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Editorial articles

March 2017 Br J Cardiol 2017;24:11–12 doi:10.5837/bjc.2017.005

Optimising BP measurement and treatment before elective surgery: taking the pressure off

Simon G Anderson, Nigel Beckett, Adam C Pichel, Terry McCormack

Abstract

Hypertension remains a significant burden on mortality and morbidity, contributing to increasing costs to healthcare provision globally. There is detailed evidence-based guidance on the diagnosis and treatment of hypertension in the community, however, during the peri-operative period for elective surgery, consideration of an elevated blood pressure remains a conundrum. This is a consequence of paucity of evidence, particularly around specific blood pressure cut-offs deemed to be clinically safe. Postponement of planned surgical procedures due to elevated blood pressure is a common reason to cancel necessary surgery. A sprint audit of 11 West London Hospitals with national audit data indicated that the number of cancellations was 1–3%, equating to approximately 100 cancellations per day in the UK.1 This suggests that approximately 39,730 patients per year may have had a cancellation of a surgical procedure owing to a finding of pre-operative hypertension.2 The Association of Anaesthetists of Great Britain and Ireland (AAGBI) together with the British Hypertension Society (BHS) recognise the need for a nationally agreed policy statement on how to deal with raised blood pressure in the pre-operative period and have jointly published guidelines titled: “The measurement of adult blood pressure and management of hypertension before elective surgery” in the journal Anaesthesia.2

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Cardiovascular screening of young athletes with electrocardiography in the UK: at what cost?

January 2017 Br J Cardiol 2017;24:(1) doi:10.5837/bjc.2017.002 Online First

Cardiovascular screening of young athletes with electrocardiography in the UK: at what cost?

Harshil Dhutia, Sanjay Sharma

Abstract

The promotion of exercise as a positive and powerful health intervention has never been more important, when consideration is given to the global epidemic of disease states related to a sedentary lifestyle. However, intensive exercise may be a trigger for sudden cardiac death in individuals harbouring quiescent cardiovascular diseases. Indeed, hereditary and congenital abnormalities of the heart are the most common cause of non-traumatic death during sport in young athletes.1 

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Cut out the middleman

November 2016 Br J Cardiol 2016;23:127 doi:10.5837/bjc.2016.035

Cut out the middleman

Terry McCormack

Abstract

Following Brexit, like many other people with Irish parents, I started the process of applying for an Irish passport. The Irish embassy website informed me, to my surprise, that I had become an Irish citizen on the day I was born. Despite that status, and despite owning a home in County Kerry, I have to admit I know very little about the Irish healthcare system. In fact, having worked my entire life in English healthcare, I do not fully understand the systems in the other three constituent countries of the UK either. My career has mostly involved both primary and secondary care, so I do understand the issues and difficulties of communication between hospitals and general practitioners (GPs).

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Can marriage mend a broken heart (and save the National Health Service)?

November 2016 Br J Cardiol 2016;23:130–1 doi:10.5837/bjc.2016.036

Can marriage mend a broken heart (and save the National Health Service)?

Nicholas D Gollop

Abstract

Ischaemic heart disease (IHD) is the leading cause of mortality worldwide.1 It is a debilitating, life-changing illness that can reduce quality of life and life-expectancy. While surgical, percutaneous and optimal medical interventions can significantly improve the clinical course of the disease, our understanding of the biopsychosocial mechanisms promoting survival following an acute IHD event, such as an acute coronary syndrome (ACS), is still limited. 

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Digital health – game-changing empowerment or corporations preying on the worried well?

October 2016 Br J Cardiol 2016;23:128 doi:10.5837/bjc.2016.031

Digital health – game-changing empowerment or corporations preying on the worried well?

Francis White

Abstract

Over and over we hear the message that healthcare spending is out of control, the National Health Service (NHS) needs to save £20 billion and that is before the baby boom* generation fully enters the most expensive part of their healthcare journey…

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British Heart Valve Society update: a change in the NICE guidelines on antibiotic prophylaxis

August 2016 Br J Cardiol 2016;23:91–2 doi:10.5837/bjc.2016.027

British Heart Valve Society update: a change in the NICE guidelines on antibiotic prophylaxis

John B Chambers, Martin H Thornhill, Mark Dayer, David Shanson

Abstract

The National Institute for Health and Care Excellence (NICE) has made an important change to Clinical Guideline 64 (CG64)1 adding the word ‘routinely’ to Recommendation 1.1.3: “Antibiotic prophylaxis against infective endocarditis is not recommended routinely for people undergoing dental procedures”. In a letter about the change,2 Sir Andrew Dillon, CEO of NICE, confirmed that “… in individual cases, antibiotic prophylaxis may be appropriate”. 

