Beatwise The Podcast

What do the new ESC guidelines actually mean for people living with heart failure?In this episode of Beatwise The Podcast, I speak with heart failure nurse Becky Hyland, chair of the British Society for Heart Failure Nurse Forum, about how updated European Society of Cardiology guidelines should translate into everyday care in the UK.We explore changes to heart failure definitions and staging, and why recognising people at risk could help shift services towards prevention and earlier diagnosis. We also discuss foundational medical therapy, including MRAs and finerenone, and the practical challenges of getting treatments to the patients who could benefit. But a recommendation is only useful if we can put it into practice.Becky shares her perspective on the barriers facing heart failure services, from commissioning and workforce pressures to prescribing and follow-up. We discuss who checks blood results, who adjusts medication, and who patients can contact when they need support.We also explore why a heart failure diagnosis should be the beginning of the investigation. Understanding the underlying cause - whether coronary artery disease, valve disease, an inherited condition or cardiac amyloidosis - can make a difference to the treatment offered.Finally, we discuss when to consider devices and valve interventions, recognising advanced heart failure earlier, and how specialist referral and palliative care can support patients and their families. Throughout the conversation, we return to the importance of working together and ensuring that patients are involved in decisions about their care.Key issues addressed:Changes to heart failure definitions and ejection fraction categoriesHeart failure stages and the shift towards preventionFoundational medical therapy, MRAs and finerenoneAccess to treatment and follow-up for patients with HFpEFMonitoring kidney function and potassium, and adjusting medicationIdentifying the underlying cause of heart failureThe role of cardiac imaging, genetic testing and amyloidosis assessmentWhen to consider CRT and valve interventionsRecognising advanced heart failure and referring earlierPalliative care, symptom support and planning around patients’ wishesWorkforce, shared pathways and education in UK servicesHelping patients understand and participate in their careEPISODE HIGHLIGHTS:00:00 What Do the New Guidelines Mean for Heart Failure Care?02:19 Changes to Ejection Fraction Categories and Heart Failure Stages04:37 Prevention, Earlier Diagnosis and Teamworking08:47 Foundational Medical Therapy and MRAs11:28 Blood Tests, Medication Monitoring and Follow-Up16:16 Why We Need to Find the Cause of Heart Failure17:25 Imaging, Genetics and Amyloidosis21:08 Devices and Heart Valve Interventions25:47 Recognising Advanced Heart Failure and Referring Earlier30:51 UK Priorities: Workforce, Shared Pathways and Education35:18 Where Are the Gaps in Your Heart Failure Service?38:31 Closing ThoughtsIf you enjoyed this episode, please like, rate, and subscribe to Beatwise The Podcast. Your support helps me reach more listeners and continue providing valuable content.Don't forget to follow me on social media @sarah.theheartdoc for the latest updates, behind-the-scenes content, and more engaging discussions. Stay connected and be part of our growing community!

Has digoxin been pushed aside too soon in modern heart failure care?In this episode of Beatwise The Podcast, I speak with Prof. John Cleland about the evolving evidence for digoxin and other digitalis glycosides in heart failure, and whether these long-established treatments still have a role alongside contemporary guideline-directed medical therapy.We revisit the original DIG trial and explore why digoxin fell out of favour, from concerns around sudden cardiac death and arrhythmias to the arrival of newer heart failure therapies. Prof. Cleland explains how modern treatments including beta blockers, MRAs, ARNi, SGLT2 inhibitors and device therapy may change the risk-benefit equation.We also discuss the important differences between digoxin and digitoxin, how digitalis glycosides work, and new evidence that is prompting clinicians to take another look at this old class of drugs. So where might digoxin fit into heart failure management today?Prof. Cleland shares his perspective on its potential role as an additional therapy for patients with HFrEF who remain symptomatic despite guideline-directed treatment, as well as its use in congestion and atrial fibrillation. We also explore the evidence in patients with HFpEF and AF, including findings from RATE-AF, and what the DECISION trial adds to the debate.Finally, we discuss practical considerations around digoxin dosing and monitoring - and why Prof. Cleland believes the question of digoxin’s role in modern heart failure care still deserves a definitive large-scale clinical trial.Key issues addressed:Why digoxin fell out of favour in heart failure careDigoxin vs digitoxin: what is the difference?How digitalis glycosides work in heart failureWhat the original DIG trial actually showedHow modern heart failure therapy may change the safety of digoxinThe role of digoxin in HFrEF despite guideline-directed medical therapyDigoxin for atrial fibrillation and heart-rate controlWhat RATE-AF tells us about digoxin vs beta blockers in HFpEF and AFWhether digoxin has a role in managing congestionThe latest evidence from DECISION and contemporary digitalis trialsDigoxin dosing, therapeutic levels and monitoringWhy we may need a large, pragmatic digoxin trialEPISODE HIGHLIGHTS:00:00 The Comeback of Digoxin?00:50 Introducing Prof. John Cleland01:33 Digoxin vs Digitoxin: What’s the Difference?02:27 How Digitalis Glycosides Work03:13 What Did the DIG Trial Show?04:50 Why Did Digoxin Fall Out of Favour?06:55 Has Modern Heart Failure Therapy Changed the Risk?07:39 Who Should Receive Digoxin Today?08:34 Digoxin in HFrEF and Sinus Rhythm10:39 Digoxin and Atrial Fibrillation11:37 HFpEF, AF and the RATE-AF Trial13:24 Can Digoxin Help with Congestion?16:22 The DECISION Trial and Current Guidelines17:24 Low Blood Pressure and Advanced Heart Failure19:11 Digoxin Dosing and Monitoring20:57 Does Digoxin Need a New Mega-Trial?23:43 Final ThoughtsIf you enjoyed this episode, please like, rate, and subscribe to Beatwise The Podcast. Your support helps me reach more listeners and continue providing valuable content.Don't forget to follow me on social media @sarah.theheartdoc for the latest updates, behind-the-scenes content, and more engaging discussions. Stay connected and be part of our growing community!

