Tag Archives: audit

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Introduction For many years coronary angiography (CA) has been used as the gold standard in the assessment of coronary artery disease (CAD), and even a normal result is considered a worthwhile outcome.1 However, concern has been raised about the use and overuse of what is an invasive and expensive procedure.2-4 We examined our cardiac catheter database to assess our diagnostic yield in terms of detecting CAD, and also in terms of subsequent referral for coronary revascularisation, whether this be by percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG), in a population of patients being assessed for possible CAD.

Introduction Therapeutic interventions in chronic heart failure (CHF) can lead to renal dysfunction. Combination of the aldosterone antagonist (AA) spironolactone with either angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), reduced mortality and hospitalisation rates and improved the New York Heart Association (NYHA) functional class in patients recruited into the Randomised Aldactone Evaluation Study (RALES).1 That study showed no statistically significant difference in the incidence of hyperkalaemia between those on AA and those on placebo.1 However, when the results of the trial were implemented int

The Sheffield audit of heart failure discharge advice given to GPs by Kanaan, Bashforth and  Al-Mohammed (see pages 113–16) illustrates perfectly the imperfections of implementing research findings and guidelines into every day clinical practice. The paper rightly points out the selective nature of the entry criteria of patients to RALES (Randomised Aldactone Evaulation Study).1 Most research trial patients are more scrupulously managed and monitored than in real world circumstances. The traditional way of organising discharge summaries usually defaults to the least experienced junior staff. The perception is often that a career in account

Temporary pacing lead insertion in Lanarkshire hospitals between 2005 – 2007 Dear Sirs, The retrospective study recently reported by Yassin et al. (Br J Cardiol 2010;17:34-5) has some potential confounding factors not reported by the authors. In addition, there is a complete absence of data from their questionnaires, with any appropriate analysis. The study looks at procedures performed between 2005 and 2007. During this timeframe the numbers of doctors in training were being reduced and doctors in more junior grades did not always possess the same procedural experience as would have been previously expected, related to the impact of f

Introduction This retrospective audit was performed to assess whether patients discharged from the cardiology ward at the Queen Elizabeth Hospital, Birmingham, following ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI) were prescribed the recommended medication at appropriate doses. The evidence for the prognostic benefit of drugs such as angiotensin-converting enzyme (ACE) inhibitors, beta blockers and statins after a myocardial infarction (MI) is derived from studies in which these drugs were used at high doses, such as Acute Infarction Ramipril Efficacy (AIRE),1 Carvedilol Post-I

Optimising care UK hospitals should set up acute heart failure units to help raise standards of care, according to Professor Henry Dargie (Golden Jubilee National Hospital, Glasgow). Presenting the inaugural Philip Poole-Wilson memorial lecture (see box), Professor Dargie said that there have been great improvements in heart failure treatment, with effective drugs, devices and interventions, plus a multidisciplinary team approach. In addition, clinical trials have shown a 50% absolute reduction in heart failure mortality with modern treatments, proving what can be achieved with specialist care. But trial results are not being reproduced in c

A reminder The article by Pollard and Sutherland (pages 247–49) reminds us of the importance of such effective treatments as smoking cessation, regular exercise, a balanced diet enriched by fresh fruit but deficient in trans-fats, and a suitable body mass index.2 The author presents findings from a survey conducted on patients offered CR in the light of Department of Health guidelines outlined in the National Service Framework (NSF) for Coronary Heart Disease (2000), and raises several points.3 First, CR has once again been shown to achieve its intended goals. Additionally, it is an extremely popular intervention among patients, with nearly

Introduction As the management of patients with acute coronary syndromes (ACS) has changed over recent years, so cardiology services have had to adapt their configurations. We instituted a comprehensive system of nurse specialist-led diagnosis and management of ACS and audited the impact of these changes. The evidence informing our management of ACS patients comes from national registries, such as the prospective registry of acute ischaemic syndrome in the UK (PRAIS-UK)1 and large clinical trials.2-3 The PRAIS-UK registry investigated the management and outcome of 1,046 patients with unstable angina (UA) and non-ST elevation myocardial infarc

Planning development The agreement drawn up by the Heart Team, within the Department of Health, and BCIS some years ago suggested that new centres should not be developed until existing provider units were at capacity. As more cath labs have been built and more cardiologists have been appointed it has been possible, particularly in the current National Health Service (NHS) climate, to make a case for local development of services regardless of whether current providers are able to cope with local demand or not. From a national and regional perspective it would be illogical to develop multiple small-volume centres while other existing centres,