cardiologyhd #38

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Regent’s Park Heart Clinicsat Scarborough Hospital

CARDIAC CATH • EP • CRM • ECHO • CT/MRI

Issue 38 • Sep/Oct 2012See the online version atCardiologyHD.com

2 Sep/Oct 2012 www.cardiologyhd.com

CONTENTS

EDITORIAL BOARD

03PRODUCT NEWSRound-UpGet the latest news from companies related to their new products.

10JOURNALSGlobal UpdateOur popular and entertaining journal trawl from around the world.

14COMING UPNext Editi onThe last editi on of the year will be the last editi on for our magazine.

06CHARLES BLOE TRAININGECG ChallengeAnother challenging ECG Challenge to test your skills. Answer on page 11.

11ECG CHALLENGEAnswerFind the Charles Bloe Training ECG Challenge answer here.

15EVENTSWhat’s OnA quick overview of cardiology events happening around the world.

07FAST FACTSBehind the HeadlinesGeneral interest arti cles related to cardiology making news in the UK.

12SITE VISITScarborough HospitalSee the new cath lab service provided by Regent’s Park Heart Clinics Ltd.

CONTENTS

Dr John PaiseyJournal ReviewerConsultant Cardiologist, Royal Bournemouth Hospital

Dr Dan McKenzieJournal ReviewerConsultant Cardiologist, Musgrove Park Hospital

Prof Simon RedwoodConsulti ng EditorConsultant Cardiologist, Guy’s & St Thomas’ Hospital

Dr Rodney FoaleConsulti ng EditorConsultant Cardiologist, Imperial College Healthcare NHS Trust

Mr Dennis SandemanNursing Consulti ng EditorChest Pain Nurse Specialist, NHS Fife

Ms Sophie BlackmanManagement & CRM Consulti ng EditorHead of Clinical Cardiac Physiology, West Hertf ordshire NHS Trust

Mr Tim LarnerDirector & Chief Editor

Dr Magdi El-OmarLead Consulti ng EditorConsultant Cardiologist, Manchester Heart Centre

Dr Richard EdwardsConsulti ng EditorConsultant Cardiologist, Freeman Hospital

Prof Ahmed MagdyConsulti ng Editor (Middle East)Head Unit Cardiology, Nati onal Heart Insti tute, Cairo

Disclaimer:This publicati on should never be regarded as an authoritati ve peer reviewed medical journal. This publicati on has been designed as a guide only, to inform readers who work in the cardiology environment about latest news stories and the diff erent techniques used by others around the world. Whilst all care is taken in reviewing arti cles obtained from various companies and contributors, it is not possible to confi rm the accuracy of all statements. Therefore it is the reader’s responsibility that any advice provided in this publicati on should be carefully checked themselves, by either contacti ng the companies involved or speaking to those with skills in the specifi c area. Readers should always re-check claims made in this publicati on before employing them in their own work environment. Opinions expressed by contributors are their own and not necessarily those of their insti tuti on, Coronary Heart Publishing Ltd or the editorial staff .

Copyright © 2006 - 2012 by Coronary Heart Publishing Ltd. All rights reserved. Material may only be reproduced by prior arrangement and with due acknowledgment of Coronary Heart Publishing Ltd. The publicati on of an adverti sement or product review does not imply that a product is recommended by Coronary Heart Publishing Ltd.

+ more editors online

Above: Judith Jamieson, Regent’s Park Cardiac Physiologist at Scarboorugh.

Cover Photo (from left): Liz Merrick (Senior Nurse, Regent’s Park), Tim Larner (Senior Radiographer, Regent’s Park), Judith Jamieson (Cardiac Physiologist, Regent’s Park), Julie Anderson (Senior Nurse, Regent’s Park) - Photos by Tim Larner

www.cardiologyhd.com Sep/Oct 2012 3

PRODUCT NEWS[ Round-Up ]Lister Hospital meets increased service demand with advanced imaging technologyLister Hospital in Stevenage, part of the East and North Hertfordshire NHS Trust, has installed a SOMATOM® Definition Flash and Definition AS+ from Siemens Healthcare with its syngo®.via imaging software for rapid multi-modality clinical image reporting. The hospital has also taken installation of an Artis zee™ Floor-mounted system, suited to angiography and fluoroscopy examinations. These are being used for a wide range of procedures including cardiac, angiography and brain angiography plus both CT systems are being used for lung biop-sies, renal work and stroke services.

