There’s no such thing as ‘too fit’

News from the World of Cardiovascular Research

Publisher: Journal of the American Medical Association (JAMA)

Having reduced cardiorespiratory fitness (CRF) is as harmful to survival as coronary artery disease, smoking cigarettes or diabetes, suggests a retrospective study published Oct. 19 in JAMA Network Open.

Researchers analyzed data from 122,007 patients who underwent exercise treadmill testing, and stratified those individuals into five CRF groups based on how they stacked up against the average person of their age and sex: low (below 25th percentile), below average (25th-49th percentile), above average (50th-74th percentile), high (75th-97.6th percentile) and elite (97.7th percentile or higher).

Elite performers were 80 percent less likely to die than low performers over the median follow-up of 8.4 years. They were even 23 percent more likely to survive than high performers, an important finding considering recent evidence has suggested extreme amounts of exercise might actually be harmful. In this study, there appeared to be no upper limit for the benefit of increased CRF.

“Potentially adverse cardiovascular findings in highly active cohorts, including an increased incidence of atrial fibrillation, coronary artery calcification, myocardial fibrosis, and aortic dilation, have raised concern for potential cardiovascular risk above a certain exercise or training threshold,” wrote lead author Kyle Mandsager, MD, of the Cleveland Clinic Foundation, and colleagues. “It remains unclear whether these associations are signals of true pathologic findings or rather benign features of cardiovascular adaptation. The present study is the first, to our knowledge, to specifically evaluate the association between extremely high CRF and long-term mortality.”

The researchers noted their study is also different from many previous reports because it uses an objective measure of physical fitness rather than self-reported activity levels. Also, genetic factors and other lifestyle habits may contribute to both aerobic fitness and improved survival, they wrote.

Upon multivariable adjustment, Mandsager et al. found participants with below-average CRF versus above-average CRF had 41 percent decreased odds of survival—a risk on par with smoking or diabetes, and even greater than coronary artery disease (29 percent increased risk of all-cause mortality). And the survival odds were even greater for people with CRFs categorized as high or elite for their age and sex.

“These findings not only reinforce the large collective body of evidence correlating aerobic fitness with numerous health benefits but also illustrate the importance of aerobic fitness as a powerful, modifiable indicator of long-term mortality,” the authors wrote. “Healthcare professionals should encourage patients to achieve and maintain high levels of fitness.”

If you have any heart concerns or symptoms and would like to be reviewed, please contact the Dorset Heart Clinic to be seen by one of our expert cardiologists. We will always provide an appointment within a few days of being contacted.

Clot-busting drugs prevent 4,000 strokes each year

News from the World of Cardiovascular Research

Publisher: European Heart Journal

Half a million people in the UK are living with the undiagnosed heart rhythm disorder — Atrial Fibrillation — unaware they are at greater risk of having a stroke.

Increased use of anticoagulant drugs in patients who have a common heart rhythm disorder prevented four thousand strokes in England between 2015 and 2016.

The analysis — part-funded by us and published today in the European Heart Journal (EHJ) is re-assuring for patients who suffer from the condition known as atrial fibrillation, and a major success story for stroke prevention.

Atrial fibrillation (AF) affects around 1.2 million people in the UK, with 500,000 people believed to be living undiagnosed and unaware that they are at a 5-fold higher risk of stroke compared to those unaffected.

The findings highlight the urgent need for better screening and diagnosis of AF to ensure patients receive the clot-busting treatment which could prevent a devastating stroke.

Professor Chris Gale, Honorary Consultant Cardiologist at the University of Leeds commented on net next steps:

“Sudden strokes in people who have AF are unnecessarily common. Treatments which prevent AF-related strokes are saving lives, but there are still many thousands of people in the UK living with undiagnosed AF who are missing out.

The BHF-funded team from the University of Leeds used national data to analyse the known patients with AF, people seeing a consultant for stroke, new AF diagnoses and the use of anticoagulants amongst high risk patients between 2006 and 2016.

They found that, since 2009, the number of people with AF who are being treated with anticoagulants has more than doubled.

