December 2015 Br J Cardiol 2015;22:134–5 doi: 10.5837/bjc.2015.039
Andrew J Turley
Cardiac implantable electronic devices (CIEDs) have an unquestionable evidence base in patients with reduced left ventricular ejection fraction (LVEF), already on optimal medical therapy. Implantable cardioverter defibrillators (ICDs) effectively treat ventricular arrhythmias, which account for up to 50% of mortality in patients with reduced LVEF.1 Likewise in appropriately selected patients, cardiac resynchronisation therapy (CRT) reduces hospitalisation rates, improves symptoms and prolongs life-expectancy.2
December 2015 Br J Cardiol 2015;22:136 doi: 10.5837/bjc.2015.040
The UK population is getting older and the amount of cardiovascular disease is increasing significantly, fuelled by a steep rise in the incidence of obesity and diabetes. Heart failure is increasing in incidence because of improved survival rates following myocardial infarction and more effective treatments, with an estimated 500,000 sufferers.1 People with heart failure are more at risk of sudden cardiac death and many can benefit from cardiac devices such as implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation devices (CRT-D/Ps). This increasing need was recognised by the National Institute of Health and Care Excellence (NICE) in 2014 with the publication of the revised guidelines for the use of such devices.2 Nevertheless, the UK remains well below the European average for ICD implants, although is improving in terms of CRT devices;3 the latter due to a higher than average implant rate of CRT pacemakers. However, the rate of implantation of all high-energy devices (ICD + CRT-D) is only slightly more than half the European average.
December 2015 Br J Cardiol 2015;22:156 doi: 10.5837/bjc.2015.042
Sathish Parasuraman, Konstantin Schwarz, Nicholas D Gollop, Brodie L Loudon, Michael P Frenneaux
Cardiopulmonary exercise testing (CPEX) is a valuable clinical tool that has proven indications within the fields of cardiovascular, respiratory and pre-operative medical care. Validated uses include investigation of the underlying mechanism in patients with breathlessness, monitoring functional status in patients with known cardiovascular disease and pre-operative functional state assessment. An understanding of the underlying physiology of exercise, and the perturbations associated with pathological states, is essential for healthcare professionals to provide optimal patient care. Healthcare professionals may find performing CPEX to be daunting, yet this is often due to a lack of local expertise and guidance with testing. We outline the indications for CPEX within the clinical setting, present a typical protocol that is easy to implement, explain the key underlying physiological changes assessed by CPEX, and review the evidence behind its use in routine clinical practice. There is mounting evidence for the use of CPEX clinically, and an ever-growing utilisation of the test within research fields; a sound knowledge of CPEX is essential for healthcare professionals involved in routine patient care.
December 2015 Br J Cardiol 2015;22:132–3 doi: 10.5837/bjc.2015.038
Ravi De Silva
The Government is soon to publicly disclose a league table for cardiac surgical units within National Health Service (NHS) England. While this information may be useful and raise questions as to why one unit may be better or worse than another, we are also to be made aware of surgeons who are performing significantly better or worse than expected in terms of risk-adjusted mortality. But are patient deaths following surgery caused exclusively by the surgeon, as surgeon-specific mortality data (SSMD) would imply? And is the surgeon with the lowest operative mortality the best doctor? In my opinion the answer to both these questions is a resounding no.
December 2015 Br J Cardiol 2015;22:158 doi: 10.5837/bjc.2015.043
M Justin S Zaman on behalf of all ACRAN healthcare professionals
This is an audit of 10 Anglia region cardiac rehabilitation (CR) programmes against the British Association of Cardiovascular Prevention and Rehabilitation (BACPR) seven core standards. Methods included a questionnaire that encapsulated these standards, a SWOT (strengths, weaknesses, opportunities, threats) analysis and assessment of local outcomes.
Overall, all 10 CR services were compliant with the vast majority of basic standards set by BACPR but the audit also highlighted gaps in ideal care processes, such as a shortage of psychologists, occupational therapists and pharmacists, and inadequate audit processes. Local strengths were highlighted that will encourage future cross-pollination across the network. Outcomes were collected variably ad hoc but there was some consistency that CR across the region improved exercise tolerance, reduced anxiety and reduced smoking, but had little effect on blood pressure and body mass index, comparable to the national audit.
Anglia CR services were shown to be fit-for-purpose and there were local areas of excellence, but local areas of need and gaps in CR were highlighted that will cross-pollinate to improve all CR services in East Anglia.