bhf.org.uk/recipesearch.

IngredientsRecipes: Anne Sheasby; food styling: Sara Lew

is; prop styling: Tony Hutchinson; photography: W

illiam Shaw

1 tsp olive oil3 spring onions, finely chopped½ red pepper, deseeded and finely diced85g (3oz) frozen peas40g (1½oz) half-fat mature cheddar-style cheese, finely grated

3 medium eggs, beaten125ml (4fl oz) skimmed milk2 tbsp finely snipped fresh chivesFreshly ground black pepper, to taste

1 Preheat oven to 180°C/fan 160°C/gas mark 4. Lightly grease then line 6 cups of a muffin tin with squares of non-stick baking paper (to cover base and sides of each cup and act as muffin cases); set aside.

2 Heat oil in a small, non-stick frying pan. Add spring onions and red pepper; sauté over a medium heat for about 5 minutes or until softened. Spoon mixture into prepared muffin cups; scatter peas over

Methodtop, dividing evenly. Sprinkle cheese over top, dividing evenly.

3 Beat eggs and milk together in a bowl; stir in chives and black pepper. Pour into muffin cups, dividing evenly; gently stir to distribute vegetables and cheese in egg mixture, if necessary.

4 Bake in oven for 20–25 minutes or until risen, set and golden brown. Cool slightly; lift frittatas out of tin and serve.

These recipes are from Heart Matters magazine, Jul/Aug 2015. If you’d like to receive Heart Matters and you’re not a member, join for free by calling 0300 330 3300 (costs are similar to 01 and 02 numbers) or visit bhf.org.uk/heartmatters.

“Swap frozen baby broad beans for the peas. Try 1–2 small shallots in place of the spring onions.”

Anne’s tips

23%


Sugars2.2gLow

Energy361kJ86kcal

Fat4.9gMed

Saturates1.6gMed

Salt0.2gMed


HOLIDAY TREATS

Mini pea & red pepper frittatas

Preparation time: 25 minutesCooking time: 25–30 minutesMakes 6 mini frittatas


FREE

July/August 2015


Shifting gear

HOLIDAY TREATS

PULL OUTAND KEEP

RECIPECARDS

7MYTHS ABOUT

CHEESE



Try our healthy fish and chips (Jul/Aug 2014). Call 0870 6006566 or go to bhf.org.uk/recipesearch.

1 Heat 1 teaspoon oil in a non-stick saucepan. Add onion; sauté over a medium heat for 5 minutes until softened. Add garlic; cook gently for 1 minute. Add ground spices; cook gently for 1 minute. Remove from heat.

2 Place chickpeas in a mixing bowl; mash well using a potato masher. Stir in sautéed onion mixture. Add egg, parsley, chopped coriander and black pepper, mixing well to make a coarse paste. Cover; chill in fridge for 20 minutes.

Ingredients3–4 tsp rapeseed oil1 small red onion, finely chopped1 clove garlic, crushed1½ tsp ground cumin1½ tsp ground coriander400g (14oz) can chickpeas in water, drained and rinsed1 medium egg, beaten

1–1½ tbsp chopped fresh flat-leaf parsley1–1½ tbsp chopped fresh corianderFreshly ground black pepper, to tastePlain flour, for dustingNatural yoghurt, for dippingMixed lettuce, cucumber and tomato salad, to serve

Method

“Alternatively, serve these falafels with the cucumber and yoghurt dip from Nov/Dec 2014, and salad. Try adding the finely grated zest of ½ a lemon to the mashed chickpea mixture, or rolling the shaped falafels in sesame seeds before baking.”

3 Preheat oven to 180°C/ fan 160°C/gas mark 4. Divide falafel mixture into 12 even portions. Using lightly floured hands, roll each one into a walnut-sized ball; flatten slightly. Brush falafels all over with remaining oil; place on non-stick baking sheet.

4 Bake in oven for 20–25 minutes or until crisp and light golden. Serve hot or cold with natural yoghurt for dipping and a mixed lettuce, cucumber and tomato salad.

Anne’s tips

23%


Sugars0.4gLow

Energy214kJ51kcal

Fat2.6gMed

Saturates0.3gLow

Salt0g

Low0%4% 2%0%3%


Anne cooks each recipe for us twice (at least!) to ensure everything we recommend is healthy and delicious. For even more meal ideas, visit bhf.org.uk/recipesearch.

HOLIDAY TREATS

Crispy baked falafels

Preparation time: 25 minutesCooking time: 25–30 minutesMakes 12

1 Preheat oven to 200°C/fan 180°C/gas mark 6. Line a baking sheet with non-stick baking paper; set aside.

2 Heat 1 teaspoon oil in a small, non-stick frying pan. Add onion; sauté over a medium heat for 5 minutes, until softened. Transfer to a bowl; cool slightly. Add carrot, apple, minced pork, herbs, mustard and black pepper; mix well.

3 Lay a sheet of filo pastry on work surface; brush with a little of remaining oil. Place another filo sheet on top; brush with a little more oil. Place final filo sheet on top. Cut filo stack in half lengthways. Dividing pork

Recipes: Anne Sheasby; food styling: Sara Lewis; prop styling: Tony H

utchinson; photography: William

Shaw

6 tsp olive oil1 small red onion, finely chopped1 small carrot (about 85g/3oz unprepared weight), coarsely grated1 crisp eating apple (such as Granny Smith or Braeburn, about 150g/5½oz unprepared weight), peeled, cored and coarsely grated

250g (9oz) lean minced pork1 tsp dried herbes de Provence2 tsp Dijon mustardFreshly ground black pepper, to taste3 large sheets of filo pastry (each sheet about 43 x 26cm/17 x 10½in)2 tsp poppy seeds (optional)

Ingredients

Methodmixture in half, place it along a long edge of each strip of pastry, moulding into an even sausage shape as you go. Brush uncovered pastry with a little more oil. Roll up each one, enclosing pork mixture inside (with join underneath); brush with remaining oil. Cut each large roll into 8 even smaller rolls; sprinkle with poppy seeds (if using).

4 Place rolls on prepared baking sheet. Bake in oven for 25–30 minutes, until crisp and deep golden and pork is cooked. Transfer to a wire rack; serve hot or cold.

“Try using minced turkey or chicken thigh meat in place of the pork. Swap in dried sage for the dried mixed herbs.”

Anne’s tips

≠ To find out more about maintaining a healthy diet, read our free booklet Time to eat well. Visit bhf.org.uk/HMpublications or call 0870 600 6566.

23%


Sugars1.7gMed

Energy317kJ76kcal

Fat3.9gMed

Saturates0.8gMed

Salt0.1gMed


10 MINUTES TO CHANGE YOUR LIFE Time to eat well

HOLIDAY TREATS

Pork & apple filo rolls

Preparation time: 30 minutesCooking time: 30–35 minutesMakes 16

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