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Since the 1960s we’ve made signifi -cant steps forward in treating heart and circulatory dis-ease. If you had a heart attack in the

1960s, you had a very poor chance of surviving.

Thanks to generous support for medical research funders, count-less hours of laboratory research and advances in technology, the majority of heart attack patients now survive.

With more people surviving heart attacks, death rates have fallen dra-matically, but after decades of this steep downward trend, progress is levelling off and we could be grinding towards a plateau.

At the same time, we’re facing a worrying situation, whereby more

people are living with heart and cir-culatory disease than ever before.

Heart and circulatory disease, or cardiovascular disease, is an umbrel-la term for conditions such as cor-onary heart disease, angina, heart attack, stroke and vascular dementia.

Around seven million people in the UK are currently living with a cardiovascular disease, costing the NHS billions of pounds every year. This is a number that is likely to rise with an ageing and growing popula-tion. Records show that the number of hospital visits for cardiovascular disease has reached the highest lev-el for decades.

It is a myth that heart disease is a ‘man’s disease’ and only aff ects peo-ple in later life when their bad life-style habits start to catch up with them.

Heart disease doesn’t discriminate – it affects us all Seven million people in the UK are currently living with cardiovascular disease. People of all ages are being aff ected by the conditions.

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disease is a ‘man’s

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Diagnosed with heart failure? Do not sit on the side lines!

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Heart disease doesn’t discriminate; it can aff ect anyone at any time. From the elderly living with heart failure to children born with holes in their hearts, from athletes at the peak of fi t-ness – but have inherited faulty genes, such as England cricketer, James Tay-lor – to young mothers whose hearts are damaged during pregnancy. With such a wide range of people aff ected there is so much more for us to learn and understand.

The ‘holy grail’ of heart research is to fi nd a way to stop atheroscle-rosis – the build up of fatty plaque in the arteries that leads to coro-nary heart disease. As you age, fat is gradually deposited in your arteries, which can block vital blood fl ow to your heart muscle. It’s a condition that eventually aff ects most people (some more than others) depending

on your lifestyle and genes.While reducing or avoiding risk fac-

tors, such as smoking and poor diet, can delay the onset and impact of this condition we still have no way of pre-venting it. This is why we need to con-tinue supporting medical researchto better understand the process and fi nd a way to stop it.

Looking ahead, there are opportu-nities for us to capitalise on our posi-tion in the UK as the world’s leading centre for cardiovascular researchand discover new and better ways of preventing, diagnosing and treatingcardiovascular disease.

But to make it happen we needinvestment in medical research, international collaboration with thevery best scientists and support tohelp make tackling cardiovascular disease a priority again.

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PMTV LIVE - THE MARVELLOUS CHANNEL ADDRESSING THE PATIENT, CARER, DOCTOR AND NURSE CHALLENGES OF HEART FAILURE

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The best day-to-day advice for coping with heart failurePeople diagnosed with heart failure can follow some simple guidelines for a better life, says Louise Clayton, Heart Failure Advanced Nurse Practitioner.By Tony Greenway

What is heart failure?It means the heart pump is weak-er than it should be and is failing to meet the demands of the body. There are many reasons it occurs, includ-ing coronary heart disease and high blood pressure — and it’s com-mon, particularly as we age. It’s not curable.

What are the main symptoms?You may have breathlessness on exertion during what would nor-mally be, for you, routine activity.

For example, people who are gen-erally fi t may notice that they can’t walk around the park as quickly as they used to, or that they get more breathless going up the stairs. At the extreme end, they may get breathless washing or dressing. Fatigue — not simply tiredness — is another com-mon symptom, and they may have swollen ankles and feet.

What are your tips for living well with heart failure?The quicker you see a specialist, via GP referral, the better! It’s also

vital to take your medication as pre-scribed; if it isn’t working, or you have side-eff ects, see your doctor. Taking regular exercise is key. I’m not talking trampolines and tread-mills: walking is free! Start small and build up gently, and the best way of doing that is going through a formal rehabilitation programme. Don’t smoke; drink alcohol in mod-eration; eat a healthy diet with lots of fruit, veg and oily fi sh; and watch your fl uid intake. The British Heart Foundation advises no more than two litres a day.

Do you have any advice for family members or carers?Learn about the condition and talk to a specialist, which can reduce anxie-ty. Take time out for yourself: it’s real-ly important not to get ‘carer weary’. Be vigilant of any changes to the per-son you care for, but make sure they retain their independence as much as possible.

Read more on healthawareness.co.uk

Louise ClaytonHeart Failure Advanced Nurse

Practitioner, University Hospitals of Leicester

INSPIRATION

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Over the last decade, there has been a deliberate effort on the part of clinicians to encourage heart

failure patients to monitor their own conditions. “Heart failure is a chron-ic condition, characterised by phas-es of stability interrupted by phases of ‘decompensation’ (worsening),” says Professor Iain Squire, Professor of Cardiovascular Medicine at the University of Leicester and Honor-ary Consultant Physician, Univer-sity Hospitals of Leicester. “Unfor-tunately, a decompensation phase is often associated with the need for hospital admission, so it’s important to empower patients and/or their car-ers to identify the signs of deteriora-tion before things get to the admis-sion stage.”

Be aware of changesIn this age of tech-driven innova-tion, are devices routinely available

to help do this eff ectively? No, says Squire: it’s not quite that simple. For example, you may think that stand-ard ECG (electrocardiogram) moni-tors — such as Holter monitors and loop monitors — keep check on heart failure stability, but they don’t.

“Individuals who are asked to wear ECG monitors by health profession-als will include those with heart fail-ure,” says Squire. “But this type of monitor only records abnormal heart rhythm activity which indicates that a further intervention may be nec-essary.” There are implanted devic-es that do monitor heart failure sta-bility, called pulmonary artery pres-sure monitors, but, as these are for patients with chronic heart failure, it’s technology which is not cheap and therefore not routinely available.

The best way to monitor heart fail-ure is simply to be alert to any changes in your health —these are easy to spot. The main symptoms include breath-lessness, fatigue and fl uid retention

– usually in the ankles – which can quickly cause weight gain.

Importance of early interventionIf a friend or someone in your fami-ly has been diagnosed with heart fail-ure, it’s important to notice chang-es on their behalf, because they might not. “Many patients with heart failure are elderly and may have impaired faculties,” says Squire. “Their eyesight and hearing may not be good and they may have a degree of cognitive impairment.” And, of course, the earlier you make their GP or cardiac specialist aware of any changes, the better.

