Harefield Hospital

Abstract Background Direct-to-patient platforms can remove geographic and clinic-capacity barriers to rare-disease research. Heart Hive was developed to support nationwide, genomics-enabled cardiomyopathy research and rapid patient-study matching. Methods Adults with a cardiomyopathy diagnosis or inherited risk self-enrol in the heart hive platform, complete baseline data about their condition for study matching, and are invited to provide longitudinal data including patient-reported outcomes. In a pilot Cardiomyopathy Study to validate this route of patient identification, participants provided online consent and returned saliva kits by post for central targeted sequencing (cardiomyopathy panel). Participants have consented to linkage with national death registrations (ONS) and Hospital Episode Statistics (HES). Engagement is supported by formal PPIE and patient-group partnerships. The Cardiomyopathy Study is ongoing: initially focused on HCM/DCM, it now includes ARVC and Takotsubo and is transitioning to whole-genome sequencing to characterise both rare and common variation. Results As of October 2024, 338 participants met eligibility for the validation study; 227/338 (67.5%) enrolled and completed baseline surveys; 195/227 (86%) returned saliva kits; 174 were sequenced for the study; follow-up survey completion was 83% among sequenced participants. The pilot cohort (98 DCM; 76 HCM) was 57% female, 97.7% White European ancestry, median age 57.5 years at recruitment; 78% had never previously taken part in cardiovascular research. Genetic architecture was equivalent to a clinic-recruited comparator: rare variants in DCM genes in 34.7% vs 30.6% (p=0.42) and in HCM genes in 44.7% vs 38.2% (p=0.30), with no gene-level distribution differences. Actionable variants were identified in 17% of DCM and 29% of HCM participants opting for personal results. Conclusions The pilot Cardiomyopathy Study validates that patient self-report can identify cardiomyopathy patients with the same accuracy as clinic-ascertained cohorts based on equivalent genetic architecture. We also show our approach generates strong engagement and retention. The Heart Hive platform operationalises a trial-ready, patient-centred model for cardiomyopathy: fully decentralised enrolment, sustained retention, and linkage-ready approvals for registry-verified outcomes. More broadly, the Heart Hive platform provides a national ‘front door’ for REC-approved cardiovascular research: patient–study matching (including genotype where required), study-specific e-consent, longitudinal participant-facing data capture and democratised sharing of study opportunities with research-willing participants. Optional mail-out genomic sequencing can be deployed when a project requires genotype-confirmed eligibility, enabling rapid feasibility checks, start-up, and re-contact for precision-therapy studies.

Yew leaf intoxication – a rare yet potentially fatal condition caused by ingestion of Taxus baccata leaves – can lead to severe cardiotoxicity, manifesting as cardiac arrhythmias and cardiogenic shock. This report presents a case of a patient who ingested approximately 30 grams of yew leaves in an attempted overdose. The patient was admitted to the emergency department in cardiogenic shock and experienced cardiac arrest upon arrival. They were successfully resuscitated in the emergency department. Given their haemodynamic instability, they were transferred to a quaternary centre and treated with veno-arterial extracorporeal membrane oxygenation, along with other supportive measures including gastroscopy, intralipid, digoxin immune fab (antidote for digoxin toxicity), insulin, amiodarone, and adrenaline infusions. The patient showed significant improvement through multidisciplinary interventions, leading to successful weaning off extracorporeal membrane oxygenation and subsequent decannulation. They were then repatriated to the initial admitting hospital for further recovery. This case underscores the importance of early recognition and intervention in yew leaf poisoning, highlighting the critical role of veno-arterial extracorporeal membrane oxygenation in managing severe cardiogenic shock secondary to yew leaf toxicity. A review of existing literature reveals limited reported cases of veno-arterial extracorporeal membrane oxygenation use in yew leaf poisoning, underscoring the rarity of such interventions and the need for heightened clinical awareness and preparedness for life-saving treatments.

AimsTo analyze and compare the efficacy and safety of cryoballoon catheter ablation (CBA) and radiofrequency ablation (RFA) in the first treatment of patients with persistent atrial fibrillation (PerAF).Methods116 patients with PerAF who underwent the first-time catheter ablation were enrolled retrospectively, including 56 patients in CBA group and 60 patients in RFA group. The primary endpoint was symptomatic onset after 3 months of ablation or occurrence of atrial arrhythmia (ATA) with any documented duration more than 30 s. The secondary endpoints were perioperative complications and re-ablation 3 month after procedure.ResultsNo remarkable difference existed between CBA group and RFA group in the recurrence rate one year after operation (CBA 16.1% vs. RFA 23.3%, P = 0.360). Additionally, the complication rates were similar between the two groups (CBA 25.0% vs. RFA 35.0%, P = 0.312).ConclusionIn this real-world study, the effectiveness and overall safety of CBA and RFA in the treatment of PerAF were comparable.

