The research, carried out by Leeds Teaching Hospitals NHS Trust and the University of Leeds, found that ultrasound screening commonly identifies heart muscle weakness in people with pacemakers, which is best treated in specialised heart failure services.
Funded by the National Institute for Health and Care Research (NIHR), the independent study is one of the largest of its kind in the world. It demonstrates the effectiveness of a comprehensive strategy for screening and management with major implications for healthcare policy.
With up to 30% of the one million pacemaker users in the UK having undiagnosed heart failure, the study highlights the potential need for combined heart failure-pacemaker clinics across the country and could influence cardiac care guidelines globally.
Pacemakers are small devices, around the size of a matchbox, that send electrical pulses to the heart to keep it beating regularly and not too slowly. They can significantly improve quality of life and can be lifesaving for some people. However, pacemakers can inadvertently contribute to heart muscle weakness, especially in patients with pre-existing conditions like high blood pressure, previous heart attacks or arrhythmias.
The study has the potential to reshape how patients using pacemakers are managed. If future research replicates these results, guidelines for managing patients using pacemakers could shift globally – Dr Maria Paton
Leeds is home to the largest cardiac device research hub in the UK. An expert team led by Cardiac Scientist Dr Maria Paton (pictured above right) and Consultant Cardiologist Dr Klaus Witte (pictured above left) investigated whether screening for heart muscle weakness followed by treatment with medication could reduce hospitalisations and extend lifespans.
Explaining the study’s novel dual focus, Dr Paton said: “Screening for a condition must lead to a treatment that improves outcomes; otherwise screening to find a condition that has no effective treatment increases healthcare costs without patient benefit.”
A cohort of 1,201 patients was randomised into two groups: one receiving heart scans and potential treatment adjustments based on the results and the other receiving usual care without screening. Screened patients underwent a 30-minute heart ultrasound scan to identify heart muscle weakness. Treatment consisted of a specialist heart failure clinic delivering comprehensive care and optimising medications.
The findings, published in Nature Medicine journal, suggest an advantage for patients managed in a specialist clinic compared to those under the usual care pathways. Patients in the specialist clinic received tailored medication regimes, and pacemaker programming to manage their heart failure.
Dr Klaus Witte, a senior lecturer at the University of Leeds, said: “The results are promising. Screening and then directing patients to specialist care that focuses on both the pacemaker and heart function could improve long-term outcomes.”
Dr Paton, who has a background in cardiac physiology research, added: “The study has the potential to reshape how patients using pacemakers are managed. If future research replicates these results, guidelines for managing patients using pacemakers could shift globally, emphasising the need for access to heart function assessments and tailored care.”
Pacemaker implantation is one of the most common types of heart surgery in the UK with an estimated 43,000 procedures carried out every year.
The paper, ‘Echocardiographic screening for heart failure and optimisation of the care pathway for individuals with pacemakers: a randomised controlled trial’, can be found on the Nature Medicine website.