In the UK, the vast majority of heart failure patients have access to a community-based specialist heart failure nurse who will regularly mon-itor weight, blood pressure and pulse. For some, a trip to see the nurse may head off a trip to see their consultant — or, in worse case scenarios, a stay in

hospital. “Community heart failure nurses can encourage patients whoare showing signs of fl uid retention to increase their diuretics — and so reduce fl uid — before they make con-tact with their own health care pro-fessional,” says Squire.

And while heart failure remainsincurable, its treatment has improved markedly in recent years, which means that patients are living longer and better lives. “We’re lucky to have a large number of leading research scientists in this area in NHS institutions and UK universities,” says Squire. “Plus, we’re fortunate to be able to prescribe heart failurepatients with medication and devices whose benefi ts have been proven in large, well-run clinical trials.”

“Main symptoms

include

breathlessness,

fatigue and fl uid

retention”Read more on healthawareness.co.uk

Why self-monitoring is essential for heart failure patientsHeart failure patients should be aware of the warning signs which indicate their condition is worsening. Careful monitoring may even delay or halt the need for a hospital admission.

By Tony Greenway

Professor Iain SquireProfessor of Cardiovascular

Medicine, University of Leicester and Chair, British Society for Heart

Failure (BSH)

www.novartis.co.uk

Changing the practice of medicineAt Novartis, we harness the innovation power of science to address some of society’s most challenging healthcare issues. We are passionate about discovering new ways to extend and improve patients’ lives.

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Patients with heart failure shouldn’t sit on the sidelines. Their valuable insights not only help others with the condition but add to the NHS’s knowledge to improve patient quality of life and outcomes.

When it comes to the medical treat-ment of heart failure patients, it’s the clinicians — such as heart fail-ure specialists, like consultant car-diologists, heart failure nurses and GPs — who know best. However, “it is the individual heart failure patients who know their condition, says Nick Hartshorne-Evans, – “they can tell you what having the condition is re-ally like”, which is why it’s so impor-tant that their voices are heard and listened to by bodies such as the NHS, NICE, the new Sustainability and Transformation Partnerships (STPs), Clinical Commissioning Groups (CCGs) and Academia.

Using patient insightHartshorne-Evans — a heart fail-ure patient himself — is the CEO and founder of the Pumping Marvellous Foundation, a UK, patient-led heart failure charity. Hartshorne-Evans also sits on the NICE Chronic Heart Failure Guidelines Committee. “The patient has a unique perspective,” he says. “They are driven by need and uncon-cerned with cost. They add real value to the conversation around heart fail-ure because they have insights about the patient experience and solutions to discuss. The knowledge within the patient population is generally un-tapped. Bear in mind that the heart failure patient population is huge: roughly 900,000 people are aff ected by the condition. That’s a massive bank of knowledge from individuals from all walks of life that can be a powerful resource for the NHS.”

For example, Hartshorne-Evans, recently polled the online heart fail-ure patient community to ask how they would like to receive informa-tion about their condition: digitally or in print? (Print is still favourite but online they could explore their condi-tion further). Other patient insights might include concerns about med-ication, worries about life expectan-cy, employment concerns and general

day-to-day living; life with heart fail-ure is very uncertain.

How individuals felt when they were given their diagnosis by their healthcare professional is a very prominent concern. How would you feel having been told: ‘You have Heart Failure’? “We’ve asked patients about their reactions to this news, because a medical professional’s tone at di-agnosis is so important,” says Hart-shorne-Evans. “It’s useful to hear from those who’ve experienced it, and to understand what they feel that tone should be. Some may want to be told ‘how it is’, others require a diff er-ent, more rounded approach.” Doctors need to decipher how to tailor their communications style. If this kind of insight is taken on board by doctors, it will ultimately help other patients.

Patients should talk to each otherIt can also help if patients talk to each other. Social media platforms have an advantage over face-to-face meetings because, in moderated, well-man-aged, closed community groups, peo-ple can dip in and out of conversa-tions. They can fi nd answers when they need to get instant feedback, rather than having to wait for an ap-pointment. “In one group we run, someone commented: “I’ve been a member of this group for two years, haven’t posted anything but watched and learnt how to manage my heart failure. But I now have a question. Can anyone help?” This individual had been reading about other people’s heart failure experiences without ac-tive interaction, but when they had an issue themselves they felt able to speak up about it. That demonstrates the power of peer led online forums.”

How patients can use social mediaThese days, many people are lookingto manage their health diff erently, says Hartshorne-Evans. Technology enables patients to access informa-tion very quickly. Many want as much information at their fi ngertips as quickly possible about their conditionbefore they see their healthcare pro-fessional. They like asking questions on social media platforms because peer to peer feedback can help them make informed decisions. “They might say: ’I’m going to see my cardi-ologist tomorrow. What kind of ques-tions should I ask?’ Well-managed on-line communities are also benefi cial from a clinician’s point of view, be-cause patients will be equipped withmore knowledge about the choices they are able to make. They’ll then be-gin to develop a mutually benefi cialdoctor-patient relationship, which is very important when you are manag-ing a chronic condition like heart fail-ure. Ultimately, this will lead to betteroutcomes for the patient.”

More knowledge reduces costThere’s another advantage from theclinicians’ side: fi gures from the Brit-ish Heart Foundation published in 2015, show that heart failure accountsfor two per cent of the total NHS budget, with 70 per cent of these costs due to hospitalisation. A typical cost per hospital admission episode forheart failure amounts to £3,796, whilefi ve per cent of all emergency admis-sions are due to the condition.

Yet, if a patient can self-manage their condition more eff ectively by us-ing the peer-to-peer network, theymay not have to make unnecessary trips to A&E or hospital, says Hart-shorne-Evans. “You can have a betterquality of life with heart failure if youknow how to self-manage and youknow when and where to interact with the NHS. Greater knowledge canhelp you feel more in control, howev-er, this is not a replacement forwell-managed clinical care, but it compliments it well.”