Disclaimer: This sponsored episode of Beatwise has been independently developed and produced by Beatwise, with financial support from Bayer. Bayer has no role in speaker selection or in developing the content. This episode is strictly non-promotional and contains no discussion or reference to prescription-only medicines.In this episode of Beatwise The Podcast, I speak with Helen Kilminster about a topic that may not sound exciting at first but has huge implications for patient care: heart failure coding.We explore why accurate NHS coding is about far more than administration. The way heart failure is identified and coded influences everything from disease prevalence and service planning to funding, workforce, and access to specialist clinics. In particular, we discuss why heart failure with preserved ejection fraction (HFpEF) remains under-recognised despite accounting for around half of all heart failure cases.Helen shares her experience working in primary care, describing how audits, weekly data tracking, and careful review of investigations such as echocardiograms and NT-proBNP can help identify patients who may otherwise be missed. We also discuss the challenges of variable discharge summaries, the importance of clear communication between primary and secondary care, and how better coding can support earlier diagnosis and more proactive management.Finally, we explore how these ideas align with the NHS 10-Year Plan, including community-based care, technology-enabled monitoring, integrated neighbourhood teams, and whether concepts such as "pre-heart failure" coding could help identify high-risk patients before they develop advanced disease.Key issues addressed:Why accurate heart failure coding mattersWhy HFpEF is frequently missed in clinical practiceHow coding influences funding, workforce and specialist servicesThe role of primary care audits in identifying undiagnosed HFpEFImproving communication between primary and secondary careCommunity screening initiatives and raising awareness of heart failureThe NHS 10-Year Plan and the future of integrated heart failure careWhether "pre-heart failure" coding could support earlier intervention and preventionWhether you work in primary care, secondary care, or have an interest in heart failure services, this episode highlights why improving identification and coding is fundamental to delivering better care for patients.EPISODE HIGHLIGHTS:00:00 Coding sounds boring... but it isn't01:05 Meet today's guest03:02 Why HFpEF gets missed03:26 The reality of heart failure audits in primary care06:01 Complex patients need joined-up pathways08:24 The cost of inaccurate coding10:02 Community screening and awareness initiatives12:53 How the NHS 10-Year Plan could transform care16:24 How secondary care can improve coding and communication20:08 Why discharge summaries matter24:03 Could "pre-heart failure" coding improve prevention?26:24 Helen's elevator pitch for improving heart failure care28:12 Wrap up and final thoughtsIf you enjoyed this episode, please like, rate, and subscribe to Beatwise The Podcast. Your support helps me reach more listeners and continue providing valuable content.Don't forget to follow me on social media @sarah.theheartdoc for the latest updates, behind-the-scenes content, and more engaging discussions. Stay connected and be part of our growing community!

