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Health related quality of life (HRQoL) is rarely routinely measured in the clinical setting. In the absence of patient reported data, clinicians rely on proxy and informal estimates to support clinical decisions. This study compares clinician estimates (proxy) with patient reported HRQoL in patients with advanced heart failure and examines factors influencing discrepancies. Seventy-five patients with heart failure, (22 females, 53 males) completed the EQ-5D-5L questionnaire. Thirty-nine clinicians (11 medical, 23 nursing, 5 allied health) completed the proxy version (V1) producing 194 dyads. Correlation was assessed using Spearman’s rank tests, systematic bias was examined with Bland–Altman analyses. Inter-rater agreement at the domain level, was investigated using linear weighted Kappa statistics while factors influencing the IRG were explored using independent student t-tests, analysis of variance and regression. There was a moderate positive correlation between clinician HRQoL estimates and patient reported utility (r = 0.38; p

BACKGROUND: Ventricular assist devices (VADs) have provided a temporising solution to many individuals with refractory heart failure (HF) while awaiting a suitable donor for heart transplantation which remains the gold standard in treatment. Many of the discussions around VADs involve ongoing morbidity; however, one aspect of VADs that is often overlooked is the utility of their log files. We decided to review the literature for mentions of the clinical utility of VAD log files. METHODS: A keyword search was utilised on PUBMED using the terms ‘Ventricular Assist Device’ and ‘Log files’. Perhaps unsurprisingly, this search only yielded 4 results with further articles being discovered through the bibliography of these publications. RESULTS: The 4 identified articles provided basic information on log files, particularly with reference to the HVAD. Logs can be categorised into three types—data (pump parameters), events (changes in parameters) and alarms (abnormal function). Using a combination of these logs, we can readily identify abnormal pump operation such as the development and progression of pump thrombosis, suction events and gastrointestinal bleeding. However, the research potential of log files was not discussed in these publications, particularly as it pertains to areas such as studying speed modulation and pulsatility in VADs. CONCLUSIONS: VADs are an important staple in the treatment of patients with refractory HF. Log files provide a treasure-trove of information and knowledge that can be utilised for clinical benefit. Furthermore, log files provide an excellent tool for conducting research into device functionality. Current literature on the clinical utility of log files is sparse with much untapped potential.

A heart rate profile is constructed from continuous measurement of heart rate before, during and after exercise, typically in the context of an exercise stress test. It contains important clinical parameters such as resting heart rate, maximal heart rate during exercise, and decrease of heart rate in the recovery phase. An increase in resting heart rate, a decrease in heart rate elevation in response to exercise, and a delay in heart rate recovery are significant predictors of sudden death (Cole et al. 1999; Jouven et al. 2005). These measurements, when derived from a controlled exercise stress test regime, have high intra-individual reproducibility over 3 years, indicating their usefulness as a diagnostic tool (Orini et al. 2017). Heart rate parameters and profiles have been measured and constructed with exercise stress tests under controlled environments. This is often performed with a treadmill in a laboratory setting. With increasingly widespread availability of wearable wrist-worn fitness trackers, such as Fitbit and Apple Watch, we hypothesise that we can construct heart rate profiles for an individual using heart rate and physical activity (e.g. as measured by global positioning system and accelerator) data from a person’s wearable monitor. The main advantage of this approach is that it opens unprecedented opportunity to continuously and non-invasively monitor a person’s heart rate profile under free-living conditions, which would better match this person’s realistic activity profile. These devices are socially acceptable, generally inexpensive, and are already widely available in many communities. This potential cardiac function monitoring technology can be seamlessly incorporated into a user’s daily life, without the need for clinically based exercise stress testing. A number of recent studies have assessed the accuracy of popular wrist-worn wearable fitness trackers (Dooley et al. 2017; Shcherbina et al. 2017). They found that while energy expenditure estimations are often less accurate, the measurements of heart rate are generally considered accurate. These findings suggest that it should be possible to extract heart rate dynamics information before, during, and after an exercise event, which can be easily defined without accurate measurement of energy expenditure. Here, we present a new open source R package called CardiacProfileR. It is designed to efficiently extract heart rate and physical activity data from a Training Center XML (TCX) file which is generated by the most modern fitness tracking devices. CardiacProfileR can identify periods of active exercise from the data, and construct a heart rate profile for each period of active exercise. This package produces interactive visualisation of one or multiple heart rate profiles in two dimensions or three dimensions. This enables aggregation and comparison of data from multiple periods of exercise or comparison between multiple people. As far as we know, CardiacProfileR is the first open source R package that provides an end-to-end analysis framework for wearable fitness sensor data. CardiacProfileR is available via an MIT license at https://github.com/VCCRI/CardiacProfileR.