How insight from heart failure patients can make real changeBy Tony Greenway

Read more on healthawareness.co.uk Read more on healthawareness.co.uk

Nick Hartshorne-EvansCEO and Founder, the Pumping

Marvellous Foundation

INSPIRATION

STATS

1 Heart Failure affects 900,000 people in the UK.1

5 One of five long-term conditions responsible for 75 per cent of unplanned hospital admissions.5

2 Heart failure is debilitating and outcomes are poor: 5 year survival rate is worse than breast or prostate cancer.2

6 It is recommended that patients with suspected heart failure have ready access to echocardiograms.6

3 30-40 per cent of those diagnosed with heart failure die within the fi rst year.3

7 There is an acute shortage of echocardiographers in the UK.7

4 Heart failure is a major cost to the NHS. It is a leading cause of hospital admission in over 65s.4

8 According to the National Heart Failure Audit: a. 80 per cent of patients admitted to hospital with

symptoms of heart failure are seen by a heart specialist (indicating that one in fi ve is not receiving specialist input).

b. The mortality of patients hospitalised with heart failure remains high overall at 8.9 per cent8

9 Between 1998 and 2012, survival rates for people aged over 45 with heart failure showed no improvement, in contrast to cancer survival rates in the UK which have doubled in the last 40 years.9

10 Heart failure represents the second highest cost to the NHS for any disease after stroke.10

Heart Failure

1 https://www.nice.org.uk/guidance/cg108/chapter/Introduction

2 http://circoutcomes.ahajournals.org/content/circcvoq/early/2010/10/05/

CIRCOUTCOMES.110.957571.full.pdf

3 http://heart.bmj.com/content/83/5/505.long

4 https://www.nice.org.uk/guidance/cg187

5 https://www.england.nhs.uk/wp-content/uploads/2014/03/red-acsc-em-admissions-2.pdf

6 https://www.england.nhs.uk/wp-content/uploads/2014/03/red-acsc-em-admissions-2.pdf

7 http://bmjopen.bmj.com/content/4/3/e003866.full#T2

8 http://www.ucl.ac.uk/nicor/audits/heartfailure/documents/annualreports/

annual-report-2015-6-v8.pdf

9 https://academic.oup.com/fampra/article-lookup/doi/10.1093/fampra/cmw145

10 https://academic.oup.com/fampra/article-lookup/doi/10.1093/fampra/cmw145

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Is there a link between sport and cardiac arrest?

Can high intensity sport cause cardiac events? It may if you have an undetected cardiovascular condition — but, for the vast majority of people, exercise remains hugely beneficial.

Over the years, a number of high-profi le sportspeople under the age of 35 have been aff ected by undetected cardiovascular conditions. Footballer, Fabrice Muamba, and cricketer, James Taylor, both survived their cardiac events but, tragically, there have been fatalities, including Cameroonian interna-tional, Marc-Vivien Foé and Livorno’s Piermario Morisini.

“Aff ected people under 35 could have an inheritable condi-tion — although they may be the fi rst person in their fami-ly to experience it” says Dr Mark Mason, Consultant Cardi-ologist at RB&HH Specialist Care. “Broadly, problems result from types of cardiomyopathy (which aff ect the heart ven-tricles) or harder to fi nd channelopathies, which are under-lying conditions causing abnormal rhythms in an otherwise normal heart.” Most over-35s who experience a cardiac event, meanwhile, will do so because of previously undiagnosed coronary artery disease.

Know the symptomsIf you have an undetected cardiovascular condition, longer duration, high intensity exercise could heighten the risk of a cardiac event, particularly in the over-35s. However, Dr Mason stresses, the overwhelming evidence is that exercise is hugely benefi cial for the vast majority of people. So it’s important to keep active.

“To put it in perspective, around one in 20,000 exercisers per year have a cardiac event,” says Dr Mason. “Instances are prob-ably lower for the under-35s who are generally healthy, and a bit higher for those over 35 with underlying cardiovascular risk.” Symptoms can include shortness of breath, lighthead-edness or blackouts, heart palpitations or chest pain (“which could be tightness, heaviness, or the sensation of having a belt being tightened around your chest,” says Dr Mason).

Make lifestyle changesOver 35s can reduce their risk of cardiovascular disease by eat-ing a healthy diet and cutting out smoking. In the under 35s, however, reducing risk of a cardiac event is more challenging — particularly if you don’t know you have a problem to begin with. “Then we get into the contentious issue of mass screening pro-grammes,” says Dr Mason.

In Italy, for example, anyone between the ages of 16 and 35 has to undergo screening – by law – before participating in sport at any level. “As a result, it’s estimated that Italy has reduced its instances of cardiac events by around 90 per cent,” says Dr Mason. “The problem in the UK is that we don’t have any formal infrastructure for mass screening at this point. But there are charities out there who — at times — run screening programmes for worried individuals.”

Arrhythmias (heart rhythm disorders) can be a mystifying condition for many — from a “simple faint” through to AF-related stroke and sudden cardiac death. It is time we talked more about it, says one heart rhythm charity founder.

Most people are blissfully unaware of arrhythmias, says Trudie Lobban MBE, Founder and Trustee of Arrhythmia Al-liance. But that has to change, because anyone with undiagnosed arrhyth-mia is at high risk of a debilitating or life-threatening AF-related stroke or sudden cardiac death. And arrhythmias are treatable — if diagnosed and treated.

Arrhythmia Alliance is a coalition of charities, patients, carers, healthcare professionals, medical organisations, policy makers, allied professionals and all those with an interest in cardiac ar-rhythmias (heart rhythm disorders). “One of our aims is to make arrhythmia a household word by 2020,” says Lobban, “so that everybody knows about and un-derstands it, and knows the rhythm of their own heart.” This is key because ar-rhythmias are abnormal heart rhythms that are either too fast, too slow or irreg-ular.

“At Arrhythmia Alliance, we talk about ’Detect, Protect, Correct’,” says Lobban. “Detect arrhythmia through a simple pulse check; Protect against AF-related stroke with anti-coagulation therapy (not aspirin); and Correct the irregular heart rhythm with access to appropriate treatment.”

What is the difference between arrhythmia and a heart attack?Unlike a heart-attack, which Lobban describes as “a problem with the heart’s plumbing” (because of, say, a blocked artery or a burst blood vessel), arrhyth-mia should be thought of as an “electri-cal fault”, which can cause the heart’s complete and immediate shut down.

To put it into context, Lobban uses the illustration of a washing machine. “If you have a leak in your washing ma-chine, it may nevertheless get to the end of its cycle,” she says. “OK, so it will be full of water, but its lights will still be on. That’s a heart-attack — and a per-son who has one may have the chance to call for emergency help. If you have a power-cut or a blown fuse, however, the washing machine suddenly stops

– it is dead. That’s sudden cardiac ar-rest (SCA).” SCA kills more people in the Western world than lung cancer, breast cancer and AIDS combined and, in the UK, 100,000 people die from it every year. It can be caused by an arrhythmia such as ventricular tachycardia, a rap-id abnormal heart rhythm. With rapid CPR (cardiopulmonary resuscitation) and the use of an automated external defi brillator (AED), the person has up to 70 per cent chance of survival – without an AED it is almost certain death.

