Speakers

Prof. Martin COWIE
Professor of Cardiology, National Heart and Lung Institute, Imperial College London, London, United Kingdom

Martin Cowie is Professor of Cardiology at the National Heart and Lung Institute at Imperial College London. He is an Honorary Consultant Cardiologist at the Royal Brompton and Harefield NHS Foundation Trust, where he leads the heart failure service, and he was a Non-Executive Director of the National Institute for Health and Care Excellence (NICE) from 2016-2020.

Professor Cowie's research interests focus on health technology assessment and delivery of efficient and effective care for patients with heart failure, with a focus on diagnostics, drugs, or devices. He also has had a longstanding interest in evaluating remote monitoring and now digital technologies in heart failure.

Professor Cowie is a founding member and past-Chairman of the British Society for Heart Failure, in addition to being a Fellow of the American College of Cardiology, and the European Society of Cardiology (ESC). He chairs the Digital Health Committee of the ESC, and was responsible for organizing the first European Society of Cardiology Digital Summit in October 2019 in Tallinn (please view on https://www.escardio.org/Education/Digital-Health-and-Cardiology/educational-resources-on-digital-health). Professor Cowie was shortlisted for the NHS Digital Champion (Leadership) Award in England in 2017, was awarded the Thomas Lewis Medal for services to British Cardiology in 2019, and was the recipient of the Roy Award from the UK Heart Failure Patient Charity, Pumping Marvellous in 2019 for outstanding contribution to excellence in heart failure.

Professor Cowie is an Associate Editor of Heart and Journal of the American College of Cardiology- Heart Failure, and is an editorial board member of many other journals. He has contributed chapters to many books, and has written a book for patients entitled “Living with Heart Failure – A Guide for Patients”. He has published 300+ Pub-Med listed papers, has a current h-index of 78, with his work cited 70 000 times in the scientific literature.

He particularly enjoys speaking to members of the public about cardiovascular health issues, and has spoken at the Cambridge Science Festival, The Wellcome Foundation, The Dana Foundation, and most recently delivered a TEDx talk on “Beating the World’s Biggest Killer”, which you can view on
 https://www.youtube.com/watch?v=t_Xp65OUtU0  He has spoken at countless scientific meetings all around the world – and enjoys interacting with any audience.

back

Abstract

Emerging Data in Heart Failure: Are We Doing Enough for Our Patients?

There are now many options for patients with heart failure with reduced ejection fraction (HFrEF). New trials - such as DAPA-HF1 and EMPEROR-reduced2 - suggest that SGLT2 inhibition may soon be another pillar to HFrEF therapy. But how good are we at applying the knowledge we already have? This lecture will focus on how we can ensure that patients are managed according to best practice.   Many patients are losing out in terms of length of life, hospitalisation risk, and quality of life due to under-treatment. A global survey, QUALIFY, confirms that doctor compliance with guidelines is an important prognostic factor that is often overlooked.3

Heart rate is a good marker of prognosis (including hospitalisation risk) in HFrEF. We have known for 20 years that beta-blockade (BB) may improve prognosis – largely mediated by better heart rate control at rest and on exertion. Even when a BB is used at optimally tolerated doses, many patients still have a high resting heart rate, indicating a poorer prognosis.4 Corolan, an If channel blocker, is a well-tolerated drug that slows sinus rhythm and its use can improve patient quality-of-life, and reduce the risk of cardiovascular mortality and HF hospitalisation risk.5,6 Despite us knowing this for over a decade, many, if not most, patients are left with a higher-than-ideal resting heart rate.

When we see a patient with HFrEF, we must not forget the basics: in addition to lifestyle measures polypharmacy will be required - the better the doctor is at following the guidelines the better the patient’s outcome will be.  The OPTIMIZE-HF programme uses simple tools to drive up the quality of care – using protocols, discharge check lists, and patient information (written and electronic) to help improve outcomes without additional expenditure.7   

References

  1. McMurray JJV, Solomon SD, Inzucchi SE et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N. Engl. J. Med. 2019; 381: 1995 – 2008.
  2. Packer M, Anker SD, Butler J et al. Cardiovascular and renal outcomes with empagliflozin in heart failure. N. Engl. J. Med. 2020; 383: 1413 – 24.
  3. Komajda M, Schope J, Wagenpfeil et al. Physicians’ guideline adherence is associated with long-term heart failure mortality in outpatients with HFrEF: the QUALIFY International registry. Eur. J. Heart Fail. 2019; 21: 921 – 929.
  4. DeVore AD, Mi X, Mentz RJ et al. Discharge heart rate and beta-blocker dose in patients hospitalized with heart failure: findings from the OPTIMIZE-HF Registry. Am. Heart J. 2016; 173: 172 – 8.
  5. Swedberg K, Komajda M, Bohm M et al. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. Lancet 2010; 376: 875 – 85
  6. Ekman I, Chassany O, Komajda M et al. Heart rate reduction with ivabradine and health related quality of life in patients with chronic heart failure: results from the SHIFT study. Eur. Heart J. 2011; 32: 2395 – 2404.
  7. Cowie MR, Lopatin YM, Saldarriaga et al. The Optimize Heart Failure Care Program: initial lessons from global implementation. Int. J. Cardiol. 2017; 236: 340 – 44.   

 

back