“With an increase in demand for CT services, we needed high-end imaging systems that would effectively future-proof the department. The latest installation completes the redevelopment and expansion of the CT service at the Lister Hospital,” said Dr William Topping, Con-sultant Radiologist at the East and North Hertfordshire NHS Trust.

“Lister Hospital clearly chose the new imaging systems from Siemens Healthcare with the patient in mind,” said Andreas Hadjiphanis,

Regional Sales Manager at Siemens Healthcare. “In addition to its low dose and Dual Source capabilities, the systems feature a range of applications, such as the clinical colonography package, to increase ease of use and patient throughput.”

Go places with InHealth

For more information, or to discuss in more detail please contact:[email protected] 01494 560000 www.inhealthgroup.com

Follow us

InHealth is one of the UK’s leading healthcare providers and is committed to providing accessible, modern and efficient healthcare services when and where they are needed.

Our scanning and treatment centres provide diagnostic scans and other proceduresin over 280 locations throughout the UK.

St. Peter’s Hospital’s cardiac catheterisation lab (Chertsey), one of the leading cardiac centres in the UK, is looking for two key personnel to join the team. This is an exciting opportunity as two new state of the art catheterisation laboratories are being built and the successful candidates will play an important role in the development.

Lead cardiac nurse, band 7

NMC registered nurse who can lead the nursing team and support and assist the angiography services manager to ensure clinical standards are met.

You must have experience as a cardiac nurse with evidence of working in a cardiac catheterisation laboratory and be happy being part of a shift and on-call rota.

Cardiac nurse band 6

NMC registered senior cardiac nurse expected to support nursing staff in the management and organisation of the cardiac sessions for our two cardiac catheterisation labs and day ward.

Successful candidates will have previous cardiac catheterisation lab experience, immediate life support certificate and understanding of infection control issues. This role will require the successful candidate to be part of the on-call and shift rota.

We also have an opportunity for a mobile cardiac nurse to join our team supporting our cardiac catheterisation units.

Mobile cardiac catheterisation lab nurse, nationwide including Ireland

NMC registered cardiac nurse to join our team supporting InHealth’s fleet of cardiac catheterisation units. The successful candidate will have experience of working as a scrub nurse within a cardiac cath lab and due to the nature of the post, will have a UK driving licence and be happy travelling to various UK/Ireland locations.

Nurse Advert_140812_759 Copyright © 2012 InHealth Limited


“Don’t Cut Your Tips”New recycling program buys your whole used EP cathetersIn the past, EP staff could only cut the ti ps of EP catheters as part of a plati num recovery pro-gram. Now these departments are earning up to four ti mes more by recycling many of their whole catheters with EPreward.

Increase your department’s earnings up to four fold. EPreward, a U.S. company developed and managed by an EP nurse, purchases a wide variety of whole diagnosti c EP and ultra-sound catheters, the Agilis Sheath, Atherectomy devices, IVUS and OCT catheters. Their new program greatly increases the payments earned by Cardiology Departments from outdated plati num ti p companies.

To verify this diff erence in earnings, a prominent NHS hospital conducted a side by side test using an identi cal batch of catheter ti ps. Payment from The London Refi nery, EP Recyclers/Eco-Wires Recycling, EPreward’s high paying Plati num Recovery service and EPreward’s whole catheter “Buy Back” program was determined for the same 345 catheters with the results shown below.

The London Refi neryPlati num Recovery

EP Recyclers/Eco-Wires Recycling

Plati num Recovery

EPrewardPlati num Recovery

EPrewardWhole Catheter Buy Back

£ 651.79 £ 818.06 £ 1,445.90 £ 3,191.00

NHS Hospital’s earnings for an Identical Group of 345 EP Catheters

EPreward documents every catheter and catheter ti p, provides all collecti on materials and pays for shipping. Time to sett lement is one week from the date of receipt. Their website also contains over 75 FREE educati onal programs, a Training and Review secti on and much more. Don’t sett le for less, receive the earnings you deserve with EPreward.

Visit EPreward at the HRC Conference in Birmingham, England 24-26, September 2012.Contact EPreward and your hospital Waste Manager to verify the status of this program for your facility.

Reach them by email: [email protected], website: www.epreward.com or phone: 001-561-375-7857

Nati onal Cardiology Programme

Regent’s Park is rolling out a nati onal programme to provide one of its clients with 12-lead ECG’s,

non-invasive cardiac monitoring & vital signs measurement. Would suit cardiac physiologists or qualifi ed nurses who have ECG recogniti on skills and the ability to carry out these tests.