In this episode of Beatwise The Podcast, I speak with Dr Brian Halliday about one of the biggest advances in the treatment of obstructive hypertrophic cardiomyopathy (HCM): cardiac myosin inhibitors.For decades, treatment has focused on managing symptoms with medications such as beta blockers, verapamil and disopyramide, alongside septal reduction therapies for selected patients. We explore how cardiac myosin inhibitors represent a different approach by targeting the underlying hypercontractility that drives left ventricular outflow tract obstruction.We discuss the science behind these therapies, how they work at a molecular level, and the evidence from landmark clinical trials including EXPLORER-HCM, VALOR-HCM and SEQUOIA-HCM. Dr Halliday explains what these studies have taught us about symptom improvement, exercise capacity, left ventricular outflow tract gradients and the potential to reduce the need for invasive septal reduction therapy.We also discuss how these treatments are being introduced into clinical practice, including patient selection, specialist referral pathways, echocardiographic monitoring, and what the future may hold for patients with both obstructive and non-obstructive HCM.Key issues addressed:Traditional treatment options for obstructive HCMHow cardiac myosin inhibitors workThe evidence from EXPLORER-HCM, VALOR-HCM and SEQUOIA-HCMMyosin inhibitors versus beta blockersReferral pathways, monitoring and prescribing in the UKFuture directions for HCM treatmentWhether you care for patients with HCM or live with the condition yourself, this episode provides an overview of how treatment is evolving and what these new therapies may mean for the future.EPISODE HIGHLIGHTS:00:00 Welcome and episode focus01:02 Traditional HCM treatments02:46 How myosin inhibitors work06:26 Landmark mavacamten trials10:23 Aficamten and new evidence11:45 Beta blockers versus myosin inhibitors16:19 Referral pathways and monitoring20:33 NHS prescribing and echocardiographic follow-up21:42 Future of HCM treatment23:44 Wrap up24:35 Final thanks and subscribeIf you enjoyed this episode, please like, rate, and subscribe to Beatwise The Podcast. Your support helps me reach more listeners and continue providing valuable content.Don't forget to follow me on social media @sarah.theheartdoc for the latest updates, behind-the-scenes content, and more engaging discussions. Stay connected and be part of our growing community!

Heart failure, chronic kidney disease (CKD) and metabolic disease are deeply interconnected, yet healthcare systems have traditionally treated them as separate conditions. In this episode of Beatwise, I’m joined by Dr Andrew Frankel, Consultant Nephrologist at Imperial College Healthcare NHS Trust, to explore why cardiorenal metabolic (CRM) medicine is transforming how we care for patients.We discuss the shared biology linking heart, kidney and metabolic disease, why "creatinine fear" continues to prevent optimal treatment, and how therapies such as SGLT2 inhibitors, finerenone and GLP-1 receptor agonists are reshaping outcomes across multiple specialties.We also explore the future of integrated cardiorenal care, including multidisciplinary services, workforce education, patient-centred CRM hubs and what healthcare systems need to do next to improve outcomes while reducing fragmentation of care.Key topics discussed: Why cardiorenal metabolic disease should be viewed as a single disease process rather than separate conditionsThe common pathophysiology linking heart failure, CKD and metabolic diseaseThe problem with "creatinine fear" and premature discontinuation of life-saving therapiesThe four pillars of modern cardiorenal metabolic treatmentPractical prescribing tips for SGLT2 inhibitors, including eGFR thresholds and sick day rulesHyperkalaemia as a barrier to guideline-directed medical therapy and how to overcome itThe role of finerenone and non-steroidal MRAs in cardiorenal careWhy GLP-1 receptor agonists offer benefits far beyond weight lossHow integrated cardiorenal services can improve patient outcomes and reduce healthcare costsThe future of CRM hubs and one-stop multidisciplinary care pathwaysAbout my guest:Dr Andrew Frankel is a Consultant Nephrologist at Imperial College Healthcare NHS Trust and a leading advocate for integrated kidney care, cardiorenal medicine and workforce education. He is also co-host of the educational podcast For Kidneys' Sake, which provides practical updates on chronic kidney disease and cardiorenal metabolic care.EPISODE HIGHLIGHTS:00:00 Welcome and Guest Introduction01:29 Why Cardiorenal Medicine Matters03:14 Creatinine Fear and GFR Misconceptions04:31 The Four Pillars of Cardiorenal Therapy07:53 Practical Use of SGLT2 Inhibitors10:58 Hyperkalaemia as a Barrier to Treatment14:22 Building Integrated Cardiorenal Services19:04 Specialist Roles and Shared Care20:40 GLP-1 Receptor Agonists and New Weight-Loss Therapies23:33 Lifestyle Medicine and CRM Hubs26:28 Closing Reflections28:41 Final Thanks and SubscribeIf you enjoyed this episode, please like, rate, and subscribe to Beatwise The Podcast. Your support helps me reach more listeners and continue providing valuable content.Don't forget to follow me on social media @sarah.theheartdoc for the latest updates, behind-the-scenes content, and more engaging discussions. Stay connected and be part of our growing community!

