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Publication Extending the reach of expert amyloidosis care : a feasibility study exploring the staged implementation of a UK amyloidosis network(Elsevier, 2024-01-19) Choy, Chern Hsiang; Steeds, Richard; Pinney, Jennifer; Baig, Shanat; Turvey-Haigh, Lauren; Wahid, Yasmin; Cox, Helen; Zaphirou, Alex; Srinivasan, Venkataramanan; Wilson, David; Fryearson, John; Ahamed, Mubarak; Lim, Sern; Chue, Colin; Pratt, Guy; Fontana, Marianna; Gillmore, Julian D.; Moody, William E.; University Hospitals Birmingham NHS Foundation Trust; University of Birmingham; Worcestershire Royal Hospital; South Warwickshire University NHS Foundation Trust; University College London;; Cardiology; Medical and Dental; Fryearson, JohnThere has been an exponential increase in the diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CA). In response, the Midlands Amyloidosis Service was launched with the aim of providing patients with a timely diagnosis, remote expertise from the National Amyloidosis Centre and access to emerging transthyretin (TTR)-directed therapies. This was a descriptive study of a pilot hub-and-spoke model of delivering specialist amyloidosis care. Patients with suspected amyloidosis were referred from the wider Midlands region, and seen in a consultant-led multidisciplinary clinic. The diagnosis of ATTR-CA was established according to either the validated non-biopsy criteria or histological confirmation of ATTR deposits with imaging evidence of amyloid. Study endpoints were the volume of service provision and the time to diagnosis from the receipt of referral. Patients (n=173, age 75±2 years; male 72 %) were referred between 2019 and 2021. Eighty patients (46 %) were found to have cardiac amyloidosis, of whom 68 (85 %) had ATTR-CA. The median time from referral to diagnosis was 43 days. By removing the need for patients to travel to London, an average of 187 patient-miles was saved. Fifteen (9 %) patients with wild-type ATTR-CA received tafamidis under the Early Access to Medicine scheme; 10 (6 %) were enrolled into phase 3 clinical trials of RNA interference or antisense oligonucleotide therapies. Our results suggest that implementing a UK amyloidosis network appears feasible and would enhance equity of access to specialised amyloidosis healthcare for the increasing numbers of older patients found to have ATTR-CA. Keywords: Amyloidosis; Screening; Transthyretin amyloid cardiomyopathy.Publication In-hospital resuscitation(RCN Publishing (RCNi), 2016-11-16) Morrow-Barnes, Abby; South Warwickshire University NHS Foundation Trust; Nursing and Midwifery Registered; Morrow-Barnes, AbbyA CPD article, on the Resuscitation Council UK guidelines for in-hospital resuscitation, improved Abby Morrow-Barnes’ knowledge of how to recognise and respond to adults in cardiac arrest.Publication Assessment of the physiological adaptations to chronic hypoxemia in Eisenmenger syndrome(Tech Science Press, 2016-05-19) Bowater, S. E.; Weaver, R. A.; Beadle, R. M.; Frenneaux, M. P.; Clift, P. F.; Queen Elizabeth Hospital, Birmingham; University of Birmingham; South Warwickshire University NHS Foundation Trust; University of East Anglia; Cardiology; Medical and Dental; Beadle, R. M.; Bowater, Sarah; Clift, PaulObjective: Eisenmenger syndrome is characterized by severe and lifelong hypoxemia and pulmonary hypertension. Despite this, patients do surprisingly well and report a reasonable quality of life. The aim of this study was to investigate whether these patients undergo adaptation of their skeletal and cardiac muscle energy metabolism which would help explain this paradox. Design and setting: Ten patients with Eisenmenger syndrome and eight age- and sex-matched healthy volunteers underwent symptom-limited treadmill cardiopulmonary exercise testing, transthoracic echocardiography and (31) P magnetic resonance spectroscopy of cardiac and skeletal muscle. Five subjects from each group also underwent near infrared spectroscopy to assess muscle oxygenation. Results: Despite having a significantly lower peak VO2 , patients with Eisenmenger syndrome have a similar skeletal muscle phosphocreatine (PCr) recovery, a measure of oxidative capacity, when compared to healthy controls (34.9 s ± 2.9 s vs. 35.2 s ± 1.7 s, P = .9). Furthermore their intracellular pH falls to similar levels during exercise suggesting they are not reliant on early anaerobic metabolism (0.3 ± 0.06 vs. 0.28 ± 0.04, P = .7). While their right ventricular systolic function remained good, the Eisenmenger group had a lower cardiac PCr/ATP ratio compared to the control group (1.55 ± 0.10 vs. 2.17 ± 0.15, P < .05). Conclusions: These results show that adult patients with Eisenmenger syndrome have undergone beneficial physiological adaptations of both skeletal and cardiac muscle. This may, in part, explain their surprisingly good survival despite a lifetime of severe hypoxemia and adverse cardiopulmonary hemodynamics. Keywords: Eisenmenger Syndrome; Energy Metabolism; Hypoxemia; Magnetic Resonance Spectroscopy.Publication