Opportuniti es available for occasional sessions without the need for full/part ti me commitment.

To fi nd out more please email Bryn Webber, Cardiac Services Director:

[email protected]

www.rphc.co.uk

BARD® EP Mini Case Review Sessions, HRC 2012 BirminghamDelegates will be pleased to hear that due to popular demand, the BARD® EP Mini Case Review Sessions are to be held again during break ti mes and lunchti mes on the BARD® EP stand, at the 2012 Heart Rhythm Congress in Birmingham. A Consultant Electrophysi-ologist will present the Electrograms from a real life EP case. Parti cipants will be encouraged to interact with the case, including making measurements of intervals. The sessions are aimed at Cardiology SpR’s or Cardiac Physiologists with at least a basic EP knowl-edge. The sessions will be limited to a small group of 5 people and thus aim to be interacti ve. Pre registrati on will be required and can be booked at the BARD® EP stand during the meeti ng.


For a copy of any of the papers and product guides from this page, telephone Fukuda Denshi on 01483 728065[ More Informati on ]

Fukuda Denshi publish key CAVI Clinical Report on Anti -arteriosclerosis agents and CAVIFukuda Denshi has recently published a Clinical Report on Anti -arte-riosclerosis agents and CAVI, and is the second Clinical Report the company has published on the revoluti onary Cardio Ankle Vas- c u -lar Index measurement.

The VaSera VS-1500N from Fukuda Denshi is a lightweight and compact vascular screening device with a wide range of features including CAVI and kCAVI, providing a comprehensive report of key parameters in less than ten minutes.

CAVI is the new arteriosclerosis index that measures the degree of artery sti ff ness between the heart and ankle, and is independ-ent from fl uctuati ons in blood pressure. It has been derived by the constant parameter ß, providing a consistent result that can help to predict ischemic disease and future cardiovascular complicati ons.

Fukuda Denshi has published a paper exploring anti -arterioscle-rosis agents and CAVI, and describes the method for measuring CAVI, along with the clinical implicati ons of CAVI. The Report also

describes the infl uence of hypoglycaemic agents on CAVI, the infl u-ence of anti hyperlipidemic agents on CAVI and the infl uence of anti -hypertensive agents on CAVI.

Explanatory charts and diagrams enhance the six page, full colour Clinical Paper, which concisely details the key results found during the research.

2011/12 Diagnosti c Ultrasound product guide available now from Fukuda DenshiFukuda Denshi recently published a handy pocket guide on their range of diagnosti c ultrasound soluti ons.

The full colour, 8 page pocket guide provides comprehensive prod-uct informati on on Fukuda Denshi’s complete range of diagnosti c ultrasound equipment, including their UF-870AG, with PC-based Open Architecture platf orm, fully digital, multi -beam processing and advanced ergonomic workfl ow. The UF-870AG is suitable for a wide range of applicati ons, including Ob/Gyn, Cardiology, Abdominal, Pae-diatric and Neonatal.

Also included in the product guide is the UF-400AX, fully digital port-able ultrasound system. The UF-400AX has a full digital beam for-mer, high density and wide band probes and a high resoluti on, 10” mono CRT display. The portable UF-400AX weighs around 10kg and also has a wide variety of applicati ons, suited to adult, paediatric and neonatal pati ents.

The pocket guide also features a handy chart to help users choose the best model to meet their requirements, and also details the probes available with each model.

Product dimensions, weight, and key features are all provided within the pocket guide, along with product images.

Fukuda Denshi publish handy pocket guide on their Criti cal Care range Fukuda Denshi recently published a full colour handy pock-et guide on their range of pati ent monitoring soluti ons.

The 12 page pocket guide is a perfect pocket companion to provide comprehensive product informati on on Fukuda Denshi’s range, which includes:

• The new DS-8500 system, with the most intelligent interface yet. The DS-8500 is available with 15 or 19” display opti ons and has a modular design for a bett er, fl exible confi gurati on.

• The DS-7700 system, with multi ple display confi gurati ons, Arrythmia analysis and convenient bed-transfer between centrals and team nursing opti on.

• The DS-7000 system, ideal for OR applicati ons, with 12” colour LCD touch-screen display.

• The DS-7100 system, off ering various displays and multi ple variati ons in a portable multi -parameter monitor and an 8.4” touch-screen display.

• The DS-7200 integrated monitor with 12” display and fl exible modules.

