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  1. Article: Implementing a clinical scientist-led screening clinic for hypertrophic and dilated cardiomyopathies.

    Draper, Jane / Bastiaenen, Rachel / Carr-White, Gerald / Bueser, Teofila / Webb, Jessica / Evans, Colin / Nuthoo, Soraya / Sheikh, Nabeel

    Echo research and practice

    2024  Volume 11, Issue 1, Page(s) 10

    Abstract: Background: The burden of screening for inherited cardiac conditions on health services grows ever larger, with each new diagnosis necessitating screening of additional family members. Screening these usually asymptomatic, low-risk individuals is ... ...

    Abstract Background: The burden of screening for inherited cardiac conditions on health services grows ever larger, with each new diagnosis necessitating screening of additional family members. Screening these usually asymptomatic, low-risk individuals is currently performed by consultant cardiologists, consuming vital clinic resources that could otherwise be diverted to sicker patients requiring specialist consultant input. Clinical scientists now constitute a highly skilled and often underutilised group of individuals with training in areas such as clinical evaluation, 12-lead electrocardiography (ECG) interpretation, and echocardiography. These skills place them in a unique position to offer a full screening evaluation in a single consultation. The aim of this study was to implement and evaluate a novel clinical scientist-led screening clinic for first-degree relatives of patients with hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM). The clinical scientist-led screening clinic was established at a London tertiary centre to allow review of asymptomatic, first-degree relatives of patients with a confirmed diagnosis of HCM or DCM, independent of a cardiology consultant. Patients were evaluated with history, examination, ECG, and echocardiography, with further investigations if deemed necessary. A retrospective review was performed of the first 200 patients seen in the clinic.
    Results: Of the 200 individuals reviewed between September 2019 and July 2022, 99 had a proband with HCM and 101 a proband with DCM. Overall, 169 individuals (85%) revealed normal screenings and were discharged. Thirty-one individuals (15.5%), all asymptomatic, revealed ECG changes and/or significant echocardiographic findings. Of these, 21 individuals (10.5% of the total cohort) were subsequently diagnosed with a cardiomyopathy or early phenotypic changes consistent with a cardiomyopathy (11 with HCM and 10 with DCM). These individuals were referred on to an inherited cardiac conditions consultant clinic for regular follow-up. Overall, 179 consultant clinic appointments were saved which could instead be allocated to patients requiring specialist consultant input.
    Conclusions: This is the first description of a clinical scientist-led screening clinic for first-degree relatives of patients with HCM and DCM. The findings demonstrate that implementation of such a service into routine clinical practice is feasible, effective, safe, and can free up capacity in consultant clinics for patients requiring specialist input.
    Language English
    Publishing date 2024-04-17
    Publishing country England
    Document type Journal Article
    ZDB-ID 2777997-X
    ISSN 2055-0464
    ISSN 2055-0464
    DOI 10.1186/s44156-024-00045-0
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Detecting heart valve disease: can we do better?

    Draper, Jane / Chambers, John

    The British journal of general practice : the journal of the Royal College of General Practitioners

    2016  Volume 66, Issue 644, Page(s) 156–157

    MeSH term(s) Atrial Fibrillation/diagnostic imaging ; Chest Pain/diagnostic imaging ; Early Diagnosis ; Echocardiography ; Heart Murmurs/diagnostic imaging ; Heart Murmurs/etiology ; Heart Murmurs/pathology ; Heart Valve Diseases/diagnostic imaging ; Heart Valve Diseases/pathology ; Humans ; Practice Guidelines as Topic ; Prevalence ; Pulmonary Disease, Chronic Obstructive/diagnostic imaging ; Referral and Consultation ; Risk Assessment ; United Kingdom
    Language English
    Publishing date 2016-03
    Publishing country England
    Document type Journal Article
    ZDB-ID 1043148-2
    ISSN 1478-5242 ; 0035-8797 ; 0960-1643
    ISSN (online) 1478-5242
    ISSN 0035-8797 ; 0960-1643
    DOI 10.3399/bjgp16X684181
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: What Proportion of Patients With Heart Failure and Left Ventricular Ejection Fraction 40% to 49% Fulfill the Criteria for Heart Failure With Mid-Range Ejection Fraction?

