Survival rates after cardiac arrest (CA) are increasing, with more patients and their families living with the psychological consequences of surviving a sudden CA. The currently available neuropsychological assessment tools and therapies were not designed for CA, and may be inadequate. The Essex Cardiothoracic Centre set up the United Kingdom's first dedicated multidisciplinary ''Care After REsuscitation'' (CARE) service, offering CA survivors and their caregivers systematic psychological, cognitive, and specialized medical support for the first 6 months after CA. Twenty-one patients were recruited into the CARE pilot service evaluation. Patients' health at hospital discharge was poor; however, by 6 months all components (except general health) had improved significantly, and were close to that experienced by ''healthy'' individuals. Five (26%) required referral to a psychiatrist, with all 5 (26%) subsequently being diagnosed with moderate-to-severe depression, and 3 (16%) with comorbid post-traumatic stress disorder. Our study demonstrates a large unmet clinical need in general and neuropsychological assessment, and our results suggest that offering appropriate and prompt specialist diagnosis and therapies leads to an improvement in health at 6 months.

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Ultrasound analysis of the calcaneus and serum markers of bone turnover were used to examine the bone status of healthy Nigerian women who reside in an area of the world where dietary calcium intake is generally low and estrogen replacement therapy is not widely available. A total of 218 women (108 premenopausal and 110 postmenopausal) between the ages of 16 and 95 years were enrolled in the study. Broadband ultrasound attenuation (BUA) and speed of sound velocity (SOS) were measured and used to calculate the stiffness index (SI) of the calcaneus. In this cross-sectional study, the Nigerian women exhibited a marked age-dependent decline in SI that was defined by the regression equation SI = 105.9 - 6.62E-3 x Age2. SI was significantly correlated with age (r = -0.41, P < 0.001) and with serum NTx concentrations (r = -0.26, P < 0.001), but not with serum levels of bone-specific alkaline phosphatase (BSAP). Years since menopause was also significantly correlated with SI (r = 0.40, P < 0.001). A significant increase in serum NTx concentration occurred at least a decade before a significant decline in SI was evident. In the total study group, 24% of the women had T-scores indicative of osteopenia and 9% had T-scores indicative of osteoporosis, based on US reference data. Although the reported current incidence of fracture is low in women in sub-Saharan West Africa, these data show that after menopause Nigerian women have a decline in bone quality and increase in bone turnover similar to North American Caucasian women.

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BackgroundArterial stiffness is an independent predictor for cardiovascular disease and mortality. There has been no previous research comparing the acute effects of exercise on arterial stiffness in resistance and endurance athletes. This information would help to reveal how arterial function responds to exercise training.ObjectivesTo measure and compare arterial stiffness and hemodynamic variables in resistance athletes, endurance athletes and controls, before and after moderate intensity exercise.MethodsCentral and peripheral pulse wave velocity (PWV) was measured using Doppler ultrasound and calculated by the ‘foot to foot’ method before and after exercise. PWV was initially measured at rest for a 1 min period. Thereafter subjects cycled for 30 min at moderate intensity (60% of maximum heart rate, based on age). PWV was measured at postexercise intervals of 3, 15 and 30 min. Blood pressure and heart rate measurement preceded all PWV measurements.ResultsControls were significantly younger than both athletic groups (p<0.05). Groups did not significantly differ in resting PWV. There was no change in central/peripheral PWV after exercise in the resistance and control groups. Central PWV significantly increased post exercise in endurance athletes (mean (sd) resting PWV: 8.0 (2.0) m/s; 3 min postexercise: 10.5 (4.0) m/s; p=0.027, 95% CIs: 0.30 to 4.42) and recovered to resting values by 15 min. Systolic blood pressure increased significantly (p<0.05) in the endurance group from 136 (16) g at rest to 151 (13) 3 min after exercise.ConclusionsPWV in the endurance group significantly increased after exercise, possibly due to the concomitant rise in blood pressure. However, PWV did not change in response to exercise in the resistance or control groups. Lack of significant differences between the groups may be explained by problems with ultrasound measurement and a small sample size in the resistance group.

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Introduction: There is limited data using continuous monitoring to assess outcomes of atrial fibrillation (AF) ablation. This study assessed long‐term outcomes of AF ablation in patients with implantable cardiac devices. Methods: 207 patients (mean age 68.1 ± 9.5, 50.3% men) undergoing ablation for symptomatic AF were followed up for a mean period of 924.5 ± 636.7 days. Techniques included The Pulmonary Vein Ablation Catheter (PVAC) (59.4%), cryoablation (17.4%), point by point (14.0%) and The Novel Irrigated Multipolar Radiofrequency Ablation Catheter (nMARQ) (9.2%). Results: 130 (62.8%) patients had paroxysmal AF (PAF) and 77 (37.2%) persistent AF. First ablation and repeat ablation reduced AF burden significantly (relative risk 0.91, [95% CI 0.89 to 0.94]; P <0.0001 and 0.90, [95% CI, 0.86–0.94]; P <0.0001). Median AF burden in PAF patients reduced from 1.05% (interquartile range [IQR], 0.1%‐8.70%) to 0.10% ([IQR], 0%‐2.28%) at one year and this was maintained out to four‐years. Persistent AF burden reduced from 99.9% ([IQR], 51.53%‐100%) to 0.30% ([IQR], 0%‐77.25%) at one year increasing to 87.3% ([IQR], 4.25%‐100%) after four years. If a second ablation was required, point‐by‐point ablation achieved greater reduction in AF burden (relative risk, 0.77 [95% CI, 0.65–0.91]; P <0.01). Conclusion: Ablation reduces AF burden both acutely and in the long‐term. If a second ablation was required the point‐by‐point technique achieved greater reductions in AF burden than “single‐shot” technologies. Persistent AF burden increased to near pre ablation levels by year 4 suggesting a different mechanism from PAF patients where this increase did not occur.

Background Increasing evidence exists suggesting that cardiac contractility modulation therapy (CCM) improves symptoms in heart failure patients if various selection criteria are fulfilled. The aim of this study is to analyse an unselected sample of heart failure patients to establish what percentage of patients would meet the current criteria for CCM therapy. Methods All patients admitted to two district general hospitals in the UK in 2018 with a diagnosis of heart failure were audited for eligibility for CCM therapy. The selection criteria were (a) ejection fraction (EF) 25%‐45%, (b) QRS duration less than 130 ms, (c) New York Heart Association (NYHA) class 3‐4 and (d) treated for heart failure for at least 90 days and on stable medications. Exclusion criteria included: (a) significant valvular disease, (b) permanent or persistent atrial fibrillation, (c) biventricular pacing system implanted or QRS duration more than 130 ms and (4) patients not suitable for device therapy as a result of palliative treatment intent. Results A total of 475 patients were admitted with heart failure during the study period. From this group, 24 (5.1%) patients fulfilled the criteria for CCM therapy. The mean age and ejection fraction were 70.8 ± 10.2 and 32.5% ± 7.4%. The majority of patients were men (71%) and had an ischaemic cardiomyopathy (75%). If patients with atrial fibrillation were included, an additional 18 (3.8%) patients potentially may be eligible for CCM. Conclusion Only 5.1% of all patients presenting with heart failure might benefit from cardiac CCM. This is a small proportion of the overall heart failure population. However, this population has no other current option for device therapy of their condition.