Do you pay attention to the haematocrit? In case you’d forgotten, it should lie between 39% and 54%, and in case you thought it’s a waste of time, here is a study to prove otherwise. Elderly patients undergoing non-cardiac surgery were followed up to see it being a bit under or over these limits really made any difference to postoperative cardiac events and mortality. And yes, it did – not enormously, but at the top end, discernibly riskier as soon as you get over 50%, which is a bit surprising.
Having heart failure these days is a full-time occupation. You go to bed wearing a positive pressure ventilation mask, get up and browse on a dozen tablets, run back and forth to the toilet between phone calls from the heart failure nurse and the vicar, dash off to the practice nurse or the path lab for a blood test, go to the rehabilitation department for a bit of gentle exercise; and then check the calendar for your next pacemaker appointment. Biventricular pacing is an increasingly used therapy for heart failure with left systolic dysfunction. It’s not especially reliable or simple to install, according to this systematic review, but of definite benefit in postponing death and hospital admission in patients with evidence of impaired synchrony between the ventricles. It is often combined with implantation of a defibrillator, but if I had heart failure, I would want the symptomatic benefit of the pacing without anything that might stop me dropping dead painlessly.