    Webb, Jessica / Draper, Jane / S Carr-White, Gerald

    The American journal of cardiology

    2018  Volume 122, Issue 12, Page(s) 2166–2167

    MeSH term(s) Heart Failure/classification ; Heart Failure/physiopathology ; Humans ; Severity of Illness Index ; Stroke Volume/physiology ; Ventricular Function, Left/physiology
    Language English
    Publishing date 2018-09-13
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 80014-4
    ISSN 1879-1913 ; 0002-9149
    ISSN (online) 1879-1913
    ISSN 0002-9149
    DOI 10.1016/j.amjcard.2018.08.055
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Murmur clinic: validation of a new model for detecting heart valve disease.

    Draper, Jane / Subbiah, Sheila / Bailey, Rikki / Chambers, John B

    Heart (British Cardiac Society)

    2018  Volume 105, Issue 1, Page(s) 56–59

    Abstract: Objectives: We aimed to determine if auscultation or a point-of-care scan could reduce the need for standard echocardiography (transthoracic echocardiogram (TTE)) in community patients with asymptomatic murmurs.: Methods: Requests from general ... ...

    Abstract Objectives: We aimed to determine if auscultation or a point-of-care scan could reduce the need for standard echocardiography (transthoracic echocardiogram (TTE)) in community patients with asymptomatic murmurs.
    Methods: Requests from general practitioners were directed to a new murmur clinic. Auscultation and a point-of-care scan were performed by a cardiologist between 1 October 2013 and 31 December 2014 and by a scientist between 21 July 2015 and 9 May 2017.
    Results: In the first phase (cardiologist), there were 75 patients, mean age 54 (56 women), and in the second phase there were 100 patients, mean age 60 (76 women). In the total population of 175, abnormalities were shown on TTE in 52 (30%), on point-of-care scan in 52 (30%) and predicted on auscultation in 45 (26%) (p=0.125; 95% CI -0.02 to 0.29). The sensitivity of auscultation was not significantly different for the cardiologist (91%) as for the scientist (83%) (p=0.18; 95% CI -0.22 to 0.175) and the specificity was 100% for both. Accuracy was 97% for the cardiologist and 95% for the scientist. For the point-of-care scan, the sensitivity, specificity, positive and negative predictive values and accuracy were 100% for both cardiologist and scientist.
    Conclusion: Most patients in a specialist murmur clinic had normal auscultation and point-of-care scans and no additional valve disease was detected by standard echocardiography. This suggests that a murmur clinic is a valid model for reducing demand on hospital echocardiography services.
    MeSH term(s) Echocardiography/methods ; Female ; Heart Auscultation/methods ; Heart Auscultation/standards ; Heart Murmurs/diagnosis ; Heart Valve Diseases/diagnosis ; Heart Valve Diseases/physiopathology ; Humans ; Male ; Medical Overuse/prevention & control ; Middle Aged ; Point-of-Care Testing/standards ; Predictive Value of Tests ; Reproducibility of Results ; Sensitivity and Specificity ; United Kingdom
    Language English
    Publishing date 2018-07-26
    Publishing country England
    Document type Journal Article ; Validation Study
    ZDB-ID 1303417-0
    ISSN 1468-201X ; 1355-6037
    ISSN (online) 1468-201X
    ISSN 1355-6037
    DOI 10.1136/heartjnl-2018-313393
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Comparison of the Diagnostic Accuracy of Plasma N-Terminal Pro-Brain Natriuretic Peptide in Patients <80 to those >80 Years of Age with Heart Failure.

    Draper, Jane / Webb, Jessica / Jackson, Tom / Jones, Hamish / Rinaldi, Christopher A / Schiff, Rebekah / McDonagh, Theresa / Razavi, Reza / S Carr-White, Gerald

    The American journal of cardiology

    2018  Volume 122, Issue 12, Page(s) 2075–2079

    Abstract: Plasma N-Terminal Pro-Brain Natriuretic Peptide (NTproBNP) is known to increase with age, however, the performance of this biomaker is unclear in patients >80. This study sought to define the diagnostic accuracy of plasma NTproBNP in patients >80 in a ... ...