In this episode of BeatWise The Podcast, I am joined by Professor Joseph Selvanayagam to explore cardiac metabolism in hypertrophic cardiomyopathy (HCM), the evolving treatment landscape in HCM, and the findings of the RESOLVE-HCM trial investigating perhexiline in non-obstructive disease.We explore the heterogeneity of HCM, including the differences between obstructive and non-obstructive forms of the condition, why symptoms are not always explained by LV outflow tract obstruction alone, and how treatment strategies are beginning to move beyond symptom management toward disease-modifying therapies.We also discuss the role of myocardial energetics and metabolic dysfunction in HCM, how perhexiline works as a CPT1 inhibitor to shift myocardial metabolism toward more oxygen-efficient glucose use, and why this may be particularly relevant in non-obstructive HCM where treatment options remain limited.Professor Selvanayagam takes us inside the design of the randomized, double-blind RESOLVE-HCM trial, including the use of cardiac MRI imaging and maximal LV wall thickness as the primary endpoint over 12 months. We review the trial findings, where several endpoints including diastolic function, NT-proBNP, and quality-of-life measures favored perhexiline, with mental health quality-of-life outcomes reaching statistical significance.We also explore the importance of therapeutic drug monitoring given perhexiline’s narrow therapeutic index, the risks of hepatotoxicity and neurotoxicity, and the future direction of metabolic therapies in cardiomyopathy.Key topics discussed: Obstructive vs non-obstructive HCMWhat drives symptoms in hypertrophic cardiomyopathyThe evolution of HCM therapiesCardiac metabolism and myocardial energeticsHow perhexiline worksThe RESOLVE-HCM trialCardiac MRI endpoints in HCM researchTherapeutic drug monitoring and safetyDisease-modifying therapies in cardiomyopathyEPISODE HIGHLIGHTS:00:00 Welcome to Beatwise00:27 Why metabolism matters01:59 Meet Professor Selvanayagam02:29 HCM types and symptoms04:29 Treatment landscape update05:42 Why RESOLVE-HCM07:20 How perhexiline works08:44 Trial design and imaging12:53 RESOLVE-HCM results14:43 Clinical use and safety17:15 Future trials and wrap up18:54 Final takeawaysIf you enjoyed this episode, please like, rate, and subscribe to Beatwise The Podcast. Your support helps me reach more listeners and continue providing valuable content.Don't forget to follow me on social media @sarah.theheartdoc for the latest updates, behind-the-scenes content, and more engaging discussions. Stay connected and be part of our growing community!

In this episode of Beatwise The Podcast, I speak with Dr Archana Ganapathy about a problem we don’t talk about enough in heart failure: congestion that we can’t properly see.Many patients leave hospital still fluid overloaded at a tissue level - despite looking “better” clinically. And that gap is part of why readmissions and outcomes remain poor. We discuss why current tools - from clinical exam to imaging and biomarkers - often fall short, and why understanding where fluid sits in the body matters just as much as how much is there.We then explore bioimpedance: what it is, how it works at the bedside, and why it may offer a more objective way to guide treatment. Dr Ganapathy also shares early insights from the BioHF trial, including what happens when fluid management is guided by measurement rather than estimation.For further context, Dr Ganapathy’s recent review on congestion assessment in decompensated heart failure is linked here: Advances in Congestion Assessment in Decompensated Heart FailureKey issues addressed: Why “hidden” congestion is so common in heart failureThe limitations of weight, BNP, imaging and clinical examWhy fluid distribution mattersHow bioimpedance works in practiceEarly findings from the BioHF trialIf you care for patients with heart failure - or live with it - this is worth understanding.EPISODE HIGHLIGHTS:00:00 Hidden congestion problem02:00 Why assessment falls short05:05 Fluid location matters07:02 Promise of bioimpedance08:54 How bioimpedance works13:06 BioHF trial design17:16 Early findings & future impact22:29 Recruitment & next steps23:06 Wrap upIf you enjoyed this episode, please like, rate, and subscribe to Beatwise The Podcast. Your support helps me reach more listeners and continue providing valuable content.Don't forget to follow me on social media @sarah.theheartdoc for the latest updates, behind-the-scenes content, and more engaging discussions. Stay connected and be part of our growing community!Thank you to Maltron International Limited for sponsoring this episode.