The researchers estimate that, had the uptake of anticoagulants stayed at 2009 levels, there would have been around 4,000 more strokes in patients with AF in England in the 2015/16 financial year.

Stroke is the fourth biggest killer in the UK and the leading cause of disability and in 2016, killed almost twice as many women as breast cancer.

Atrial fibrillation is the most common type of irregular heartbeat; it causes the heart’s chambers to beat in an uncoordinated, irregular manner. AF can cause blood to pool in the heart, which can form into a blood clot. It this clot travels to the brain it can block the blood supply, leading to a stroke.

AF contributes to between 20–30 per cent of all strokes, and treating these patients with anticoagulants — drugs which slow the formation of blood clots — can cut patients’ risk of stroke by two thirds.

Professor Sir Nilesh Samani, our Medical director points out the importance of spotting AF:

“Spotting AF is surprisingly easy; all it takes is a simple pulse check. A normal heart beat will feel regular, but if you find yours is irregular or random, go and see your GP. It could save your life,”

So why have things improved? The researchers say the reason more people are taking anticoagulant drugs is likely thanks to efforts across the health service to educate patients and doctors about the benefits of anticoagulation. It also comes down to changes to guidelines in the UK and Europe, and the development of new types of anticoagulants which provide a safer and more convenient alternative to warfarin.

Richard, a 47-year-old father of two from Dorset, was diagnosed with atrial fibrillation four years ago. After a Saturday morning coffee, he had sensations of butterflies in his chest. When it didn’t go away after a few hours, and he started to feel abnormally tired, he took himself to A&E.

“I had a heart attack when I was 36, so I knew I needed to get things checked. It was a complete shock when the doctors told me my heart was beating at between 170 and 200bpm. I could barely tell.

If you have any heart concerns or symptoms and would like to be reviewed, please contact the Dorset Heart Clinic to be seen by one of our expert cardiologists. We will always provide an appointment within a few days of being contacted.

Genetic tool to predict adult heart attack risk in childhood

News from the World of Cardiovascular Research

Publisher: Journal of the American College of Cardiology

People at high risk of a heart attack in adulthood could be spotted much earlier in life with a one-off DNA test, according to new research which we part-funded, published today in the Journal of the American College of Cardiology.

An international team led by researchers from the University of Leicester, University of Cambridge and the Baker Heart and Diabetes Institute in Australia used UK Biobank data to develop and test a powerful scoring system, called a Genomic Risk Score (GRS) which can identify people who are at risk of developing coronary heart disease prematurely because of their genetics.

People who are at high risk could be encouraged to make important lifestyle changes from an early age and be offered lifesaving medicines on a case to case basis, should they be necessary.

Genetic factors have long been known to be major contributors of someone’s risk of developing coronary heart disease – the leading cause of heart attacks. In today’s health system, doctors identify those at risk doctors use scores based on lifestyle and clinical conditions associated with coronary heart disease such as cholesterol level, blood pressure, diabetes and smoking. But these scores are imprecise, age-dependent and miss a large proportion of people who appear ‘healthy’, but will still develop the disease.

1.7 million genetic variants in a person’s DNA

The ‘big-data’ GRS technique takes into account 1.7 million genetic variants in a person’s DNA to calculate their underlying genetic risk for coronary heart disease.

The team analysed genomic data of nearly half a million people from the UK Biobank research project aged between 40-69 years. This included over 22,000 people who had coronary heart disease.

A powerful tool

The GRS was better at predicting someone’s risk of developing heart disease than each of the classic risk factors for coronary heart disease alone. The ability of the GRS to predict coronary heart disease was also largely independent of these known risk factors. This showed that the genes which increase the risk of coronary heart disease don’t simply work by elevating blood pressure or cholesterol, for example.

People with a genomic risk score in the top 20 per cent of the population were over four-times more likely to develop coronary heart disease than someone with a genomic risk score in the bottom 20 per cent.

In fact, men who appeared healthy by current NHS health check standards but had a high GRS were just as likely to develop coronary heart disease as someone with a low GRS and two conventional risk factors like high cholesterol or high blood pressure.

These findings help to explain why people with healthy lifestyles and no conventional risk factors can still be struck by a devastating heart attack.

