HEARTBEAT FONT TRIAL

Indications for an implanted cardiac defibrillator are unclear, with a high rate of device complications in these patients. However, as the study by Broendberg and colleagues 5 shows, the dominantly inherited ryanodine receptor-2 (RyR2) gene has variable penetrance with gene-positive family members having fewer symptoms and a lower risk of sudden cardiac death compared with proband patients presenting with symptoms or sudden death ( figure 3).Īs Pflaumer 6 explains in an editorial, the RyR2 gene is important in regulation of cardiac myocyte calcium homeostasis thus, anti-arrhythmic medications may be effective in some patients. ‘Finally, at present, the potential of Electronic health records (EHR) for development and validation of risk prediction tools across diseases remains largely untapped with few multicentre studies and even fewer with validation across sites.’ ‘The current paradigm of multivariable Cox regression models informed by prospective cohort studies testing the incremental gain of novel biomarkers one by one needs to be challenged.’Ĭatecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare condition that presents with sudden death in about 1/3 of affected patients. We also need to show that risk stratification improves clinical outcomes, not just personalization of secondary prevention therapies. Most CVD risk scores predict only atherosclerotic events other types of heart disease such as heart failure and atrial fibrillation are increasingly common. Still, there are several issues to address in future studies. Risk stratification could allow more intensive monitoring of secondary prevention in those at highest risk thus PREDICT-CVD has great value, particularly because it is based on routine clinical data. ( figure 2).īanerjee 4 comments that although we have robust tools for identifying people at risk of incident CVD, we have only limited ability to predict recurrent CVD events in patients with known CAD. Predicted event rates matched actual event rates in the original cohort with overestimation of risk in those at highest risk in a second cohort.

In addition to conventional risk factors, the risk score included ethnicity, comorbidities, body mass index, and renal function.

Poppe and colleagues, 3 developed a CVD risk score, called PREDICT-CVD, based on almost 25 thousand patients under age 80 years with known CVD in a New Zealand primary care cohort. In addition to interventions aimed at all CAD patients, more costly interventions can be directed to those who will benefit most if we can achieve adequate risk stratification. There is a potential of even greater benefit in low-income and middle-income countries, where the heaviest burden of cardiovascular disease reside and where the access of rehabilitation programmes and specialised care may be impaired.’ In the accompanying editorial, Marcolino and colleagues note that ‘It is also important to emphasise that it was an educational tool and an effective way of empowering patients to make informed decisions.’ 2 They go on to suggest that ‘The high effectiveness and low cost of this intervention, however, turn it as an excellent candidate to be scaled to reach a global population. Cost savings would be substantial, given that the text messaging programme is quite inexpensive. Overall, the TEXT ME programme was estimated to result in 563 fewer myocardial infarctions, 361 fewer strokes and 1143 additional QALYs in a target population of 50 thousand CAD patients.

The programme, called TEXT ME, consists of 4 weekly text messages for 6 months with message content targeted to each participant’s baseline cardiac risk factor profile across the domains of general health and medication adherence, diet, exercise, and smoking cessation.

HEARTBEAT FONT TRIAL

Burn and colleagues 1 used a Markov model, based on a previous randomised trial and meta-analysis, to evaluate the effect of a simple text messaging programme for secondary prevention of adverse cardiovascular disease (CVD) events and improvement in quality adjusted life years (QALYs) in patients with known coronary artery disease (CAD). We all look at our phones all the time text messaging offers a simple way to reach our patients one on one. It has been challenging to develop effective interventions to increase the number of people engaged in heart healthy behaviours.

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