Editorial articles

This is the tenth anniversary issue of the British Journal of Cardiology(BJC) and, to mark the occasion, we have invited editorials from medical and nursing groups officially associated with the journal.

The ability to deliver increased cardiac services in line with the National Service Framework (NSF) is dependent on a skilled workforce being developed at an unprecedented rate. The numbers of trained staff are at present inadequate, and they will remain so using traditional models of training.

Thrombolytic therapy remains the predominant reperfusion strategy for ST segment elevation myocardial infarction (STEMI) in the UK, with government policy directed towards optimising thrombolytic delivery. However, the publication of the first Myocardial Infarction National Audit Project (MINAP) report last year informed us that only 28% of hospitals supplying data treated the target 75% of eligible patients inside 30 minutes.

The early, non-invasive detection of coronary artery disease is a major challenge confronting contemporary cardiology. In particular, the early identification of vulnerable plaques that may lead to acute coronary syndromes (ACS) poses a major dilemma.

The Coronary Artery Revascularisation in Diabetes (CARDia) trial is an investigator-initiated study and is the first prospective study designed specifically to address the hypothesis that optimal percutaneous coronary intervention (PCI) with stenting and abciximab is not inferior to up-to-date coronary artery bypass grafting (CABG) as a revascularisation strategy for diabetics with multivessel or complex single vessel coronary disease.

Physicians aiming to prevent vascular disease, either when managing an individual patient or when designing a clinical trial, usually think about reducing the risk of stroke or ischaemic heart disease, or their combination. And, yet, an explosion in numbers of another vascular-related condition is looming, namely in dementia. This first edition of Heart & Brain focuses on dementia in general, and vascular dementia more specifically.

The British Journal of Cardiology begins a series of articles exploring the work of the Coronary Heart Disease Collaborative. This editorial gives a brief introduction to its origins, aims and philosophy for readers not yet involved in its activities.

Over the last decade, technical improvements have made off-pump coronary artery bypass (OPCAB) surgery a routine procedure. Exposure and positioning of the three main coronary targets with minimal haemodynamic deterioration has been achieved with a combination of pericardial retraction sutures, the Trendelenburg manoeuvre, and rotation of the operating table.1-3 Intracoronary shunts have been introduced to prevent snaring-related injury of the coronary vessels and to allow myocardial perfusion during the construction of the anastomoses.

The donor crisis in heart transplantation John Pepper n the area of heart failure, public debate and research funding have been focused on new trends such as xenotransplantation and tissue engineering. Neither approach is expected to have an important role during this decade. We should not neglect organ transplantation, though it is dependent on a scarce resource. Legislation can be effective in the long term, but improving rates of organ donation has more to do with changing attitudes and behaviour.

With the publication recently of the results of learned deliberations of two working parties of the Royal College of Physicians (RCP),1,2 attention continues to focus on the organisational and training aspects of the care of the seriously ill. These documents are the latest in a series of publications that have made proposals for improvement. The intensive care medicine (ICM) community has for many years been drawing attention to the plight of the critically ill, with frustratingly little response from the UK Department of Health. The Audit Commission report Critical to Success3 provided independent evidence that variation in facilities and patterns of operation had important impacts on patient care and cost-effectiveness. Published subsequently were a report of the National Expert Group Comprehensive Critical Care4 and an operational document from the Department of Health.