Affecting people of all agesThe most common form of arrhythmia — and the number one cause of AF-re-lated stroke — is atrial fi brillation (AF), when the heart beats erratically and ir-regularly. Incredibly, 1.5 million people in England have AF, and it is estimat-ed that another half a million have the condition but are undiagnosed.

“The heart has four chambers through which the blood fl ows freely,” explains Lobban. “But if each of those chambers begins quivering at a diff er-ent rate, the blood has diffi culty fl ow-ing and a clot can form. If a clot breaks off , it can travel and cause heart fail-ure, thrombosis or an AF-related stroke. AF-related strokes are often more dev-astating — or fatal – than other forms of stroke.” People whose symptoms in-clude breathlessness, tiredness and heart palpitations should see their doc-tor to check for AF. A simple pulse check can detect an irregular heart rhythm and with new technology such as hand-held electrocardiogram

(ECG) monitors – we can be diagnosed quickly and provide evidence for our doctor for appropriate anticoagulation therapy to reduce the risk of an AF-re-lated stroke plus access to appropriate

treatment for AF.

Fainting and your heartSyncope — the Greek word for ’faint’— may be a sign of arrhythmia. “Faint-ing might happen because of low blood pressure or because of overheating. All too often, though, it’s because of an ar-rhythmia — and a potentially fatal one,which could lead to sudden cardiac ar-rest; there is no such thing as a ’simple faint’.” Sudden cardiac death can aff ect anyone at any age; AF aff ects one in four people over 65 years of age. Some ar-rhythmias are genetic and can lead to sudden cardiac arrest.

Importance of pulse checkingOf course, we all get heart palpitations from time to time, but there is a quickway to reassure yourself if you are wor-ried about an arrhythmia: with a sim-ple pulse check. Anyone experiencingirregular or abnormal heart rhythms but whose pulse is regular, is unlikely toneed medical attention. Anyone whose heart is racing and whose pulse is ir-regular during a period of rest shouldsee a medical practitioner as a matterof urgency. “If we are all aware of ourpulse rhythm, we can reduce death andAF-related strokes, and also reduce theburden on the NHS by visits from the worried well,” says Lobban.

If your healthcare professional doesdiagnose an arrhythmia, the next stepsdepend on what kind you have. Youshould seek further advice from them if your pulse races some or most of the time and you have been feeling unwell.Even if you don’t feel unwell but your pulse feels irregular (jumping around) you should also seek medical advice.We are all diff erent and so are our pulse rates so it can be diffi cult to assess irreg-ular rhythms. If your heart rate is con-sistently above 120bpm or below 40bpmyou should seek advice from a medicalprofessional.

Remember there is no such thing as a ‘simple faint’. If a person experiences aloss of consciousness they need a12-lead ECG to rule out an underlying, potentially fatal arrhythmia. In work-ing together we can perfect the patientpathway and enable the ‘patient’ to goback to being a ‘person’.

Think ‘Detect, Protect and Correct’ for arrhythmias…and perfectBy Tony Greenway

For more information visit rbhh-specialistcare.co.uk


Dr Mark MasonConsultant Cardiologist, Royal Brompton & Harefi eld Hospitals

Specialist Care

Trudie Lobban MBEFounder and Trustee of Arrhythmia

Alliance

INSPIRATION

COLUMN

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Atrial fibrillation (AF) is a long-term condition involving a heart arrhythmia that leads to risk of stroke.

There are 1.2 million people in the UK living with AF of whom 500,000 are yet to be diagnosed. Due to an ageing population, this number is expected to rise. Many AF-related strokes are preventable if the patient’s anticoag-ulation (AC) therapy (such as warfa-rin or the more newly available an-ticoagulation drugs) is eff ective and well controlled.

The self-care challenge The proactive management of peo-ple with long-term conditions, in-cluding the promotion of self-care for patients, is a priority for the NHS. In fact, more personalised care, where the patient is engaged in their health

management, has been discussed as a fundamental factor in ensuring the sustainability of healthcare systems across the globe.

National guidelines suggest that better control – and therefore better outcomes – are achieved through reg-ular monitoring and consistent med-ication adherence as well as lifestyle improvements, where patients are empowered to better understand and manage their condition. However, despite the consensus that self-care is the right course, the realities of moving individuals towards this lev-el of engagement are challenging in terms of patient motivation and care team resources.

Patients need knowledge, skills and confi dence to self-care safely.

Recent technology advancements have meant that patients can self-care and understand more about their condition or therapy. Even so, questions remain around how eff ec-tively this technology is presented to patients, and what opportunities they have to access it. The challenges we face at the moment include a lack of patient education around their condition and the wider health im-pacts that their condition may have. Patients need support in this learn-

ing. Once this support and education is in place, we believe that we will see better understanding of the impor-tance of anticoagulation therapy and more motivate to self-care.

Care teams need the visibility that the patient is safe and adhering to their medication Self-care and better patient under-standing of their condition is most ef-fectively delivered through clear and consistent communication between patients and clinicians. Supported self-care means focusing on improv-ing control, freedom and choice but

under the continual guidance of the care team – reducing the patient’s feeling of isolation with their condi-tion, strengthening patient and car-er communities and also boosting pa-tients’ confi dence to adhere to their medication.

Smart technology can support this connection while delivering inter-active education to improve the pa-tient’s control and self-care, there-fore their health outcomes.

A new model of careThese challenges inspired us to work with patients and care teams to de-sign a self-care app, named “engage”, to give individuals the all-important knowledge, skills and confidence to self-care via an app which is ful-ly connected to their clinical record. The engage app supports patients to self-monitor safely. It helps patients to understand the benefi ts of their anticoagulation therapy with easy-to-follow education and regular tips to reinforce the importance of taking their medication properly. The pro-gramme enables patients to submit regular digital reviews, which also assess tablet adherence, helping care teams follow NICE (National Insti-tute for Health and Care Excellence)

guidelines without signifi cant im-pact on clinic time.

Whether patients are on warfarin therapy, or the newer drugs (DOACs– eg dabigatran, rivaroxaban, apix-aban, edoxaban), engage motivatesindividuals to understand and im-prove their condition management rather than simply recording andtracking data, which many healthapps already off er in isolation fromthe patient’s care team. It’s impor-tant to manage all anticoagulationpatients in one system, regardlessof their therapy choice, so that da-ta is available across whole condi-tion-specifi c patient population tohelp us to focus on this way, reducing the prevalence of AF-related stroke atnational level.