In this episode of Beatwise The Podcast, I speak with Helen Kilminster - Senior Pharmacist ACP and Deputy PCN Clinical Director -  about a part of heart failure care that is often overlooked: coding. We explore a part of heart failure care that is often overlooked: coding. Not as an administrative task - but as something that directly shapes patient outcomes. Because if heart failure isn’t coded accurately, it often isn’t fully visible. Patients are missed, risk isn’t under-recognised, and opportunities for earlier intervention are lost.We discuss how coding underpins everything from diagnosis to commissioning - and why small inconsistencies in how heart failure is recorded can have system-wide consequences. Helen shares how practices are identifying missed patients through NT-proBNP testing and case-finding, how coding supports risk stratification alongside comorbidities, and why clearer communication between cardiology and primary care is essential.We also explore the challenges of inconsistent terminology, and the importance of correctly coding NICE-defined heart failure subtypes - HFrEF, mildly reduced EF, and HFpEF - to ensure patients receive appropriate care.Key issues addressed:Why heart failure coding directly affects diagnosis and outcomesHow GP coding systems work in practiceThe problem of inconsistent terminology across care settingsWhy NICE heart failure subtypes need to be clearly codedUsing NT-proBNP and case-finding to identify missed patientsHow coding informs funding, commissioning, and service designTools to support better codingThe role of communication between primary and secondary careThis episode is produced in collaboration with the British Society for Heart Failure.EPISODE HIGHLIGHTS:00:00 Why coding matters01:40 How GP coding works04:33 Finding missed heart failure06:20 Sharing codes across care08:27 Contracts and subtypes11:49 Defining heart failure types13:48 Tools for better coding17:35 Funding and commissioning23:54 NHS reform and teams28:59 Patient impact and equity33:23 Practical coding tips37:05 Final takeawaysFURTHER LEARNING:NICE GuidanceOpenPrescribingOpenCodelistsBritish Society for Heart FailureIf you enjoyed this episode, please like, rate, and subscribe to Beatwise The Podcast. Your support helps me reach more listeners and continue providing valuable content.Don't forget to follow me on social media @sarah.theheartdoc for the latest updates, behind-the-scenes content, and more engaging discussions. Stay connected and be part of our growing community!

In this episode of Beatwise The Podcast, I speak with Paul Pozzo, a leading patient advocate and former chair of Amyloidosis UK. Paul shares his experience living with wild-type amyloidosis, from the challenges of delayed diagnosis to becoming a powerful voice for patients in research and healthcare advocacy.Diagnosed in 2015 at a time when no disease-modifying drugs were available, Paul was initially treated with standard heart failure therapies before later joining clinical trials that helped stabilize his condition and improve his quality of life.Together, we explore the critical role of patient advocacy in rare diseases, the need for earlier diagnosis, and how research participation is helping transform outcomes for people with amyloidosis.We also discuss the importance of recognising early warning signs, including:unexplained breathlessnesscarpal tunnel syndromeneuropathykidney problemsand the finding of a “thick heart” on cardiac imagingBeyond diagnosis and treatment, the conversation highlights the need for holistic care, including multidisciplinary support, cardiac rehabilitation, and attention to mental wellbeing. Paul also explains how patient organisations like Amyloidosis UK provide vital support through education, community connections, and advocacy, helping patients and families navigate what can often be a complex and isolating diagnosis.This episode is an important reminder that patient voices play a crucial role in shaping research, improving care pathways, and raising awareness of rare cardiac conditions.EPISODE HIGHLIGHTS:00:00 Welcome to Beatwise01:01 Paul’s Diagnosis Story03:32 Living With Limitations06:24 Why Early Diagnosis Matters07:36 Red Flags and Patient Voice09:34 How the Charity Helps11:09 Research and Clinical Trials13:46 Symptoms and Hospital Journey17:05 Reassurance After Diagnosis21:01 Holistic Care and Rehab24:11 Call to Action and Charities30:05 Final Takeaways and ThanksIf you enjoyed this episode, please like, rate, and subscribe to Beatwise The Podcast. Your support helps me reach more listeners and continue providing valuable content.Don't forget to follow me on social media @sarah.theheartdoc for the latest updates, behind-the-scenes content, and more engaging discussions. Stay connected and be part of our growing community!