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A new analysis of the LIFE study has shown that losartan can reduce new-onset atrial fibrillation in hypertensive patients with left ventricular hypertrophy. General practitioner Brian Crichton summarises this new analysis and explains how losartan might achieve these effects....

We publish in full this report by a working group of the British Cardiac Society which shows large disparities in cardiac services between England, Scotland, Wales and Northern Ireland....

Electrocardiographic monitoring by telemetry has become commonplace throughout the UK. This survey was designed to assess its availability, to determine current practice and so to inform future recommendations for optimal telemetry working practice. Data were collected via postal questionnaire followed by telephone contact. Questionnaires were completed by 280 (99.3%) of the 282 coronary care units (CCUs) contacted. Telemetry is now widely available, with 77.3% of CCUs offering a service, though practice varies widely from unit to unit. Only 15% of telemetry services were supported by written protocols, telemetry duration was routinely set in only 17.4% and interrogation was haphazard, with fewer than 27.2% of units investigating each symptomatic event. Overall responsibility for the service was unclear, and routine medical input occurred in only 48.6% of services. The task of telemetry monitoring was delegated to relatively junior CCU nursing staff (94% D/E grade). Verbal information was commonly given to patients, but written information was very rare (2.75%). Some 70% obtained no formal patient consent (written or verbal) prior to commencing telemetry. Nonetheless, CCU staff felt strongly that the service was valuable and affected patient care positively. UK telemetry practice is haphazard, variable and poorly supported by adequate protocols. The potential for missing arrhythmias and/or for mismanaging them is evident, making a strong case for practice guidelines defining the responsibilities of staff involved, identifying best practice and outlining supportive educational requirements....

Rapid Access Cardiology Clinics were introduced many years ago for the assessment of chest pain. Following the publication of the National Service Framework (NSF) for Coronary Heart Disease (CHD)1 the number of rapid access chest pain clinics (RACPCs) has expanded dramatically. Standard 8 of the NSF for CHD describes the use of chest pain clinics to provide specialist advice to people with symptoms of angina or suspected angina. One of the goals of the NSF was that there should be at least 100 RACPCs in the UK by April 2002. This goal has been superseded. More recently, rapid access clinics have also been introduced for the assessment of suspected cases of heart failure and cardiac arrhythmias. While the concept is that a prompt ‘one-stop’ assessment provides care that is clinically superior to traditional services in a cost-effective manner, there are few data describing outcomes of the patients seen in these services. In this report, we review the available evidence on rapid cardiology services....

A consensus statement from representatives of the British Society of Echocardiography, the British Heart Failure Society, the Coronary Heart Disease Collaborative and the Primary Care Cardiovascular Society....

The prevalence of anaemia in heart failure (HF) is becoming better recognised, yet little is known about its natural history in a HF population. We examined the records of 200 consecutive patients who were admitted to our service with New York Heart Association (NYHA) class IV HF, survived and were followed for six months following discharge. Complete records were available on 120 patients. Anaemia was defined as a haemoglobin concentration of < 13 g/dL in males and < 12 g/dL in females. Forty-one patients (34%) were found to have anaemia of unknown cause on admission. At follow-up (mean time 6.1+0.3 months), 28 patients were persistently anaemic. The haemoglobin concentration in the remaining 13 had returned to normal. A further group of 11 patients had become anaemic during the six-month follow-up period. All patients had been treated with maximally tolerated medical therapy. Anaemia was found to be equally prevalent in patients with preserved systolic function HF. Factors found to be independently associated with lower haemoglobin at follow-up were female sex, a history of gastrointestinal disease, inflammatory disease and a low glomerular filtration rate (GFR). Haemoglobin concentration at follow-up was found, on univariate analysis, to be associated with an increased risk of a HF-related admission during the follow-up period and increased severity of HF symptoms. On multivariate analysis, haemoglobin concentration at follow-up was found to be an independent predictor of NYHA class III–IV symptoms. In conclusion, anaemia is prevalent in a population admitted with class IV failure. While the haemoglobin concentration had normalised in a significant number of patients during follow-up, the presence of anaemia six months after discharge was associated with having a HF-related readmission and independently associated with moderate-to-severe HF symptoms....

This is the final article in a series examining how the Coronary Heart Disease Collaborative (CHDC) supports clinical teams to improve services for coronary heart disease. The focus in this issue is on secondary prevention services....

We continue our series on the work of the Coronary Heart Disease Collaborative (CHDC), which is part of the NHS Modernisation Agency. In this issue the CHDC looks at how its teams are helping improve services for patients undergoing cardiac surgery....

Percutaneous aortic valve replacement, a new technique developed to overcome the problem of restenosis of the native valve in patients treated with balloon aortic valvuloplasty. It describes the first four cases which have been undertaken using this new technique that show the potential for its development for more widespread use in the future. ...

Patients with suspected angina pectoris pose a major challenge to all levels of cardiology services. Their pathway through their NHS care can involve many stages over many years – figure 1 shows this hypothetical journey. ...