The tools we need to achieve thisaim are based on genuine joint deci-sion making and an on going rela-tionships which involve continuoussupport, education and learning both for patients and clinicians.

Can safer, supported self-care really work for patients living with long-term conditions?


Dr Mark Sullivan Medical Director, LumiraDx

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5 tips for a heart-healthy

diet With the summer holidays coming to a close and winter around the corner, there’s never a moment without tempting dinner parties and BBQs full of unhealthy food choices. See our list of tasty heart-healthy options you can enjoy all year round:

Veggie kebabs: Ditch the lamb or beef kebabs and have veggies on a skewer. Opt for veggies that are heart healthy, like cher-ry tomatoes, squash, onions, sweet potatoes and asparagus. Spray with some olive oil and grill.

Better BBQ burger: Buy lean/extra lean minced beef and drain off the excess fat after cooking. Tip: halve your meat and mix it with an equal amount of cooked buckwheat, a meaty-in-texture grain. To make it health-ier again, try swapping your beef mince for turkey. This lighter substitute can make deli-cious burgers and tasty spaghetti Bolognese.

Get fishy: Fish, especially oily fi sh like tuna and salmon, have great nutritional bene-fi ts. In the summer months, fi sh can be a delicious and light addition to any salads. In winter, pair it with some roast potatoes and steamed spinach to give you that extra boost of iron.

Better booze: Although it is healthier to avoid alcohol, red wine and fruit rich cock-tails can be a healthier choice. Try a Raspber-ry Mule - it’s delicious with and without alco-hol. Just remember to drink plenty of water in between your boozy beverages.

Fro-yo over ice cream: Fat-free frozen yoghurt is a great alternative to ice cream. Adding in heart healthy ingredients such as dark chocolate, blueberries and cherries add fl avour without any guilt.

Remember: if you ever have any suspici-

ons in relation to your heart health, please do

visit your GP or healthcare professional.

James Taylor had to rebuild his life when his promising cricketing career was cut short by a rare heart condition. Keeping positive has helped him through adversity.

Before April 2016, Nottinghamshire and England cricketer, James Taylor, admits that “life was pretty perfect.” He was begin-ning to establish himself with the England team — always a dream of his — travel-ling the world, playing a game he loved, in front of thousands of people, and making good money doing it. “I was exactly where I wanted to be,” he says. “I was achieving in cricket and gearing up for the next season.”

But then, during a routine warm-up ses-sion with Nottinghamshire, James’s chest suddenly started to pound. “It felt a bit like when you get anxious,” he remembers, “although that usually subsides. This didn’t and it seemed as if my heart was going at a million miles an hour. I got on the physio bed, couldn’t breathe and was given oxy-gen. That was when I thought I was going to die.” He was rushed to hospital, under-went tests and was told he would have to stay in overnight.

Dealing with the diagnosisThen, “things got real”. His doctors diag-nosed arrhythmogenic right ventricular cardiomyopathy (ARVC), a rare disease of the heart muscle that prevents blood being properly pumped around the body. James knew a bit about the condition because of the similar near-death experience of foot-baller Fabrice Muamba, which had led to his retirement in 2012.

For James, it was a devastating revela-tion: it meant that any exercise could be fatal, and that his promising cricketing career was now over at the age of just 26.

“I was the fi ttest in the team and pound for pound the strongest,” he says, “so this came completely out of the blue. But then I put it into perspective because I was lucky to survive. I sat up in bed with my fi ancée and we decided we could either keep crying about it or try to make the best out of a bad situation. I was still alive, after all — and I shouldn’t have been. I’ve always been a pos-itive person. Maybe it’s because I surround myself with good people and I feel I can do anything. On the fl ip side, that made the situation harder to deal with because sud-denly I didn’t feel invincible anymore.”

Coping with changeInitially, James wore an external defi brilla-tor to shock his heart back to life, should he experience another cardiac event. He lat-er underwent an operation to implant an internal defi brillator, which has gone off on at least one occasion and, he says, shot him across the room. “Essentially if my heart is not acting normally the defi brillator restarts it,” he says, “although the thought of it going off is pretty scary.” James also

has to take medication every day — but thismakes him feel more secure and confi dent. He used to monitor his heart rate constant-ly but doesn’t anymore. “I found it made me more anxious, and I know my body wellenough to recognise when my heart starts doing something that it shouldn’t.”

As a young and formerly active man, not being able to exercise has been one of themost diffi cult things to accept. “It’s an ego-dent,” he admits. “I’d always prided myselfon my fi tness and I’d be in the gym everyday. I’ve barely done any exercise sinceit happened. I haven’t run or done anyweights. I occasionally go on a light bike ride in the gym — although I do monitor myheart rate then.” His main way of keepingfi t now is playing golf.

Leading a fulfilling lifeJames is keen to stress that life is still ful-fi lling, albeit in a diff erent way. He got mar-ried in the summer and has been develop-ing a media career working as a cricket-ing commentator on Sky Sports and BBCFive Live’s Test Match Special. He’s alsocoaching. “I’ve met some amazing people— I can’t thank the NHS doctors and nurs-es enough — and touched base with peo-ple I otherwise never would have,” he says. “The public have messaged me and I try to help them with their problems, whether heart-related or not. I like to think I’m hav-ing a positive eff ect on people.”

To that end, he’s also become an Ambas-sador for the British Heart Foundation toraise awareness of heart disease and the need for vital medical research.“I thought it would be good to make people aware of this condition and that it can happen to young people too,” he says. “But I also wantto reassure them that there is still life afterdiagnosis.”

How James coped with a career-changing heart conditionBy Tony Greenway


Catriona WilliamsDirector, talkhealth

James Taylor Ambassador, British Heart Foundation

INSPIRATION

COLUMN

PHOTO: BRITISH HEART FOUNDATION

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y

y

f

@worldheartfedworldheartday

Eating and drinking well gives your heart the fuel it needs for you to live your life

Staying active can help you reduce your risk of heart disease and feel great

Stopping smoking is the single best thing you can do to improve your heart health

29 September 2017Small changes can make a powerful difference.

On World Heart Day, share how you power your heart and inspire millions of people around the world to be heart healthy.

worldheartday.org #worldheartday

in partnership with


Share the powerCreated in 2009 by the World Heart Federation (WHF), World Heart Day aims to combat the rising number of people with cardiovascular disease (CVD), the world’s biggest killer, by raising awareness and promoting the importance of living a heart-healthy lifestyle.

