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The traditional practice of conducting the first outpatient review six weeks after cardiac surgery is not evidence-based. This study was designed to determine mortality and morbidity in the interval between hospital discharge and the first outpatient follow-up.

We enrolled patients undergoing non-emergency cardiac surgery from June 2016 to May 2017 into this prospective observational study. Prior to hospital discharge, patients were consented and given a questionnaire to document attendance at any healthcare facility. Ethical approval was obtained from the Health Research Authority.

The mean age of the 72 study patients was 68 ± 4 years. The majority underwent coronary artery bypass grafting (56.9%). The six-week postoperative morbidity rate was 38.9% and hospital readmission  15.3%. Morbidity, highest in the first week after discharge, declined to its lowest level by four weeks. Surgical site (13.9%) and respiratory complications (13.9%) were predominant causes of late morbidity. There was no mortality. Most patients (50%) expressed satisfaction with current practice, but a significant number (44.4%) would prefer earlier review.

In conclusion, morbidity during the six-week wait for the first outpatient review after cardiac surgery is not insignificant, but declines over time. Current practice does not seem to enable a positive specialist influence of the post-surgery recovery pathway.

Clinical Trials.gov registration number: NCT02832427

Anti-arrhythmic drugs and pulmonary vein isolation (with radiofrequency ablation) are established treatment options in the management of atrial fibrillation. Both methods have their advantages and drawbacks. Atrial fibrillation is the consequence of complex systemic and atrial factors, resulting in atrial remodelling. Emerging treatment strategies that target and reverse atrial remodelling may offer a promising alternative to anti-arrhythmics and ablation.

It is widely known that physical activity provides strong physical, psychological and cognitive health benefits, with over 20 different conditions showing prevention and treatment effects,¹ including mortality reductions comparable with drug treatments in heart failure and stroke.² Economic effects are important, with physical inactivity responsible for approximately 13.4 million disability-adjusted life-years worldwide, over $100 billion in healthcare expenditure in the US,³ and £0.9 billion in the UK,¹ annually. Yet, despite this, around 40% of UK adults report being insufficiently active for health, worse with increasing age and socio-economic deprivation.¹ Objectively measured findings are much worse, only 5% achieve guidelines by accelerometry, compared to 50% by self-report.⁴

Takotsubo cardiomyopathy (TTC) is characterised by transient left ventricular dysfunction accompanied by apical ballooning of the ventricle. Takotsubo pathophysiology is poorly understood and is often triggered by an emotional or physical stressor. This is a case of a 71-year-old woman who presented with sudden-onset exertional chest pain leading to inferior ST-elevation on electrocardiography (ECG) with a significant troponin rise. Immediate coronary angiography revealed a severe mid-posterior left ventricular (PLV) branch of the right coronary artery stenosis. The left coronary system was normal. Left ventriculogram revealed mid-to-apical ballooning typical of TTC. Considering the disconnect between the coronary and ventriculogram findings, a decision was made to delay percutaneous coronary intervention (PCI). The patient was treated with heart failure medications and symptoms improved. Repeat angiogram of the mid-PLV after a short period of medical therapy revealed no coronary lesion and the left ventricular function had normalised. These findings suggest that coronary artery vasospasm may have contributed to the aetiology in this case of TTC. This case adds weight to previous theories of an interplay between TTC and coronary vasospasm.

Over the last few decades there has been a steady increase in life-expectancy leading to an increase in the ageing population, placing significant demands on health and social care.¹ Among the several healthcare issues that confront older people, frailty has emerged as an important entity, and tackling frailty has assumed greater significance.² There is currently no single agreed definition of frailty, but it is widely accepted as a condition characterised by reduced response to stressors consequent to decline in multiple physiological systems associated with ageing. Prevalence of frailty in community-dwelling older adults is estimated to be around 10–14%, but figures between 4% and 49% have been quoted in various populations.^3,4 Prevalence also varies with age, with around 7% in adults over 65 years, increasing up to 25% in those aged 80 years and above.⁵ There are a number of tools to detect frailty, and the most commonly used tool is the criteria proposed by Fried and colleagues based on data from the Cardiovascular Health Study, which assesses five domains, namely weight loss (≥5% weight loss in the past year), exhaustion (effort required for activities), slow walking speed (>6–7 s per 15 feet), weakness as measured by grip strength and decreased physical activity (kilocalories/week: male <383, female <270), with the presence of three or more of these fulfilling the criteria for frailty.⁵