To many of the 50,000 people in the UK each year fitted with a pacemaker, they are literally a life saver. Placed under the skin of the chest, they detect when the heart beats too slowly or erratically and instantly emit an impulse to correct the rhythm.
But pacemakers aren't all good news. While correcting the heart's rhythm can reduce risks such as breathlessness and fatigue, they can also increase the risk of heart failure. One theory is that a heartbeat initiated by a pacemaker is less well-coordinated than a normal beat, increasing the workload on the heart. Over time, this leads to changes in the heart muscle walls which can ultimately lead to heart failure.
The regular checks currently carried out on patients with pacemakers focus on ensuring that connections and batteries are working correctly. However, research has found that checking on patient's heart function at these times can detect early signs of heart failure and possibly save lives.
"Symptoms of heart failure include shortness of breath and fatigue,"
but as pacemakers are often fitted in middle-aged or older people, these symptoms are easily dismissed as simply ageing.
The OPT-PACE Trial
The OPT-PACE trial, run by Leeds Teaching Hospitals NHS Trust and the University of Leeds, examined whether checks on the heart itself could detect signs of heart failure. The three-year study recruited 1,201 patients with pacemakers; half were routinely screened for heart failure while others continued mostly to have equipment checks.
"Screening finds about 30-40 per cent of those people [with pacemakers] have some degree of heart muscle weakness,"
says Dr Klaus Witte, one of the study leaders from University of Leeds. At rest, a normal heartbeat should be between 60-100 beats per minute; below 50 beats per minute indicates bradycardia which can cause tiredness and fainting due to insufficient oxygen-rich blood being pumped around.
"There are several reasons for this," he explains. "The patients are generally older and may have other health problems."
Patient Experience: Ian Thompson
Ian Thompson was among those invited to take part in OPT-PACE trial after suffering a previous heart attack in 2009 when his heartbeat slowed significantly below normal levels.
"My left arm was tingling... I felt hot and sick,"says Ian describing his experience before getting his pacemaker fitted.
After joining trial screening program years later, ultrasound scans revealed narrowed valves affecting blood flow. His medication dosage adjusted accordingly helped alleviate symptoms initially but eventually required surgery replacing faulty valve restoring quality life including climbing stairs again comfortably attending football matches supporting Middlesbrough team without struggles faced earlier period post-surgery recovery process overall improvement noted personally shared account experiences throughout journey managed medical conditions effectively monitored closely ongoing basis future interventions necessary considered proactively addressing concerns timely manner possible minimize potential complications arising untreated issues persist longer durations impacting adversely daily activities limitations encountered previously addressed adequately resulting positive outcomes achieved successfully implemented strategies adopted consistently achieving desired goals objectives set forth outset initiative undertaken collaboratively healthcare providers involved care provision efforts 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