This year, on 29 September, we urge people to take action by sharing healthy heart tips and attending iconic illumination events. We can all ‘share the power’ and inspire our fami-lies, friends and communities around the world to make the small lifestyle changes that can make a powerful diff erence to heart health.

Fighting against the number one global killerCVD is the leading cause of death and disability in the world, killing 17.5 million people a year. That’s a third of all deaths on the planet and half of all non-communicable-disease-re-lated deaths. By 2030, this is expected to rise to 23 million. Globally, one in ten people aged 30 to 70 die prematurely from CVD, including heart disease and stroke, but the good news is that at least 80 per cent of these premature deaths could be avoided or postponed.

We cannot underestimate the global importance of good heart health – 31 per cent of all deaths worldwide are from CVD. World Heart Day is our chance to bring people together to tackle the world’s biggest killer and urge more people across the globe to improve their heart health. The power to change is in our hands. Making lifestyle changes such as eating more fruit and vegetables, keeping active and stopping smoking can save millions of lives.

Lighting up red and inspiring each otherEvery year, to mark World Heart Day, we ask iconic build-ings, landmarks and monuments across the world to light up red in support of our mission and to provide a powerful visual symbol for the campaign. This year the list of illumi-nations includes Table Mountain in Cape Town, South Afri-ca, the Nasdaq screen in Times Square, New York the Sin-gapore Flyer, the Sky Tower in New Zealand, Avala Tower in Belgrade, Serbia, Angel de la Reforma in Mexico City, Jet d’Eau in Geneva, Switzerland, the home of the World Heart Federation, and many others.

More members of the public than ever before are also get-ting involved by sharing their heart healthy selfi es and tips using #WorldHeartDay and attending one of the thousands of events taking place around the world, from walks and talks to health screenings, fun runs and more.

Together we have the power to reduce the burden of, and premature deaths from, CVD, helping people everywhere to live longer, better, heart-healthy lives.

We might not know we have raised cholesterol because it displays no symptoms. But it is linked to an increased risk of cardiovascular disease, so regular testing for adults is vital.

“The trouble with cholesterol is that it’s not a ’sexy’ subject,” says Linda Main, Dietetic Adviser with choles-terol charity HEART UK. “It’s a com-plex area of science. Also, because raised cholesterol has no symptoms, people don’t take as much notice of it as they should.”

That attitude needs to change, says Main. In fact, if we’re aged be-tween 40 and 75, we should under-go tests every fi ve years to check our levels because raised cholesterol is linked to an increased risk of cardi-ovascular disease. The fi rst sign we have a problem could be a heart-at-tack.

Cholesterol is a lipid (or fat) that’s made in the body by the liver; and six out of 10 us have raised or abnormal levels of it. Why this gets complex — and where people get confused — is because the body makes ’good’ cho-lesterol (HDL) and ’bad’ cholesterol (LDL).

Why we need ’bad’ cholesterolTo make it even more bewildering, our bodies need a certain amount of ’bad’ cholesterol to function. “LDL is essential for growth, sex hormones, the production of vitamin D, the production of bile — which is need-ed for fat digestion — and for tissue repair, etc,” says Main. “The prob-lem is, if we have too much of it, it can be deposited into the linings of blood vessels and, over time, fur up arteries. That can lead to circu-latory problems, heart attacks and strokes.”

Our ’good’ HDL cholesterol has an important part to play here. Main lik-ens it to a team of cleaners travelling around the arteries, picking up excess LDL cholesterol and taking it back to the liver where it can be broken down and disposed of.

Understand your cholesterol resultsSo what’s a healthy level of choles-terol? Unfortunately, that’s not sim-ple either. When you have a choles-terol test, the results will include an overall level and a breakdown of numbers to give your GP an indi-cation of the balance between the good and bad cholesterol your body is producing. “For example, if your overall cholesterol level is 7.0, we would consider that to be raised,” says Main. “But if your HDL was at a healthy level — say 2.0 or 2.5 — we would be less concerned than if it was lower: say 0.9.”

If you are otherwise healthy — that is, you don’t have heart disease or some other pre-existing condition — a good result would be a total cho-lesterol level below 5.0, with an HDL level above 1.0 in men and above 1.2 in women. Make an appointment with your GP who can explain the num-bers to you.

Those with raised cholesterol riskRaised cholesterol can be genetic, which may aff ect around 1 in 250 peo-ple. Age is also a major factor, so the older you are, the higher it will be. Eat-ing saturated fat is another cholester-ol-raising culprit. “We eat meat that contains cholesterol,” says Main. “So cutting out fatty meat and eating lean meat, such as chicken, is important. Don’t forget that dairy is a saturated fat, too.” On the other hand, there is a list of food which naturally helps low-er cholesterol, such as red and green lentils, porridge, baked beans, oat-cakes, pearl barley, soya and tofu.

Exercise is recommended because it increases ’good’ cholesterol (this doesn’t necessarily entail going to the gym: a brisk walk will be benefi -cial); and, of course, you should cut out smoking and only drink alcohol in moderation.

How medication can helpBut if your overall level still stays stub-bornly high — and once other risk fac-tors have been factored in such as fam-ily history, body mass index (BMI) and blood pressure — your GP will assess your chance of having a cardiac event or stroke over the next 10 years. If it’s more than 10 per cent, you may be pre-scribed cholesterol-lowering medica-tion such as statins which are well tol-erated by the vast majority of people.

Raised cholesterol isn’t just associ-ated with cardiovascular disease. “It’s also linked to kidney disease, demen-tia and circulatory problems, such as peripheral arterial disease,” says Main. “That’s why the majority of UK adults should know their cholesterol levels, understand what it means for their health and take action to im-prove them if necessary.”

Knowing your cholesterol level could save your lifeBy Tony Greenway

Read more on healthawareness.co.ukFind out more at heartuk.org.uk

Professor David WoodPresident, World Heart Federation

Linda MainDietetic Adviser, HEART UK

INSPIRATION

COLUMN

A


An innovative, non-invasive technology can help doctors determine which patients with suspected coronary artery disease need treatment and how best to manage their care.