    Abstract Plasma N-Terminal Pro-Brain Natriuretic Peptide (NTproBNP) is known to increase with age, however, the performance of this biomaker is unclear in patients >80. This study sought to define the diagnostic accuracy of plasma NTproBNP in patients >80 in a large unselected population of heart failure (HF) patients admitted to a Tertiary Hospital in the United Kingdom. 1,995 consecutive patients over a 12 month period were screened for HF through our NTproBNP led HF service. 413 patients had their first presentation of HF and 36.1% of these patients were >80. There was a reduction in accuracy of NTproBNP with age according to the area under the curve, with an area under the curve for all HF patients of 0.734 and a 7.5% reduction in receiver operating characteristic curve area for patients >80 years compared with those under 60 to 79 years of age. The lowest NTproBNP recorded for patients with HF >80 years of age was 466 pg/ml. In HF patients >80, 40.6% patients were diagnosed with HFrEF, 31.1% with HFpEF and 28.2% with HFmrEF. Overall NTproBNP is less accurate at identifying HF in patients >80 years of age and the lowest NTproBNP recorded for a HF patient was 466 pg/ml suggesting that the NTproBNP threshold for ruling out HF in patients >80 years of age should be modified.
    MeSH term(s) Adult ; Age Factors ; Aged ; Aged, 80 and over ; Biomarkers/blood ; Female ; Follow-Up Studies ; Heart Failure/blood ; Heart Failure/diagnosis ; Heart Failure/physiopathology ; Humans ; Male ; Middle Aged ; Natriuretic Peptide, Brain/blood ; Peptide Fragments/blood ; Protein Precursors ; ROC Curve ; Reproducibility of Results ; Retrospective Studies ; Stroke Volume/physiology
    Chemical Substances Biomarkers ; Peptide Fragments ; Protein Precursors ; pro-brain natriuretic peptide (1-76) ; Natriuretic Peptide, Brain (114471-18-0)
    Language English
    Publishing date 2018-09-13
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 80014-4
    ISSN 1879-1913 ; 0002-9149
    ISSN (online) 1879-1913
    ISSN 0002-9149
    DOI 10.1016/j.amjcard.2018.09.004
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: Is heart failure with mid range ejection fraction (HFmrEF) a distinct clinical entity or an overlap group?

    Webb, Jessica / Draper, Jane / Fovargue, Lauren / Sieniewicz, Ben / Gould, Justin / Claridge, Simon / Barton, Carys / Smith, Silapiya / Tondel, Kristin / Rajani, Ronak / Kapetanakis, Stamatis / Rinaldi, Christopher A / McDonagh, Theresa A / Razavi, Reza / Carr-White, Gerald

    International journal of cardiology. Heart & vasculature

    2018  Volume 21, Page(s) 1–6

    Abstract: Background: The new category of heart failure (HF), Heart Failure with mid range Ejection Fraction (HFmrEF) has recently been proposed with recent publications reporting that HFmrEF represents a transitional phase. The aim of this study was to determine ...