Background/Objective: Warfarin is the standard anticoagulant for patients with mechanical heart valve replacement (HVR). However, its narrow therapeutic index and interpatient variability complicate early postoperative management. Evidence on how valve position influences warfarin sensitivity is limited. This study evaluated the impact of prosthetic valve position and clinical factors on early warfarin response and developed a prediction model to guide initial warfarin dosing in HVR patients. Methods: A retrospective study was conducted on 310 adults who underwent mechanical aortic, mitral, or double valve replacement at Hamad Medical Corporation (2015-2022). Warfarin was initiated within 24 h postoperatively, and patients were monitored for three days. Outcomes included daily warfarin dose, international normalized ratio (INR) levels, attainment of therapeutic INR, INR overshoot (≥4), and the warfarin dose index on day 3 (WDI3). Predictors of WDI3 were analyzed using multivariable regression, and a LASSO model was applied to a dose prediction algorithm for the day 1 dose. Results: Mitral valve recipients required lower doses than aortic or double valve groups (p = 0.008) but had higher INR overshoot rates (18.75% vs. 16.05% and 4.55%; p = 0.033). Female sex and a higher baseline INR were associated with greater sensitivity (p < 0.01), whereas mitral/double valve position predicted reduced sensitivity (p = 0.010). Only half of the cohort reached therapeutic INR by day 3. The prediction model explained ~28% of dose variance with moderate performance. Conclusions: Valve position, sex, and baseline INR significantly influence early postoperative warfarin response. Incorporating these clinical factors into dosing algorithms may optimize initial warfarin management in HVR patients.

To identify factors associated with short-term mortality among patients receiving microaxial flow pump (mAFP) therapy for acute myocardial infarction-related cardiogenic shock (AMI-CS). We searched four databases (MEDLINE, Embase, CENTRAL, and Scopus) from January 1, 2004, to January 1, 2025. We selected English-language studies that included adults with AMI-CS receiving mAFP and evaluated factors associated with short-term mortality. We excluded patients receiving concurrent venoarterial extracorporeal membrane oxygenation, as well as studies that solely included patients presenting with out-of-hospital cardiac arrest. Two authors performed citation screening and data extraction. For each factor evaluated in at least two studies, we performed meta-analyses of adjusted odds ratios (aORs) using a random-effects model. Risk of bias was evaluated using the Quality in Prognosis Studies tool, and the certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development, and Evaluations methodology. Our primary analysis included 18 studies, encompassing 20,617 patients. Median short-term mortality across studies was 50.7% (interquartile range 38.4-55.3%). Factors associated with short-term mortality based on high-certainty evidence included: increased age (aOR, 1.04 per year [95% CI, 1.03-1.05 per year] or ≥ 65 yr (aOR, 2.42 yr [95% CI, 0.77-7.64 yr]), female sex (aOR, 1.26 [95% CI, 1.09-1.45]), higher body mass index (aOR, 1.05 per point [95% CI, 1.04-1.07 per point]), higher heart rate (aOR, 1.02 per beats/min [95% CI, 1.01-1.02 per beats/min]), higher serum creatinine (aOR, 1.35 per mg/dL [95% CI, 1.08-1.70 per mg/dL]), mechanical ventilation (aOR, 2.53 [95% CI, 1.82-3.53]), vasopressors (aOR, 1.52 [95% CI, 1.11-2.08] for any vasopressors and aOR, 1.37 [95% CI, 1.18-1.58] per each vasopressor), presentation with ST-elevation myocardial infarction (aOR, 1.59 [95% CI, 1.11-2.26]), cardiac arrest (aOR, 2.85 [95% CI, 2.22-3.64]), and hypoxic-ischemic brain injury (aOR, 5.36 [95% CI, 3.03-9.47]). We identified several prognostic factors associated with short-term mortality in AMI-CS patients receiving mAFP support. This work may help inform clinicians, patients, and families regarding utilization of mAFP in AMI-CS.