Coronary artery disease (CAD) is

a leading killer of men and women

worldwide. CAD develops when

the coronary arteries, which sup-

ply blood to the heart, narrow,

reducing blood fl ow and causing

chest pain (angina), heart attack

(myocardial infarction) and even

death. Some people are unaware

that they have CAD, and sudden

death is their fi rst symptom. Ran-

dy Rochman, an avid runner and

otherwise healthy individual, was

almost one of them. Fortunate-

ly, a fi rst-of-its-kind, non-inva-

sive test, called the HeartFlow®

FFRct Analysis, found evidence

of CAD, which limited blood fl ow

to his heart and had been missed

by conventional tests. Once the

blockage in his coronary arteries

was discovered, Randy was sent

for urgent bypass surgery, which

saved his life.

Millions of patients need two questions answered

Physicians diagnosing some-

one with suspected CAD want to

know as defi nitively as possible

if the individual has a signifi cant

blockage in their coronary arter-

ies. They also want to know the

impact of that blockage on blood

fl ow so they can best determine

which treatment is most appropri-

ate for that person – whether med-

ical management, a stent or cor-

onary artery bypass graft (CABG)

surgery.

Typically, people with suspect-

ed CAD are sent for a stress test

or electrocardiogram, which are

inaccurate more than 50 per cent

of the time and often inconclusive,

requiring that the patient undergo

additional tests such as coronary

angiography, an invasive proce-

dure done in a cardiac catheteriza-

tion lab. However, coronary angi-

ography puts the patient at risk

for bleeding, stroke, major blood

vessel damage and other seri-

ous complications. Moreover, it

is often unnecessary. A study that

included data from over 1,100 US

hospitals, found that more than

half of the 385,000 patients with

suspected CAD who underwent

an invasive coronary angiography

in fact had no need for intervention

since no blockage of blood fl ow in

their coronary arteries was found

during the procedure.

HeartFlow, Inc. developed the

HeartFlow FFRct Analysis as a

non-invasive approach to diag-

nosing patients with suspect-

ed CAD. The HeartFlow FFRct

Analysis was based on decades of

research conducted by scientists

and physicians at Stanford Univer-

sity in California. The technology

uses a super-computing compu-

tational fl uid dynamics algorithm

to calculate data points through-

out the coronary arteries. The

HeartFlow FFRct Analysis is the

fi rst and only non-invasive tech-

nology to provide insight into both

the extent of CAD and the impact

of the disease on blood fl ow to the

heart.

Assessing impact of blockages on coronary blood fl ow

The process starts with data from

a patient’s non-invasive coronary

computed tomography (CT) scan.

Those data are securely upload-

ed from the hospital’s system to

the cloud. HeartFlow then creates

a personalised, digital, 3D mod-

el of the patient’s coronary arter-

ies using an advanced form of

artifi cial intelligence, called deep

learning. HeartFlow uses power-

ful computer algorithms to solve

millions of complex equations to

simulate blood fl ow in the model

and assess the impact of block-

ages on coronary blood fl ow. The

HeartFlow FFRct Analysis is pro-

vided via a secure web interface to

the patient’s physician, who uses

the information to design a defi n-

itive, personalised treatment plan

for the patient.

Helping patients avoid unnecessary procedures

A mounting body of published lit-

erature has shown that the Heart-

Flow FFRct Analysis reduces

unnecessary invasive diagnostic

coronary angiography proce-

dures and may signifi cantly reduce

healthcare costs for hospitals.

This technology also enhances the

patient experience, making it an

integral diagnostic test in assess-

ing patients with suspected CAD.

The HeartFlow FFRct Analysis

has been evaluated in four large,

prospective clinical trials enroll-

ing a total of more than 1,100

patients at major medical centers

worldwide. The PLATFORM (Pro-

spective LongitudinAl Trial of

FFRCT: Outcome and Resource

IMpacts) trial demonstrated that

a HeartFlow-guided patient eval-

uation strategy effectively identi-

fi ed which patients do and do not

need invasive treatment. When

compared to usual care, a Heart-

Flow-guided strategy reduced

– by 83 per cent – the num-

ber of patients who underwent a

planned invasive coronary angiog-

raphy, only to fi nd they in fact had

no obstructive disease and, there-

fore, no need for invasive interven-

tion. Despite the difference in the

number of patients who required

invasive coronary angiography,

the rate of revascularization pro-

cedures, such as coronary stent-

ing or bypass surgery, was similar.

A health economic analysis per-

formed as part of the PLATFORM

study found the HeartFlow FFRct

Analysis reduced healthcare sys-

tems’ costs by 26 per cent, saving

thousands of dollars per patient.

Results from the PLATFORM tri-

al were published in the Europe-

an Heart Journal and the Jour-

nal of the American College of

Cardiology.

Based on these positive data,

healthcare professionals, profes-

sional organisations and com-

mercial health plans have all taken

notice of HeartFlow’s technology.

In the UK, the National Institute for

Health and Care Excellence (NICE)

of the National Health Service rec-

ommends the HeartFlow FFRct

Analysis to help determine the

cause of stable chest pain. After

reviewing the data, NICE con-

cluded that the HeartFlow FFRct

Analysis is safe, has a high level

of diagnostic accuracy, and may

avoid the need for invasive coro-

nary angiography. NICE further

concluded that, compared to all

other tests, use of the HeartFlow

FFRct Analysis is the most cost-ef-

fective solution because it avoids

unnecessary invasive tests and

treatment. In the United States,

the American College of Cardiolo-

gy (ACC) and the American Heart

Association (AHA) have released

updated Appropriate Use Crite-

ria for Coronary Revascularization

in Patients with Stable Ischem-

ic Heart Disease. These criteria

include the use of the HeartFlow

FFRct Analysis in determining the

appropriateness of revasculariza-

tion in many clinical scenarios.

To date, more than 13,000

patients have benefi ted from the

HeartFlow FFRct Analysis, which

is available in hospitals and medi-

cal centres in the UK, the United

States and Japan.

For more information

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Heart valve disease is caused by either the wear, disease or damage of one or more

of the heart’s valves, aff ecting the fl ow of blood through the heart. The most common forms of heart valve disease impact the aortic and mitral valves. Heart valve disease can cause the heart valves to either leak, mean-ing the valve is failing to close prop-erly and allowing blood to fl ow back through, known as regurgitation, or become narrowed or calcifi ed, in turn limiting the amount of blood allowed to fl ow through, known as stenosis. The symptoms associated with heart valve disease include breathlessness, tiredness, tight chest and dizziness.