Crucially, the GRS can be measured at any age including childhood as your DNA does not change. This means that those at high risk can be identified much earlier than is possible through current methods and can be targeted for prevention with lifestyle changes and, where necessary, medicines. The GRS is also a one-time test and with the cost of genotyping to calculate the GRS now less than £40 GBP ($50 USD) it is within the capability of many health services to provide.

Our medical director, Professor Sir Nilesh Samani, Professor of Cardiology at the University of Leicester was a senior author of the study and gave his thoughts:

“At the moment we assess people for their risk of coronary heart disease in their 40’s through NHS health checks. But we know this is imprecise and also that coronary heart disease starts much earlier, several decades before symptoms develop. Therefore if we are going to do true prevention, we need to identify those at increased risk much earlier.

“This study shows that the GRS can now identify such individuals. Applying it could provide a most cost effective way of preventing the enormous burden of coronary heart disease, by helping doctors select patients who would most benefit from interventions and avoiding unnecessary screening and treatments for those unlikely to benefit.”

Lead author Dr Michael Inouye, of the Baker Heart and Diabetes Institute and University of Cambridge also commented on the findings:

“The completion of the first human genome was only 15 years ago. Today, the combination of data science and massive-scale genomic cohorts has now greatly expanded the potential of healthcare.

“While genetics is not destiny for coronary heart disease, advances in genomic prediction have brought the long history of heart disease risk screening to a critical juncture, where we may now be able to predict, plan for, and possibly avoid a disease with substantial morbidity and mortality.”

Today, we are just beginning to harness the enormous potential of genomic medicine. Within the next decade scientists anticipate to see this kind of technology bringing countless benefits to the lives of patients.

If you have any heart concerns or symptoms and would like to be reviewed, please contact the Dorset Heart Clinic to be seen by one of our expert cardiologists. We will always provide an appointment within a few days of being contacted.

Dorset Heart Clinic selected to receive another national award for Public Private Partnership of the Year

WILTSHIRE, United Kingdom, Regent’s Park Healthcare Ltd., an independent healthcare company specialising in the delivery of cardiac services, today announced that the Dorset Heart Clinic has been selected as a finalist in the Public Private Partnership (PPP) of the Year category at the 2018 LaingBuisson Independent Healthcare Awards.

Entering their thirteenth year, the Independent Healthcare Awards which are sponsored by LaingBuisson (LB) are widely considered to be the most prestigious event in the healthcare sector calendar. The citation in the PPP award category reads: “For excellence in a strategic partnership between the public and independent sectors with a focus on outcomes, value for money and innovation.”

The judging panel aims to highlight the range of achievements within the independent healthcare sector and to pay tribute to those individuals and teams who have demonstrated outstanding excellence. LB are a leading independent provider of market intelligence to the independent sector and considered to have the expertise to identify and honour the best performing care providers in an industry where the independent sector is taking an ever more important role.

Commenting on the nomination, Dr. Ohri, CEO of Regent’s Park said: “It is a tremendous privilege to be nominated by LaingBuisson for these highly prestigious awards”. He added: “I believe the nomination is an endorsement of our business development strategy that is committed to finding efficient, high quality, and smarter ways of delivering healthcare with our NHS partners”.

Last year LB received over 350 nominations, with the winners on the night receiving their Awards in front of an audience of over 850 of their peers. The Awards will be hosted at the London Park Plaza Westminster Bridge Hotel in sight of the Houses of Parliament on 15th November 2018.

British Heart Foundation scientists develop tool for spotting deadly sepsis in people who have heart failure

News from the World of Cardiovascular Research

Publisher: Journal of the American College of Cardiology

Nearly one in four deaths in people with heart failure are caused by sepsis, according to new research published today in the Journal of the American Heart Association.

Researchers we fund have developed a way to identify patients who are most at risk, often years before they become ill.

The team hope the tool will help doctors determine which patients may benefit from closer monitoring and help to ensure they receive rapid treatment when they fall ill. Sepsis is a very serious complication of an infection. Without treatment it can lead to multiple organ failure and death. Catching cases early could save thousands of lives every year.