Product dimensions, weight, and key features are all pro-vided within the pocket guide, along with product images.


History

This fi t and healthy 21 year old agreed to have an ECG recorded at a healthcare exhibiti on.

He has no past medical history. He spends a couple of hours each day working out hard at the Gymnasium.

What is your conclusion? See the answer on page 11

CHARLES BLOE TRAINING[ ECG Challenge ]

Online ECG Challenges

We have multi ple ECG Challenges on our website for you to challenge yourself, along with a variety of educati onal topics related to cardiology.

If you have an interesti ng ECG that you think would work well as a challenge,send it through to us.

Visit our website: www.cardiologyhd.com

[ More Informati on ]


FAST FACTS[ Behind the Headlines ]

The following articles are courtesy of NHS Choices

More exercise in your 50s ‘cuts heart disease risk’“Exercise in midlife protects heart,” stated the BBC News, while the Daily Mail tells us that “gardening, walking and DIY in your fifties can cut risk of heart disease”.

The news is based on a large study looking at the health of middle-aged people. Researchers found that those who met physical activity recommendations of at least 2.5 hours of moderate to vigorous exercise a week had lower levels of inflammation in their body compared with people who did not get enough exercise.

Reducing levels of inflammation is important as persistent inflammation, even at relatively modest levels, is thought to contribute to the adverse effects of ageing. For example, it is thought to contribute to loss of muscle power and strength, cardiovascular disease or CVD (conditions that affect the heart and blood vessels) and depression.

Interestingly, the results were independent of body fat. This suggests that exer-cise was still of significant benefit for people with no, or little, previous history of exercise.

The study had some limitations, including the fact that it measured markers of inflammation rather than CVD rates themselves. Nevertheless, this was a well conducted study that reinforces the health benefits of even moderate exercise.

This story had been covered by the BBC, The Daily Telegraph and the Daily Mail. The news coverage was accurate.

Can dark chocolate help control blood pressure?

“Chocolate … could reduce blood pressure,” BBC News reported.

The report is based on a well conducted review that has pooled the results of trials investigat-ing the effects of chemicals called flavanols. Fla-vanols are found in cocoa products, such as cocoa powder, dark chocolate and, to a lesser extent, milk chocolate. They are thought to widen blood vessels, causing a drop in blood pressure.

While the researchers did find a statistically sig-nificant reduction in blood pressure, the aver-age reduction was relatively modest – a drop of 2-3mmHg.

It is not possible to say whether this small dif-ference could have a positive effect on health or reduce risk of cardiovascular events, such as heart attack. As the researchers point out, this small drop may be useful if other methods, such as regular exercise, are also used to reduce blood pressure.

It is also worth noting that the trials only lasted a few weeks, so it is not possible to tell what the longer term effects would be – both in terms of pros and cons. The trials also varied widely in the dose of flavanol that was given, so it is difficult to determine what the ideal dose would be.

Chocolate in moderation can be part of a healthy balanced diet, but it is high in fat and calories. If eaten in excess any possible beneficial effects are likely to be outweighed by the risk of obesity, which itself increases the chance of high blood pressure and heart disease.

BBC News gave accurate and balanced coverage of this research and they did stress that “there are healthier ways of lowering blood pressure”.

Obese children show early signs of heart disease“Two thirds of obese children show early signs of heart disease”, the Daily Tel-egraph has reported.

The news is based on a study that examined how common risk factors for dis-eases that can affect the heart and the blood vessels (cardiovascular disease or ‘CVD’) are in severely obese children.

The researchers found that a majority of children identified had risk factors for CVD that you would normally only expect to see in older adults, such as:

• over half (56%) had high blood pressure• around one in seven had high blood glucose levels

Worryingly, researchers found that when specifically looking at those younger than 12 years, 62% already had more than one CVD risk factor.

These types of risk factors do not usually cause any noticeable symptoms in chil-dren but they significantly increase the chance of a child developing a serious disease, such as coronary heart disease in later life.

The study was reported appropriately by the BBC and Telegraph.

Introducing: The Symplicity Renal Denervation System

For distribution only in markets where the Symplicity Renal Denervation System is approved. Not for distribution in the USA or Japan. © 2011 Medtronic, Inc. All rights reserved. UC201201951EE 9/11

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JOURNALS[ Global Update ]

Cardiostati sti cal Odinism

This is brilliant, eff ecti vely a propensity matched study of propen-sity matched studies. The authors ingeniously ‘match’ observati onal studies using propensity scores to investi gate eff ect of interventi ons to randomised studies comparing the same eff ects.