In patients with advanced heart failure, morbid obesity is a relative contraindication to heart transplantation due to higher morbidity and mortality in these patients.We performed a retrospective analysis of consecutive morbidly obese patients with advanced heart failure who underwent bariatric surgery for durable weight loss in order to meet eligibility criteria for cardiac transplantation.Seven patients (4 M/3 F, age range 31-56 years) with left ventricular ejection fraction (LVEF) ≤ 25 % underwent laparoscopic bariatric surgery. Median preoperative body mass index (BMI) was 42.8 kg/m(2) (range 37.5-50.8). There were no major perioperative complications in six of seven patients. Median length of hospital stay was 5 days. There was no mortality recorded during complete patient follow-up. At a median follow-up of 406 days, median BMI reduction was 12.9 kg/m(2) (p = 0.017). Postoperative LVEF improved to a median of 30 % (interquartile range (IQR) 25-53 %; p = 0.039). Two patients underwent successful cardiac transplantation. Two patients reported symptomatic improvement with little change in LV function and now successfully meet listing criteria. Three patients showed marked improvement of their LVEF and functional status, thus removing the requirement for transplantation.Bariatric surgery can achieve successful weight loss in morbidly obese patients with advanced cardiac failure, enabling successful heart transplantation. In some patients, cardiac transplantation can be avoided through surgical weight loss.

Heart transplantation is limited by donor organ availability. Increased use of marginal donor organs, combined with increased recipient complexity, has increased the risk of primary graft failure. These changes in donor and recipient characteristics have led to a renewed focus on modifiable donor–recipient characteristics that have historically been shown to impact on post-transplant outcomes, namely size and gender matching. Recently published analyses of large registries have found that the use of body weight to size donor organs for transplantation fails to predict post-transplant outcomes, whereas newer methods such as predicted heart mass (utilizing height, age, and gender as well as weight) correlate well with a number of post-transplant outcomes, including survival. The well recognized risks of under-sizing in female donor:male recipient transplants and in recipients with increased pulmonary vascular resistance are reinforced by recent studies. Over-sizing is not associated with increased risk or survival benefit versus ideally matched adult donor hearts.

Primary graft dysfunction (PGD) is a life-threatening complication of heart transplantation that presents as left, right, or biventricular dysfunction occurring within the first 24 hours of transplant surgery for which there is no identifiable secondary cause. Myocardial injury caused by acute catecholamine toxicity and the release of multiple proinflammatory mediators in the donor, followed by ischaemia-reperfusion injury sustained during retrieval, have been considered the predominant pathogenetic processes leading to PGD. Donor, recipient, and procedural factors contribute to the development and severity of the clinical syndrome. The changing donor and recipient characteristics over the last two decades, particularly the increasing donor and recipient age, have led to heightened risk of PGD. PGD is graded from mild to severe depending on the extent of circulatory support that is required to maintain haemodynamic stability and vital organ function. While advances in acute mechanical support devices have improved the outlook for patients with PGD, the rate of mortality remains high for those with severe PGD, reaching 40 %. Potential approaches to preventing or minimising the severity of PGD include optimising donor management, donor heart preservation, and donor/recipient matching.

Background The morphological and functional differences between arteries and veins may have implications on coronary artery bypass graft (CABG) survival. Although subjective differences have been observed between radial artery (RA) and long saphenous venous (LSV) grafts, these have not been quantified. This study assessed and compared the flow characteristics and in-vivo graft flow responses of RA and LSV aorto-coronary grafts. Methods Angiograms from 52 males taken 3.7 ± 1.0 months after CABG surgery were analyzed using adjusted Thrombolysis in Myocardial Infarction (TIMI) frame count. Graft and target coronary artery dimensions were measured using quantitative coronary angiography. Estimated TIMI velocity (VE) and volume flow (FE) were then calculated. A further 7 patients underwent in-vivo graft flow responses assessments to adenosine, acetylcholine and isosorbide dinitrate (ISDN) using intravascular Doppler. Results The VE for RA grafts was significantly greater than LSV grafts (P = 0.002), however there was no difference in volume FE (P = 0.20). RA grafts showed positive endothelium-dependent and -independent vasodilatation, and LSV grafts showed no statistically significant response to adenosine and acetylcholine. There was no difference in flow velocity or volume responses. Seven RA grafts (11%) had compromised patency (4 (6%) ≥ 50% stenosis in the proximal/distal anastomoses, and 3 (5%) diffuse narrowing). Thirty-seven (95%) LSV grafts achieved perfect patency and 2 (5%) were occluded. Conclusion The flow characteristics and flow responses of the RA graft suggest that it is a more physiological conduit than the LSV graft. The clinical relevance of the balance between imperfect patency versus the more physiological vascular function in the RA graft may be revealed by the 5-year angiographic follow-up of this trial.