1 in 4 deaths

Professor Richard Cubbon, from the University of Leeds who led the study said, “We have created a simple way to identify people with heart failure who are at greatest risk of dying from sepsis. It could be part of a routine check which is already performed when they visit their doctors.”

With our risk profile, we hope people at high risk of sepsis will receive better monitoring, and infections which could lead to sepsis are treated early.”

550,000 people in the UK have been diagnosed with heart failure, but estimates suggest there may be many more cases.

Heart failure occurs when the heart is not pumping blood around the body as well as it should, most commonly when the heart muscle has been damaged – for example, after a heart attack. Around 550,000 people have been diagnosed with heart failure in the UK, but estimates suggest that in reality this figure is much higher. The debilitating condition causes breathlessness, fatigue and premature death. People who have heart failure are also more vulnerable to potentially deadly infections.

Researchers from the University of Leeds tracked 1,802 patients with chronic heart failure from 2006 to 2014 for an average of four years. The scientists collected information about each patient at the beginning of the study. During the study, 737 patients died, with 173 (23.5 per cent) deaths caused by sepsis.

The team analysed this data and found several distinct markers which flagged higher risk of death from sepsis specifically, rather than progressively worsening heart failure or sudden cardiac arrest.

Blood samples from high-risk patients contained lower levels of vitamin D and higher counts of platelets – cells which help blood clot. Those at high risk were also older, more likely to have chronic lung disease (chronic obstructive pulmonary disease) and more likely to be male.

The researchers used this data to create a ‘risk profile’ which could be used in future to flag patients at highest risk of dying from sepsis. These patients could receive counselling, closer monitoring by their GP and vaccines to prevent respiratory infections – the root cause of 70 per cent of sepsis cases in the study.

Sepsis, sometimes called blood poisoning, occurs when the immune system goes into overdrive in response to an infection and starts attacking the body’s own cells, causing damage to vital organs. It can take hold quickly and, without rapid treatment, can lead to multiple organ failure and death.

Our medical director Professor Sir Nilesh Samani, Medical Director at the British Heart Foundation also commented on the study.

“This observational study re-emphasises that, despite modern treatments, people with heart failure have a prognosis that is worse than many cancers with 2 out of 5 people dying within 4 years.

“The new finding here is that sepsis is an important cause of death in these patients accounting for almost 1 in 4 deaths. We also now know that particular characteristics of the patients, some of which may be correctable, makes them more prone to developing sepsis.

“Further research is necessary but this study highlights potentially important ways in which we may be able to improve the outlook of patients with heart failure.”

Dorset Heart Clinic shortlisted as finalist at the 2018 HealthInvestor Awards

BOURNEMOUTH, United Kingdom, 3 April 2018: Regent’s Park Healthcare and The Royal Bournemouth & Christchurch Hospitals NHS Foundation have been shortlisted as Finalist in the Public Private Partnership of the Year category at the 2018 HealthInvestor Awards. The award relates to their partnership called the ‘Dorset Heart Clinic’.

Dorset Heart Clinic is a brand new, state-of-the-art, private patient cardiology centre located within the Royal Bournemouth Hospital that opened in April 2017. The clinic is the largest dedicated private cardiology centre on the south coast of England.

This innovative strategic partnership between the two organisations ensures that private patients receive the ‘best-of-both-worlds’: world-class specialist care and the very highest standard of service, together with the confidence of being in the NHS with its safety-net of services on hand – a vast array of specialist equipment and staff often lacking in a private hospital. It also allows profits from the treatment of private patients to be re-invested back into frontline NHS care.

In summary, the Dorset Heart Clinic business model is a highly innovative and disruptive approach to the delivery of private cardiac services across the UK. It provides a novel blueprint on how the public and private sectors can co-exist in the delivery of safe, high quality and efficient care.