The fi ndings are unsurprising but important, published studies rely-ing on propensity scores are more likely to demonstrate positi ve eff ects of treatment and exaggerate the eff ects of treatment where both are positi ve.In other words they should be regarded as hypothesis generati ng only.

Issa J Dahebra and others. Eur Heart J 2012; 33 (15):1893-1901.

TexMex

Chicken wing or Cactus? Would you rather have a left atrial append-age shaped like cactus, chicken wing, windsock or caulifl ower? The answer is chicken wing (about 20% the stroke risk).

Warning may contain nuts, all data retrospecti ve.

Luigi Di Biase and others. J Am Coll Cardiol 2012;60:531–8.

Stents

The ‘amusingly’ named COMFORTABLE AMI trial has now been pub-lished. It is another trial of drug eluti ng (DES) vs. bare metal stents (BMS) in STEMI, but this ti me compares the Biomatrix biolimus-elut-ing stent, which has a biodegradable polymer. The DES showed a sig-nifi cant reducti on in MACE at 1 year (4.3% vs. 8.7%, p=0.004), mainly driven by a lower risk of target vessel reinfarcti on (0.5% vs. 2.7%, p=0.01) and ischaemia-driven target lesion revascularisati on (TLR, 1.6% vs. 5.&%, p<0.001). There will sti ll be some interventi onists that are concerned regarding the long-term risk of stent thrombosis with DES, but these seem to relate mainly to the fi rst generati on DES (Taxus and Cypher) and the 4-year data for the Biomatrix stent in LEADERS were reassuring.

Lorenz Raber and others. JAMA 2012;308:777-787.

Cardiac Surgery

Surgical trials get litt le menti on in the trawl and we now remember why. Apparently, endoscopic vein graft harvesti ng is associated with a similar risk of mortality as open vein-graft harvesti ng, but is asso-ciated with lower wound complicati ons. As expected, in the right hands, one assumes.

Judson B Williams and others. JAMA 2012;308(5):474-484.

And it is possible to develop a safe myomectomy service to treat hypertrophic cardiomyopathy with left ventricular outf low tract obstructi on in a European centre. To be fair, the discussion on the problems of septal ablati on and benefi ts of surgical myomectomy is interesti ng.

Atti lio Iacovoni and others. European Heart Journal 2012;33:2080-2087.

Ventricular Arrhythmias

Recent studies have tended not to show benefi t of Stati ns in margin-al indicati ons, but this analysis of the non ischaemic pati ents in the MADIT CRT trial suggests they may be associated with a reducti on in ventricular arrhythmias. Among 821 pati ents of whom 499 were taking stati ns over a mean follow up of 4 years the cumulati ve risk of ventricular arrhythmia or death was 19% in the non stati n group vs. 11% in the stati n group.

It should be noted this was not a predefi ned endpoint and the data is somewhat compromised by censorship, as prescripti ons changed.

Jonathon Buber and others. J Am Coll Cardiol 2012;60:749–55.

As luck would have it we also have a meta analysis of the eff ect of stati ns on sudden cardiac death. Twenty nine trials with over 113 000 pati ents with a mixture of aeti ologies and indicati ons were included. No specifi c eff ect could be discerned on cardiac arrhythmias but sud-den cardiac death was lower in the stati n group, the diff erence how-ever was ti ny in absolute terms; a drop from about 1.1 to about 1%.

Kazem Rahimi and others. European Heart Journal (2012) 33, 1571–1581.

The move to more substrate based approaches to VT ablati on opens up the questi on of how much to do. In a non randomised comparison of endocardial only ablati on and the adjuncti ve targeti ng of epicar-

Dr John PaiseyJournal ReviewerConsultant Cardiologist, Royal Bournemouth and Christchurch Hospitals NHS Foundati on Trust

Dr Dan McKenzieJournal ReviewerConsultant Cardiologist, Musgrove Park Hospital, Taunton and Somerset NHS Foundati on Trust

Follow me @johnpaisey for the latest reviews

Follow me @danmckenzie73 for the latest reviews


dial potentials those treated by the more extensive approach had an arrhythmic recurrence of 19% vs. 47% over up to 22 months in the endocardial only group. It should be noted that although epicardial access was obtained in the entire extensive ablation group, only one third required epicardial ablation (the remainder presumably had no suitable signals).