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Global health and data science: future needs for tomorrow’s cardiologist

August 2016 Br J Cardiol 2016;23:87–8 doi:10.5837/bjc.2016.026

Global health and data science: future needs for tomorrow’s cardiologist

Jonathan Evans, Amitava Banerjee

Abstract

Compared with other diseases, cardiovascular diseases (CVD) are responsible for the greatest burden of disease both globally1 and in the UK.2 Drugs for CVD and its risk factors have always been represented in the list of international blockbuster drugs. Important research innovations, such as ‘learning health systems’, ‘precision medicine’ and electronic health record (EHR)-based trials, have been led by professionals in the field of cardiology. Cardiovascular scientists from the UK have a long and strong history of research contributions with international impact. Training in cardiology is critical, not only in preparing and mentoring the clinical and academic cardiologists of the future, but also in shaping how the specialty is perceived from inside and outside. Global health and data science are overarching themes that offer new lenses through which to view CVD and cardiology. However, cardiology training in the UK barely pays lip service to either of these issues, when their implications have never been greater or more acute on our specialty. 

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Incidental findings on imaging: seeing the wood from the trees

July 2016 Br J Cardiol 2016;23:85–6 doi:10.5837/bjc.2016.023 Online First

Incidental findings on imaging: seeing the wood from the trees

Sushant Saluja, Pavel Janousek, Khalil Kawafi, Simon G Anderson

Abstract

The coronary artery calcium (CAC) score is widely believed to be an important tool in determining the risk of developing heart disease. The measurement of this score has traditionally been based on using electrocardiography triggered computed tomography (CT). This confers an advantage over non-gated CT scanning by acquiring images during diastole, which reduces motion artefact and avoids missing areas of coronary artery calcification. Radiologists are, therefore, cautious when reporting CAC on non-gated CT scans due to concerns that it may not be accurate. This means that there is currently no obligation, from a radiology perspective, to report on the degree of CAC on non-gated CT scans. While this has been acceptable for a long time, emerging evidence may force us to change our practise. 

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Management of refractory angina: the importance of winning over both hearts and minds

June 2016 Br J Cardiol 2016;23:45–6 doi:10.5837/bjc.2016.018

Management of refractory angina: the importance of winning over both hearts and minds

Christine Wright, Ranil de Silva

Abstract

Refractory angina (RA) is an increasingly common, chronic, debilitating condition, which severely reduces quality of life. It can severely impact on physical, social and psychological wellbeing. RA should be considered in patients with known coronary artery disease, who continue to experience frequent angina-like symptoms, despite surgical or percutaneous revascularisation and optimal medical therapy. Objective evidence of reversible ischaemia should also be demonstrated. Treatment is challenging and often not delivered adequately. Management should ideally be provided by a specialist multi-disciplinary team, but national provision of such services is extremely limited. As a result, patients with RA commonly enter a downward spiral of long-term local review, cycling between the outpatient department and Accident and Emergency (A&E). Consequently, a disproportionately high proportion of healthcare resource is consumed in the management of these patients due to high attendance rates in primary and secondary care, unscheduled hospitalisation, prolonged hospital stays, investigations and polypharmacy. This may be improved by the implementation of more appropriate models of care delivery.

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April 2016 Br J Cardiol 2016;23:49–50 doi:10.5837/bjc.2016.014 Online First

Growing need for trainees in adult congenital heart disease in the UK

Kate English, Aisling Carroll, S M Afzal Sohaib, Michael Stewart, Russell Smith, J Ian Wilson

Abstract

Deaths from congenital heart disease in childhood have fallen 83% in the last 25 years.1 This dramatic change has led to a significant increase in the numbers of adults with congenital heart disease (ACHD) requiring care, and prevalence is not expected to plateau until 2050.2 Even patients with extremely complex pathophysiology are now expected to survive well into adult life, and will have significantly higher rates of utilisation of all hospital services than the general population.3,4 

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