    Abstract Background: The new category of heart failure (HF), Heart Failure with mid range Ejection Fraction (HFmrEF) has recently been proposed with recent publications reporting that HFmrEF represents a transitional phase. The aim of this study was to determine the prevalence and clinical characteristics of patients with HFmrEF and to establish what proportion of patients transitioned to other types of HF, and how this affected clinical outcomes.
    Methods and results: Patients were diagnosed with HF according to the 2016 ESC guidelines. Clinical outcomes and variables were recorded for all consecutive in-patients referred to the heart failure service. In total, 677 patients with new HF were identified; 25.6% with HFpEF, 21% with HFmrEF and 53.5% with HFrEF. While clinical characteristics and prognostic factors of HFmrEF were intermediate between HFrEF and HFpEF, HFmrEF patients had the best outcome, with higher mortality in the HFrEF population (p 0.02) and higher HF rehospitalisation rates in the HFpEF population (
    Conclusion: HFmrEF patients had the best outcomes, compared to high rates of mortality seen in patients with HFrEF and high rates of HF readmissions seen in patients with HFpEF. Only 1/3 of HFmrEF patients transitioned during follow up, with the lowest mortality seen in patients transitioning to HFpEF.
    Language English
    Publishing date 2018-09-06
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 2818464-6
    ISSN 2352-9067
    ISSN 2352-9067
    DOI 10.1016/j.ijcha.2018.06.001
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: A cost effectiveness study establishing the impact and accuracy of implementing the NICE guidelines lowering plasma NTproBNP threshold in patients with clinically suspected heart failure at our institution.

    Webb, Jessica / Draper, Jane / Rua, Tiago / Yiu, Yee / Piper, Susan / Teall, Thomas / Fovargue, Lauren / Bolca, Elena / Jackson, Tom / Claridge, Simon / Sieniewicz, Ben / Porter, Bradley / McDiarmid, Adam / Rajani, Ronak / Kapetanakis, Stamatis / Rinaldi, Christopher A / Razavi, Reza / McDonagh, Theresa A / Carr-White, Gerald

    International journal of cardiology

    2018  Volume 257, Page(s) 131–136

    Abstract: Aims: The 2014 National Institute of Clinical Excellence (NICE) guidelines on the management of acute heart failure recommended using a plasma NT-proBNP threshold of 300pg/ml to assist in ruling out the diagnosis of heart failure (HF), updating previous ...

    Abstract Aims: The 2014 National Institute of Clinical Excellence (NICE) guidelines on the management of acute heart failure recommended using a plasma NT-proBNP threshold of 300pg/ml to assist in ruling out the diagnosis of heart failure (HF), updating previous guidelines recommending using a threshold of 400pg/ml. NICE based their recommendations on 6 studies performed in other countries. This study sought to determine the diagnostic and economic implications of using these thresholds in a large unselected UK population.
    Methods: Patient and clinical demographics were recorded for all consecutive suspected HF patients over 12months, as well as clinical outcomes including time to HF hospitalisation and time to death (follow up 15.8months).
    Results: Of 1995 unselected patients admitted with clinically suspected HF, 1683 (84%) had a NTproBNP over the current NICE recommended threshold, of which 35% received a final diagnosis of HF. Lowering the threshold from 400 to 300pg/ml would have involved screening an additional 61 patients and only would have identified one new patient with HF (sensitivity 0.985, NPV 0.976, area under the curve (AUC) at 300pg/ml 0.67; sensitivity 0.983, NPV 0.977, AUC 0.65 at 400pg/ml). The economic implications of lowering the threshold would have involved additional costs of £42,842.04 (£702.33 per patient screened, or £ 42,824.04 per new HF patient).
    Conclusion: Applying the recent updated NICE guidelines to an unselected real world population increases the AUC but would have a significant economic impact and only identified one new patient with heart failure.
    MeSH term(s) Biomarkers/blood ; Cost-Benefit Analysis/methods ; Heart Failure/blood ; Heart Failure/diagnosis ; Heart Failure/economics ; Hospitalization/economics ; Hospitalization/trends ; Humans ; Natriuretic Peptide, Brain/blood ; Natriuretic Peptide, Brain/economics ; Peptide Fragments/blood ; Peptide Fragments/economics ; Practice Guidelines as Topic/standards ; Reference Standards
    Chemical Substances Biomarkers ; Peptide Fragments ; pro-brain natriuretic peptide (1-76) ; Natriuretic Peptide, Brain (114471-18-0)
    Language English
    Publishing date 2018-03-06
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 779519-1
    ISSN 1874-1754 ; 0167-5273
    ISSN (online) 1874-1754
    ISSN 0167-5273
    DOI 10.1016/j.ijcard.2017.10.126
    Database MEDical Literature Analysis and Retrieval System OnLINE

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