An accompanying editorial questions the applicability of the results to a wider population given the non randomised nature of the trial, the very high (100%) acute procedural success rates and the unusual absence of complications for such a procedure.

Luigi Di Biase and others. J Am Coll Cardiol 2012;60:132–41.

Frank Bogun and Thomas Crawford. J Am Coll Cardiol 2012; 60: 142–3.

The issue of what if anything to do about premature ventricular ectopics in apparently structurally normal hearts has attracted some interest recently. A well crafted systematic review of the evidence has the main finding that the available studies are inadequate in their structural heart work up limiting any conclusions that can be drawn.

Victor Lee and others. Heart 2012;98:1290e1298.

Cardiac Resynchronisation Therapy

Predictable results from a study of predictors of response from this predictable salami slicing of MADIT CRT. Predicators of ‘super response’ (upper quartile of EF improvement) are female gender, QRS>150, LBBB, no prior MI and smaller left atrial volume. Super responders were less likely to experience the composite HF driven endpoint.

Jonathon C Hsu and others. J Am Coll Cardiol 2012;59: 2366–73.

A specific observational study on QRS morphology and duration in CRT recipients shows results concordant both with the above and previous data. Among 496 patients a longer QRS and LBBB predicted better echocardiographic and clinical outcomes. Statistically speak-ing the significant difference was seen between LBBB and other mor-phologies but looking at the Kaplan Meier those with LBBB and QRS 120-150 ms and those with non LBBB and QRS >150 ms are similar; both these groups do better than those with non LBBB QRS 120-150 and worse than LBBB QRS>150.

Data from post hoc analysis of the REVERRE trial of CRT in mild heart failure demonstrates the same with QRS duration and LBBB morphol-ogy predicting clinical and echo endpoints.

Matthew Dupont and others. J Am Coll Cardiol 2012;60:592–8.

Michael R Gold and others. Circulation 2012;126:822-829.

Can CRT cure MR? Maybe once in a blue moon.

Sem Briongos-Figuero and others. J Am Coll Cardiol 2012;60(3).

Pericarditis

We have discussed Colchicine to treat pericarditis in a previous trawl. There is now a published meta-analysis and I am going to change my practice as a consequence. Analgesia, NSAIDs, steroids and reassur-ance are all used to variable effect and with limited evidence. Col-chicine is the only drug that has been proven efficacious and safe for pericarditis prevention in randomised clinical trials with a similar primary and secondary prevention effect.

Massimo Imazio and others. Heart 2012;98:1078-1082.

Valves

Infective endocarditis remains a rare, but serious disease with a considerable associated risk of death and morbidity. 1 in 6 affected patients will die in hospital.

Standard practice has been to operate early on patients with left sid-ed IE and large vegetations (>15mm) to reduce the risk of emboliza-tion. This practice has now been validated in a randomised trial from South Korea comparing surgery within 48 hours of randomisation vs. conventional treatment. Interestingly, 77% of the ‘conventional’ group had inpatient surgery.

Duk-Hyun Kang and others. NEJM 2012;366:2466-73.

There is a new percutaneous valve in town – the St Jude Medical Por-tico Valve - and it has been tested in 10 high risk patients with good haemodynamic and clinical results (one minor stroke, one required a second transcatheter valve). The advantage is that it is both self-expanding and repositionable. It may also have the advantage of fewer patients developing high grade heart block, but bigger studies with longer follow-up are clearly needed.

Alexander B Willson and others. JACC 2012;60(7):581-586.

Imaging

NICE have decided that the exercise test will be replaced, to some degree, by coronary CT. We now have some more data to confirm this approach. The CONFIRM registry (see what we did there?) looked at 7,590 patients without ‘chest pain syndrome’ undergoing coronary CT angiography (CCTA) and coronary artery calcium scoring (CACS). As expected, over a 24-months follow-up, individuals with obstructive 2- and 3- vessel disease or left main coronary artery dis-ease on CT had greater mortality and worse outcomes than those without evidence of coronary artery disease. Coronary artery calcifi-cation appeared to be as useful as CCTA in predicting risk. We still feel uneasy about ‘screening’ CTs in asymptomatic individuals, without knowing whether subsequent intervention changes outcomes (see breast or PSA screening for similar ongoing quandaries).

Iksung Cho and others. Circulation 2012;126:304-313.