Background to the HealthInvestor Awards:

  • The HealthInvestor Awards is the biggest event of the year for the independent health industry.
  • The forum is designed to promote excellence and recognise innovation in the independent healthcare sector and attracts over 1,200 guests each year to the Grosvenor House Hotel, London. This year, the judges will be looking for organisations and individuals that have made an outstanding contribution to healthcare in 2017.
  • The HealthInvestor Awards offer an opportunity to showcase expertise and commitment to what is an increasingly important sector for the UK economy. The awards are aimed at those professionals investing in, advising or operating companies in the health and social care and the finalists represent the leading players in this diverse and burgeoning market.
  • Successful entries are shortlisted on the awards website before being sent to an independent panel of high profile judges. Finalists and other firms active in the health sector will then have the opportunity to attend a gala dinner at the Grosvenor House Hotel, London’s largest prestige events venue.

For more information please visit the Dorset Heart Clinic website: or contact the Dorset Heart Clinic on 01202 705454.

Dorset Heart Clinic opens its doors

LONDON, United Kingdom, 3 April, 2017: Regent’s Park Healthcare Ltd. (RPH), an independent healthcare company specialising in the diagnosis and treatment of heart disease, today announced the opening of “The Dorset Heart Clinic”.

The Dorset Heart Clinic is a world-class, state-of-the-art, private patient cardiology centre located within the Royal Bournemouth Hospital – it is the largest dedicated private cardiology facility on the south coast of England.

The Dorset Heart Clinic provides a comprehensive range of outpatient and invasive cardiology services that include: cardiac screening, cardiac rehabilitation, outpatient investigations, simple and complex coronary stenting, device implantation, pacemaker insertion, cardioversion, cardiac resynchronisation therapy, simple and complex cardiac electrophysiology & ablation.

The Dorset Heart Clinic comprises a fully equipped outpatient suite on the first floor of the Jigsaw building with five private consulting rooms and four treatment rooms offering a full range of outpatient cardiology investigations including cardiac CT and cardiac MRI. Inpatient cardiology services with access to four cardiac cath labs are provided from a newly refurbished private patient room area called the ‘Regent’s Park Suite’. Each of the private rooms have ensuite facilities, smart TVs, internet access and dedicated telephones. Patients will also benefit from luxury bed linen, bathroom towels, robes, slippers and toiletries, as well as a private dining menu of quality food served with silver-plated cutlery. An on-site, full-time, business and patient support team will ensure private patients receive a first-class experience in a safe, welcoming and high-quality environment.

The Dorset Heart Clinic is led by a team of consultant cardiologists from the Royal Bournemouth Hospital. They are at the forefront of their respective areas of clinical practice with reputations synonymous with excellence both nationally and internationally. They are supported by a comprehensive team of cardiac professionals that include specialist nurses, physiologists, radiographers and dietitians. The Royal Bournemouth Hospital has one of the largest and best equipped cardiac departments in the NHS with over 300 cardiac staff, 4 cath labs and 16 critical care beds. Together, the Dorset Heart Clinic team provide expertise across every aspect of cardiovascular disease management.

The Dorset Heart Clinic is registered as a private acute healthcare facility with the Care Quality Commission. It has also been awarded BUPA healthcare quality accreditation and therefore recognition as a cardiac centre across the nationwide BUPA network. The heart clinic is located in bespoke facilities, integrated with the NHS, to ensure the highest level of safety and quality.

Dr. Ohri, Chief Executive Officer of Regent’s Park Healthcare Ltd said, “This is a very exciting day for all of us. It is the culmination of many months of careful planning and a tribute to the successful working relationship between the Trust, the cardiologists’ and our company.” He added, “This is a win-win for all. It will mean private patients are assured of world-class specialist care and the very highest standard of service, together with the confidence of being in the NHS with its safety-net of resources on hand. It will allow cardiologists’ to remain within their NHS hospital, to support the NHS, and to work with staff that they know. It will also mean the Trust can repatriate income from private hospitals and re-invest these monies back into frontline NHS care.”

He said, “We feel privileged to be opening the Dorset Heart Clinic and to continue working with the highly dedicated staff and management at the Royal Bournemouth Hospital. We believe there is a large market gap for safe, high quality, private cardiology services across the region, it is a gap we intend to fill and grow in the coming months and years ahead.”

Dr. Ohri added, “In summary, the Dorset Heart Clinic will provide unparalleled world-class specialist care and the very highest standard of service to patients with heart disease from across the county and its surrounding areas, the Channel Islands and internationally.”

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