Tag Archives: cardiology

Professor Raj Thakkar The challenging questions we must ask ourselves are: How and why did we reach this status quo? What are the consequences of continuing to operate in the current care model? What should we do about it, by when and how? Are we really offering true value across the whole patient journey (and if we think we are, how do we know)? Do we honestly look outside our own business or service delivery units? Unified value and operational integration Let’s consider value for a moment. Can the NHS deliver true value-based care unless integrated-care systems (ICSs) are operationally integrated; but how can ICSs integrate if individu

Introduction Emergency department (ED) activity in the UK has steadily increased, with a 12% increase in attendances and 31% increase in downstream admissions between 2011/2012 and 2019/2020.1 Despite this, overall inpatient bed capacity has reduced.2 This was recognised in the National Health Service (NHS) Long-Term Plan (2019), which outlined an aim to reduce pressure on emergency hospital services.3 Ambulatory emergency care services were proposed as one of multiple measures to achieve this aim. Presentations with suspected cardiac pathology contribute to a significant proportion of unplanned attendances to secondary care.4–6 Of these, s

Background The COVID-19 pandemic dramatically affected many aspects of everyday life and necessitated rapid changes to healthcare delivery. Health systems around the world started to rely more heavily upon remote consultations for safe healthcare delivery.1 Despite the clear advantage of limiting movement, and, hence, reducing the risks of either contracting or spreading COVID-19, a transition to remote consultations must be treated with caution. Research in primary care prior to the pandemic found that doctors were less likely to exclude serious illness when consultations were conducted by telephone rather than face-to-face.2 Alongside the s

Introduction The coronavirus disease 2019 (COVID-19) pandemic has produced a dramatic shift in how we practise medicine, with a large reduction in specialty workload and redistribution of services to provide care for COVID-19 patients. This has necessitated changes in working patterns, clinical commitments and training for junior grades. Those in cardiology training programmes in the UK have experienced a significant loss in training opportunities, due to the loss of specialist outpatient clinics and reduction in procedural work (table 1). Trainees have traded percutaneous coronary intervention (PCI) for central lines and mechanical ventilat

Introduction The under representation of women in cardiology training is now a recognised shortfall that also extends into the consultant workforce. There are multiple reports of this phenomenon worldwide, including Europe,1 US,2,3 Canada,4 and Australia.5 In the UK, women make up 28% of trainees and 13% of the consultant tier.6 This is a stark difference to other medical specialties in the UK.7 In order to improve the recruitment of women into cardiology, it is important to first understand why alternative specialties are more successful at attracting a greater proportion of female trainees. Surveys to date have focused on the opinions of w

Current status of women in cardiology In the UK, women make up 28% of higher specialty trainees and 13% of consultants in cardiology.1 This is a stark underrepresentation, particularly as women make up over half of doctors in Core Medical Training. One might expect that we were on our way to catching up with other medical specialties in terms of representation, but change has been slow, with no big increase in the percentage of women applying for cardiology for the last few years. The most recent BJCA annual survey demonstrated that gender differences persist in subspecialty interests in cardiology.2 This year, the most popular choice for wo

Frailty is strongly associated with cardiovascular disease (CVD) and, while the precise pathophysiological mechanisms linking frailty and CVD remain to be elucidated, it is likely that this association is bi-directional.4,6,7 Loss of muscle mass and function (sarcopaenia), insulin resistance and chronic low-level inflammation observed in the frailty state can predispose to CVD. On the other hand, the presence of CVD can lead to reduced activity, muscle loss and exhaustion, thus, predisposing to frailty. Large cross-sectional and longitudinal studies have shown that those with CVD were up to two to three times more likely to be frail than tho

Introduction Twitter is a web-based micro-blogging service that defines itself as “a service for friends, family, and co-workers to communicate and stay connected through the exchange of quick, frequent messages.”1 Messages take the form of ‘Tweets’, which are a maximum of 280 characters long and may include photos, video or links to other websites, and may contain a ‘hashtag’ (e.g. #CardioEd) to help users find particular topics. Anyone can create a free Twitter account, and then start ‘following’ other accounts that they find interesting and, in turn, be ‘followed’ by individuals who are interested in their Tweets. An a

Hyperkalaemia is often multifactorial in origin and may be seen in chronic kidney disease (CKD), acute kidney injury, heart failure, diabetes, elderly patients and those prescribed renin-angiotensin-aldosterone-system (RAAS) antagonists. This important area is often somewhat neglected by healthcare professionals. Left untreated, high potassium increases the risk of mortality in CKD and can also result in increased risk of serious cardiac arrhythmia and other acute complications. Chronically it may result in patients with heart failure having symptom and life-improving treatments withdrawn. New therapies for hyperkalaemia are now coming throu

Introduction The increasing burden on healthcare services, combined with effects of austerity, has placed the National Health Service (NHS) under pressure to achieve ever-greater efficiency, while improving the quality of service. An example of the increased demand is that the total number of hospital outpatient appointments in England has increased steadily by more than 3% per annum since 2011.1,2 The government, in the 2010 white paper, set out a redesigned pathway endorsing clinically led services based on more effective dialogue and communication between general practice and secondary care.3 Thus, integration of healthcare services has be