Again looking for more indications for an investigation, the ROMI-CATT-II study compared ‘standard evaluation’ with CCTA in patients presenting to A+E with symptoms consistent with an acute coronary syndrome, but non-ischaemic ECGs and normal initial troponins. CCTA meant people were discharged from hospital sooner (7.6 hours faster), but made no statistical difference to clinical outcomes, resulted in more radiation exposure and overall costs were the same. Interestingly, only 8% of the 1000 patients randomised had an ACS, so maybe history taking needs to improve.

Udo Hoffman and others. NEJM 2012;367:299-308.

[ ECG Challenge Answer ]

• The rhythm is sinus rhythm, rate approximately 60 per minute.

• The QRS duration is prolonged.

• The PR interval is short

• There are delta waves on the upstroke of R waves.

• The diagnosis is Wolff Parkinson White syndrome (WPW)

from page 5


What service does Regent’s Park provide to the Scarborough Hospital?

Regent’s Park provides Scarborough Hospital with a fully man-aged invasive cardiology service including the facility, staffi ng and consumables.

When did you commence the service and what days is the service in operati on? Will this be expanded in the future?

The service went live in November 2011 and operates on a Tues-day and Wednesday each week. It is anti cipated that these service days will be expanded in the future to meet the needs of the local populati on.

What is the geographical intake area and populati on served by the hospital?

Scarborough and North East Yorkshire Healthcare NHS Trust (con-sisti ng of two hospitals – Scarborough District General Hospital and Bridlington Hospital) provides a range of acute hospital services for around 240,000 people living in and around Scarborough, Bri-dlington, Whitby and Ryedale. It is the largest employer in the area employing over 2,400 staff .

Scarborough General HospitalWoodlands DriveScarborough, YO12 6QLUnited Kingdom

Above: Judith Jamieson (Cardiac Physiologist, Regent’s Park)

ScarboroughScarborough is primarily a holiday town on the North Sea coast of North Yorkshire, England, with a populati on of over 50,000. The town is based below a rocky headland which supports the ruins of the 11th century Scarborough Castle. This headland separates the sea front into a North Bay and a South Bay, containing beauti ful beaches. Scarborough won the 2008/2009 award for the most creati ve and inspiring entrepreneurship initi ati ve in Europe, and was also named as the most enterprising town in the United Kingdom in 2008.- Source: Wikipedia

Regent’s Park Heart Clinics Ltd.Regent’s Park Heart Clinics is the fastest growing independent cardiology services provider in the United Kingdom. They partner with leading NHS hospitals and cardiologists to develop, fi nance and operate state-of-the-art diagnosti c and treatment faciliti es focused exclusively on cardiovascular disease. One of these sites is a modular cath lab, connected to the CCU at Scarborough Hospital, part of the newly aligned York Teaching Hospital NHS Foundati on Trust.

For more informati on visit their website: www.rphc.co.uk

CardiologyHD spoke to Bryn Webber, Cardiac Services Director at Regent’s Park Heart Clinics Ltd. on the service at Scarborough Hospital

SITE VISIT[ Scarborough Hospital ]

Scarborough

London


How many staff? Roles?

On each service day Regent’s Park provide two trained nurses, one cardiac radiographer and one cardiac physiologist. The two nurses are expected to alternate between acting as the scrub nurse and the runner. Team working is paramount and key to achieving a safe and efficient environment for patients.

Types of procedures? Future?

Currently the service provides only diagnostic coronary angiography. However our staff are trained and experienced in performing the full range of procedures carried out in a cardiac catheter lab.

Types and brands of equipment used?

Siemens Artis Zee and Siemens Sensis

Why did you choose the equipment listed above?

The equipment was evaluated through a ten-der process after which Siemens was chosen as the supplier for this facility. We regularly review the systems on offer within marketplace in order to ensure we are aware of any devel-opments we feel will benefit our NHS clients.

How many procedures are estimated to be performed a year?

600 - 700

What is the approximate percentage of cath lab cases performed radially compared with femorally?

10-15% radial

What are the benefits to patients attending your facility?

Patients attending the Regent’s Park facility at Scarborough Hospital are able to have their coronary angiogram carried out in a ‘state of the art’ facility without the need to travel in excess of 40 miles to the nearest alternative hospitals.

How is your inventory managed?

Our inventory for this service is managed centrally within the company. Consumables are re-ordered electronically by staff within each of our services via this system.

How does the lab handle haemostasis?

Digital pressure predominantly with availability of angioseal / femstop if required.

What measures has the department implemented to cut costs?

