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2 Specialties Cardiovascular medicineTable 1 Service location and main activitiesService locationPrimary cardiaccareCommunitycardiologySecondarycardiac careTertiary cardiaccareMain activitiesPrimary and secondary preventionMonitoring and management of:hypertension (eg ambulatory blood pressure)hyperlipidaemiadiabetesrenal conditions.Resting ECG testsMonitoring and management of stable chronic diseases, eg coronary heart disease, heart failureSome investigation and management of heart failure (community echo and blood tests)Ambulatory monitoring of blood pressure and ECGCardiac rehabilitationEmergency care of:acute chest paincollapseacute breathlessness suspected to be cardiac in originacute coronary conditions (heart attack)acute arrhythmiasacute heart failureheart infections (endocarditis)diseases of the heart muscleacute pericardial conditions.Clinical management of cardiac care unitsInpatients with cardiac conditionsCardiac day cases for investigation or treatmentInvestigation of suspected cardiac symptoms – in rapid-access chest pain clinics, and newer one-stop clinics forheart failure, arrhythmiasFollow-up of patients with certain valve disorders, cardiomyopathies, pericardial conditions and arrhythmiasFollow-up of some patients with congenital heart diseaseGeneral outpatient clinicsEchocardiography studies, transthoracic, transoesophageal and stress exercise ECG investigationsNuclear cardiology studies, some CT and MRIAmbulatory analyses of ECG and blood pressureInvestigations of autonomic function, eg tilt-table testingDiagnostic cardiac catheterisation and angiographySome percutaneous coronary intervention (PCI)Implantation of temporary pacemakersImplantation, renewal and follow-up of permanent pacemakers including complex devices, eg CRTSome electrophysiological studies and routine ablationImplantable ECG loop recordersImplantation and renewal of intracardiac/subcutaneous defibrillatorsCardiac rehabilitationAll secondary care services for their local population, plus:Emergency PPCI for STEMIComplex interventions:percutaneous closure of PFOpercutaneous closure of ASDsnon-surgical reduction of myocardial septumpercutaneous laser revascularisation for refractory anginacarotid artery stent placement for carotid stenosispercutaneous occlusion of left atrial appendagepercutaneous mitral valvuloplastypercutaneous aortic valvuloplasty and aortic valve replacementpercutaneous closure of acquired VSD.(continued)C○ Royal College of Physicians 2013 49
Consultant physicians working with patientsTable 1 Service location and main activities (continued)Service locationMain activitiesManagement of rare cardiac arrhythmias (eg congenital long QT syndrome, Brugada’s syndrome,arrhythmogenic right ventricular dysplasia, ventricular arrhythmias associated with familialcardiomyopathies)Screening families affected by sudden cardiac deathManagement of some cardiomyopathiesExtraction of pacemaker leads with special equipmentCardiac surgeryComplex cardiac interventionsAdvanced cardiac electrophysiologySupra-regionalcardiologyPaediatric cardiologyAssessment of adults with congenital heart diseaseMost interventions in adults with congenital heart diseaseFollow-up of certain adults with congenital heart diseasePulmonary hypertensionImplantation of left ventricular assist devicesCardiac transplantationCardiopulmonary transplantationECG = electrocardiography; PFO = patent foramen ovale; ASD = atrioseptal defect; VSD = ventriculoseptal defect; STEMI = ST-elevation myocardialinfarction.Community cardiology is an expanding subspecialtythat has a particular interest in these areas.Complementary servicesComplementary therapies do not play a major role inthe management of heart disease. However, somepatients have access to various therapies through linksbetween voluntary services and patient and carergroups.3 Working with patients: patient-centredcarePatient and carer involvement in cardiac servicesIn 2003, the British Cardiovascular Society (BCS)established a broad-based group to represent theinterests and aspirations of cardiac patients and theircarers. The Cardiovascular Care Partnership UK (CCPUK) was developed as an affiliated group of BCS in 2004to act as the patient arm of cardiology. Trustees aredrawn from various cardiac patient and carer charities,including the Children’s Heart Federation (CHF), theGUCH Association, the British Heart Foundation(BHF) Heart Support Group network, thecardiovascular network patient and carer partnershipsof England, and various healthcare professionalscommitted to patient empowerment.The CCP UK is represented on the patient involvementpanel of the Royal College of Physicians (RCP), the JointSpecialty Committee for Cardiology, the board ofMyocardial Infarction Audit Project (MINAP), Societyfor Cardiothoracic Surgery (SCTS), Department ofHealth’s (DH) working groups on cardiovascularmedicine and stroke, BHF, National Audit of CardiacRehabilitation (NACR), NICE consultations, NSFchapter groups for GUCH and arrhythmias, and theNHS Improvement Heart team.Patient-centred care in integrated care pathwaysA formal description of a patient’s view of the essentialelements of the care pathway is given in the Fifth reporton the provision of services for patients with heartdisease. 4 Among the issues raised were: involvement in decisions regarding treatment receipt of appropriate information time to interpret and reflect before decisions aremade partnership with professionals in their care support offered earlier in care pathways promotion of cardiac rehabilitation and supportgroups.Patients help to define care pathways through theirinvolvement with quality in practice teams working in50 C○ Royal College of Physicians 2013
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