2021, Volume 28, (online first)

January 2021 Br J Cardiol 2021;28(1) doi:10.5937/bjc.2021.006


Variations in surgical technique for permanent pacemaker implantation in West Midlands Dear Sirs, Around 34,000 permanent pacemakers are implanted in England annually.1 With an increasingly agein...

January 2021 Br J Cardiol 2021;28(1) doi:10.5837/bjc.2021.005

Evaluating the use of a mobile device for detection of atrial fibrillation in primary care

Patrick J Highton, Amit Mistri, Andre Ng, Karen Glover, Kamlesh Khunti, Samuel Seidu


Atrial fibrillation (AF) increases cardio-embolic stroke risk, yet AF diagnosis and subsequent prophylactic anticoagulant prescription rates are suboptimal globally. This project aimed to increase AF diagnosis and subsequent anticoagulation prescription rates in East Midlands Clinical Commissioning Groups (CCGs). This service improvement evaluation of the East Midlands AF Advance programme investigated the implementation of mobile AF detection devices (Kardia, AliveCor) into primary-care practices within East Midlands CCGs, along with audit tools and clinician upskilling workshops designed to increase AF diagnosis and anticoagulation prescription rates. AF prevalence and prescription data were collected quarterly from July to September (Q3) 2017/18 to April to June/July to September (Q2/3) 2018/19. AF prevalence increased from 1.9% (22,975 diagnoses) in Q3 2017/18 to 2.4% (24,246 diagnoses) in Q2 2018/19 (p=0.026), while the percentage of high-risk AF patients receiving anticoagulants increased from 80.5% in Q3 2017/18 to 86.9% in Q3 2018/19 (p=0.57), surpassing the Public Health England 2019 target of 85%. The East Midlands AF Advance programme increased AF diagnosis and anticoagulation rates, which is expected to be of significant clinical benefit. The mobile AF detection devices provide a more practical alternative to traditional 12-lead electrocardiograms (ECGs) and should be incorporated into routine clinical practice for opportunistic AF detection, in combination with medication reviews to increase anticoagulant prescription....

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January 2021 Br J Cardiol 2021;28(1) doi:10.5937/bjc.2021.004

ISCHEMIA trial: do the new stable chest pain guidelines need updating?

Khaled Alfakih, Saad Fyyaz, Andrew Wragg


The European Society of Cardiology (ESC) updated their guidelines on stable chest pain in 2019,1 and recommended the use of either imaging stress tests or computed tomography (CT) coronary angiography (CTCA). They emphasised the importance of imaging stress tests or CT fractional flow reserve (CT-FFR) as a second test, to assess any coronary stenoses found on CTCA. The National Institute for Health and Care Excellence (NICE) 2016 guidelines, on stable chest pain,2 recommend CTCA for all patients with new-onset chest pain and, in a separate guideline in 2017,3 recommended CT-FFR to assess coronary stenoses. This need for a second test for the assessment of the significance of coronary stenoses is to reduce the need for invasive coronary angiography (ICA), because CTCA can be associated with false-positive results, as it can overestimate the degree of coronary stenosis, compared with ICA.4...

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January 2021 Br J Cardiol 2021;28(1) doi:10.5837/bjc.2021.003

Pneumopericardium in a patient with trisomy 21 and COVID-19 following emergency pericardiocentesis

Apurva H Bharucha, Ritesh Kanyal, James W Aylward, Parthipan Sivakumar, Ian Webb


We describe a case of pneumopericardium following emergency pericardiocentesis in a patient with coronavirus disease 2019 (COVID-19)....

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January 2021 Br J Cardiol 2021;28(1) doi:10.5837/bjc.2021.002

Lockdown cardiomyopathy: from a COVID-19 pandemic to a loneliness pandemic

Baskar Sekar, Hibba Kurdi, David Smith


Social distancing/isolation is vital for infection control but can adversely impact on mental health. As the spread of COVID-19 is contained, mental health issues will surface with particular concerns for elderly, isolated populations. We present a case of Takotsubo cardiomyopathy related to lockdown anxiety....

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January 2021 Br J Cardiol 2021;28(1) doi:10.5837/bjc.2021.001

The impact of COVID-19 on cardiology training

Samuel Conway, Ali Kirresh, Alex Stevenson, Mahmood Ahmad


The coronavirus disease 2019 (COVID-19) pandemic has produced a dramatic shift in how we practise medicine, with changes in working patterns, clinical commitments and training. Cardiology trainees in the UK have experienced a significant loss in training opportunities due to the loss of specialist outpatient clinics and reduction in procedural work, with those on subspecialty fellowships perhaps losing out the most. Training days, courses and conferences have also been cancelled or postponed. Many trainees have been redeployed during the crisis, and routes of career progression have been greatly affected, prompting concerns about extensions in training time, along with effects on mental health. With the pandemic ongoing and its effects on training likely long-lasting, we examine areas for improvement and opportunities for change in preparation for the ‘new normal’, including how other specialties have adapted. The increasingly routine use of video conferencing and online education has been a rare positive of the pandemic, and simulation will play a larger role. A more coordinated, national approach will need to be introduced to ensure curriculum components are covered and trainees around the country have equal access to ensure cardiology training in the UK remains world class....

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February 2021

News from the BSH 23rd Annual Autumn Meeting: 2020 vision for heart failure

New perspectives in heart failure management and the development of the multidisciplinary workforce was the focus of the 23rd Annual Autumn Meeting of The British Society for Heart Failure (BSH) ‘2...