• Regional tendering

• Early diagnostic intervention in ACS cases to reduce length of stay.Above: Julie Anderson (Senior Nurse, Regent’s Park)

Above: Julie Anderson (Senior Nurse, Regent’s Park) and Dr Padmanabhan Shakkottai (ST4, Cardiology)


What level of experience and personal attributes does Regents Park prefer when employing new staff?

Regent’s Park staff are expected to work well within a team and dem-onstrate the ability to act as an ambassador for the company while maintaining a very high level of clinical standards and patient care.

Your cath lab team all live outside of Scarborough and travel up for the two days. Does this work well and is it easily accessible via public transport?

Yes. Public transport links are good and due to service days being back to back it has enabled our staff to stay overnight between travelling to/from site.

What other services does Regent’s Park provide to assist cardiology departments?

Regent’s Park is able to provide an entirely bespoke solution to each NHS client; therefore we will always strive to provide a solution that suits the individual requirements. This can range from providing a

temporary catheter lab to designing, funding and operating a fully managed cardiology centre. A good example of the latter option is the Cambridge Heart Clinic which has been operating since 2008.

What have been some of the challenges setting up the service in Scarborough?

Whilst there are always challenges to overcome, nearly always relat-ed to estate issues, we have gained a wealth of experience imple-menting these types of project and are therefore able to work with the NHS Trust to ensure success when setting up new services.

What is the best part of working with Regent’s Park?

Working with Regent’s Park provides the opportunity to work with many different hospitals within the NHS. Each hospital faces a differ-ing set of challenges and it is both interesting and rewarding work-ing in partnership with fellow cardiology professionals, sharing each parties experiences, and overcoming these challenges.

COMING UP[ Next Edition ]

Our Final EditionWe go back in time and look over the last six years of our magazine. See how it all started in a small London studio apartment, eventually bringing together cardiology departments from all over the world.

We’ll reveal some interesting facts about the magazine that has consistently been regarded by many as the favourite cath lab magazine in the UK, and look towards the future and the next project for our company that you can be a part of.

Australia Site VisitWe head to Cairns in Far North Queensland to visit the Cairns Private Hospital. The city is a popular travel destination for foreign tourists because of its tropical climate, and it also serves as a starting point for people wanting to visit the Great Barrier Reef.

Cardiologist InterviewWe speak with a leading UK Cardiologist.

....and other features including a final Cardiologist Hot Topic, Events, Product News, Journal Trawl, and ECG Quiz.

Above: Tim Larner with the first edition launched in 2006.


EVENTS[ What’s On ]

How to get in touch

@ Email

Phone

Post

Circulati on

Editorial, Subscripti on, & General [email protected]

Adverti sing enquiriesadverti [email protected]

Coronary Heart Publishing Ltd, Peter House, Oxford Street, Manchester, M1 5AN, UK

Editorial, Subscripti on, & General enquires+44 (0) 845 299 6220

Adverti sing enquiries+44 (0) 845 299 6220

Free Distributi on of 2800 copies to named individuals within cardiology in UK/Ireland.Distributed to all cardiology departments (invasive and non-invasive) and cardiologists.

All copies are available as a digital editi on on our website at www.cardiologyhd.com.

February 17 - 22, 2013

6th World Congress on Paediatric Cardiology & Cardiac SurgeryCape Town, South Africawww.wcpccs2013.co.za

September 23 - 26

HRC 2012The ICCBirmingham, UKwww.heartrhythmcongress.com

September 30 - October 2

PCR London Valves 2012Queen Elizabeth II Conference CentreLondon, UKwww.pcrlondonvalves.com

October 22 - 26

TCT 2012Miami,Florida, USAwww.tctconference.com

November 3 - 7

AHA Scienti fi c Sessions 2012Los Angeles Conventi on CenterLos Angeles, CA, USAmy.americanheart.org

November 23

Cardiovascular Update 2012, Strategies for Diagnosis & TreatmentLondon, UKEmail: [email protected]

February 21 - 24, 2013

Asian Pacifi c Society of Cardiology 2013 CongressPEACHPatt aya, Thailandwww.apsc2013.org

HRC PO Box 3697 Stratford upon Avon Warwickshire CV37 8YL UK Telephone: +44 (0) 1789 450 787

[email protected]

Providing education and training to promote diversity and improved technology for all involved in the treatment of cardiac arrhythmia patients

Heart Rhythm

Congress

Supported by

The Heart Rhythm CharityArrhythmia Alliance

HR-UK

Heart Rhythm UK

23rd – 26th September 2012 The ICC, Birmingham UK

HRC2012

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