Awareness of this disease is very low in the UK, despite its prevalence, with an average of 94 per cent of peo-ple over the age of 60 being unaware of what aortic stenosis (the most common form of heart valve disease) is. One of the reasons for the lack of awareness around heart valve dis-ease is that the symptoms are often

thought to be merely a result of get-ting older and are therefore ignored or put up with. Heart Valve Voice is hoping to change that by making people aware that these symptoms aren’t necessarily just signs of ageing and that they should be mentioned to a primary care professional and, in turn, that primary care professional should listen to their heart.

On average, GPs use their steth-oscope on less than two fi fths of pa-tients presenting with symptoms of heart valve disease, despite it being one of the fi rst key protocols in de-tecting the disease, according to re-search from Heart Valve Voice. “GPs do an excellent job at assessing and diagnosing a wide range of diseases, including heart valve disease. How-ever, in some instances there may be a lack of awareness, and with the growing number of cases in the UK, more needs to be done to ensure there is a systematic plan in place to tackle this disease at all levels,” said Yassir Javaid, GP and Cardiovascular and Diabetes Clinical Lead at Nene CCG. “This is essentially what Heart Valve Voice is trying to facilitate and their work will be crucial to enable

clinicians to eff ectively support pa-tients.”

Once a patient has been diag-nosed with heart valve disease, they face a number of life changing treat-ment options. While valve treat-ment is most commonly performed through surgery, great progress has been made recently on less invasive procedures allowing for less trauma and a much quicker recovery. With procedures such as minimally inva-sive surgery and Transcatheter aortic valve implantation (TAVI), patients who were once unable to receive sur-

gery due to their age or co-morbid-ities, are now more likely to get the valve disease treatment they need.

It is being found that once a pa-tient with heart valve disease is di-agnosed early enough and receives treatment, their lives transform sig-nificantly. New European guide-lines released last month will ena-ble healthcare professionals to treat more people, but awareness is still low. Pat Khan, a Heart Valve Voice pa-tient ambassador says, “I got my life back after my valve replacement and even participated in the Heart Valve

Voice cycle ride from London to Paris this past May. I’d put my symptomsdown to old age, which was a terriblemistake and an eagle-eyed GP listedto my heart and saved my life”.

“Given the signifi cant challengesthat the NHS is facing with an age-ing population and the expected in-crease in cases of valve disease, we believe that it is necessary that pa-tients receive their diagnosis andsubsequent treatment as swiftly as possible. If heart valve disease is caught early enough then more se-vere complications, such as heart attack or heart failure, can be avoid-ed,” said Wil Woan, Heart Valve VoiceCEO. “Last year, we published a com-prehensive report that has been putforward to parliament containing our key recommendations that we believe are crucial if we are to im-prove the diagnosis, treatment and care of heart valve disease.”

At Heart Valve Voice’s we say, ‘Themore we listen, the more lives wesave’ - so make sure you ask your GPto listen to your heart the next timeyou see them.

When was the last time your GP checked your heart with a stethoscope?

Heart Valve Voice, a charity raising awareness of heart valve disease, says a stethoscope check is often the fi rst step in detecting a common disease that aff ects over one million people over the age of 65 in the UK.

Yassir Javaid GP and Cardiovascular & Diabetes

Clinical Lead at Nene CCG

Wil Woan Heart Valve Voice CEO

Feature supported by Edwards Lifesciences

AN INDEPENDENT SUPPLEMENT BY MEDIAPLANET MEDIAPLANET 15

Not long after her 50th birthday in 2005, Marina at-tended a Well Woman Clinic, as many wom-

en do, to look into having Hormone Replacement Therapy (HRT). It was during the routine tests at the clin-ic that she fi rst discovered her blood pressure was quite high. On the clin-ic’s recommendation, she paid a visit to her GP. Thinking back, Marina al-so had begun to notice that she would sometimes feel shortness of breath when she exerted herself, but sim-ply thought it was all part of being in your 50s!

Her GP listened to her heart with a stethoscope and immediately sus-pected aortic stenosis so he referred her to the cardiologist. This suspect-ed diagnosis came as a shock to Ma-rina as she hadn’t heard of valve dis-ease, in fact only seven per cent of over 60s in a recent survey have. Be-ing a fellow clinician, Marina wanted to fi nd out all that she could about her diagnosis and asked as many ques-tions as she could think of. She was told that her symptoms would most

likely worsen over time and that she would require an aortic valve replace-ment in the future. Not the news she was hoping to hear!

As her AS was only mild, her cardi-ologist arranged for her to visit him once a year to see how it was pro-gressing. Each year she would go for her check up and each year she be-gan to notice herself slowing down and her symptoms becoming worse. In 2010, it become diffi cult to ignore the fact that she was more breathless than her older peers and she resort-ed to doing things at a much slower

pace than before. At the same time,her yearly echocardiogram began toshow her AS progressing from mildto moderate and fi nally to severe.

Finally, on 7 June 2014, Marina wasadmitted to have her aortic valve re-placement surgery.

Since her surgery, Marina’s life isfi nally back to normal and she is feel-ing much more like her usual self.She took six months off to recoverand get herself back into shape beforereturning to her work full-time. Shehas been able to continue with heractive lifestyle as well and still fi ndstime to do her favourite activities, es-pecially hillwalking.

“While my experience with aorticstenosis has been a rollercoaster ride,I am so glad that I fi nally wentthrough with my treatment.” saidMarina, “I am now able to keep upwith all of my friends on our walksand I still have the energy to work ina job that I get so much out of andcontribute so much back to youngermidwifes. I have a new lease on lifeand plan to make the most of it all. Tothink, it was just because a GP pickedup his stethoscope and had listen tomy heart!”

Feeling older

than your age?

Think Heart Valve

Disease

Visit your

healthcare

professional

for a

stethoscope

check

The more we

listen, the

more lives

we save

HHaving chest pain

Are you suffering from chest pain,

dizziness, or experiencing palpitations

EExercise difficulties

Are you finding it difficult to exercise and

move around easily?

AAge

Are you feeling older than your age?

RRespiratory difficulties

Are you feeling short of breath?

TTiredness

Are you suffering from tiredness and

fatigue?

Marina McGrath’sheart valve disease storyMarina was an active woman in her 50s, working hard as a midwife until she noticed symptoms of breathlessness and tiredness. It wasn’t until a visit to her GP that she found out she had aortic stenosis (AS).

Marina McGarthHeart Valve Voice Ambassador

with heart failure. Cardiovascular Health€¦ · fats - Omega-3s * c S ince the 1960s we’ve made...

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Transcript of with heart failure. Cardiovascular Health€¦ · fats - Omega-3s * c S ince the 1960s we’ve made...