Patient experience within the adult congenital heart disease outreach network : a questionnaire-based study(BioMed Central, 2018-09-03) Ooues, Georgina; Clift, Paul; Bowater, Sarah; Arif, Sayqa; Epstein, Andrew; Prasad, Neeraj; Adamson, Dawn; Cummings, Mandy; Spencer, Charles; Woodmansey, Paul; Borley, Jenny; Ingram, Thomas; Morley-Davies, Adrian; Roberts, William; Qureshi, Najmi; Hawkesford, Susan; Pope, Nichola; Anthony, James; Gaffey, Thomas; Thorne, Sara; Hudsmith, Lucy; University Hospitals Birmingham NHS Foundation Trust; Wye Valley NHS Trust; University Hospitals Coventry and Warwickshire NHS Trust; Royal Wolverhampton NHS Trust; Shrewsbury and Telford Hospital NHS Trust; University Hospitals of North Midlands NHS Trust; Worcestershire Acute Hospitals NHS Trust; South Warwickshire University NHS Foundation Trust;; Cardiology; On behalf of The West Midlands ACHD Network, UK; Medical and Dental; Nursing; Qureshi, Najmi; Clift, Paul; Bowater, Sarah; Arif, Sayqa; Hawkesford, Susan; Gaffey, Thomas; Hudsmith, LucyBackground Specialist multi-disciplinary care improves outcomes of Adult Congenital Heart Disease (ACHD) patients. Following the NHS England Congenital Heart Disease standards review, the aim is to deliver high quality, patient-centred, care closer to patients’ homes. Cardiac investigations performed on the same day of outpatient appointments reduce the non-attendance rates. This young cohort of patients, benefits from comprehensive multi-disciplinary management. We developed a Patient Questionnaire across our West Midlands ACHD network to measure patient experience. Methods Patient questionnaires were distributed to patients attending outpatient clinics in all 8 Outreach Centres and the Level 1 ACHD Centre (University Hospitals Birmingham). Results 71 males (55%) and 59 females (45%), median age range 25–34 years old (range between 16 and 75 years old), returned the questionnaires (n = 130). Most patients travelled less than one hour to hospital (93%, n = 120) and less than 20 miles (86%, n = 99). The mean travel distance was 14 ± 12.3 miles (range 1 to 160 miles), with Level 1 ACHD Centre patients travelling a significantly longer distance (mean 29.6 ± 44 miles) compared to the local Outreach Centres (mean 11.3 ± 9 miles, p = 0.0037). There was a wide variability in the provision of parking, although most patients found the appointment time and location convenient (91%, n = 117 and 95%, n = 121 respectively). There was also marked variation in the number of electrocardiograms (19–100%) and echocardiograms (0–60%) performed on the same day as their clinic appointment. Most patients felt they were given enough information regarding their condition (85%, n = 98), with no significant differences between the centres (p = 0.24). Conclusion To our knowledge, this is the first questionnaire-based study assessing patient experience within the NHS ACHD Outreach network with significantly reduced travel times and maintained high patient satisfaction. There was a wide variation in investigations performed and patient information leaflets provided. Standardisation of services is required at all centres to ensure equity of care, with Specialist Nurses’ input and more availability of tests on the day of clinic appointments in all centres.Publication Optimising patient experience within the ACHD outreach network : a questionnaire based study(BMJ Publishing Group, 2018-02-02) Ooues, G.; Clift, P.; Bowater, S.; Arif, S.; Epstein, A.; Prasad, N.; Adamson, D.; Cummings, M.; Spencer, C.; Woodmansey, P.; Ingram, T.; Morley-Davies, A.; Roberts, W.; Qureshi, N.; Hawkesford, S.; Pope, N.; Anthony, J.; Gaffey, T.; Thorne, S.; Hudsmith, L.; Queen Elizabeth Hospital, Birmingham; Hereford County Hospital; University Hospital Coventry; Royal Wolverhampton Hospital; Princess Royal Hospital, Telford; Royal Shrewsbury Hospital; Royal Stoke University Hospital; Worcester Royal Hospital; Warwick Hospital; Cardiology; Medical and Dental; Qureshi, N.Poster abstract 33 of the British Congenital Cardiac Association annual meeting, 9–10 November 2017, Great Ormond Street Institute of Child Health, London, UK.Publication Effective nurse-led interventions in heart disease(Elsevier, 2002-06) Thompson, David R.; Quinn, Tom; Stewart, Simon; University of York; George Eliot Hospital NHS Trust; South Warwickshire General Hospitals NHS Trust; University of Glasgow; Cardiology; Nursing and Midwifery Registered; Quinn, TomNurses are increasingly being involved in initiatives to improve the co-ordination, delivery and eventual outcomes of health care. Key components of these initiatives include application of evidence-based treatments, ensuring individualised follow-up and the provision of "seamless" care overall. There is evidence in key areas that nurse-led interventions for patients with heart disease are effective, and that they are likely to work in other areas if properly supported and appropriate structures and systems are put in place to promote such practice. Given the promising results to date, it would be disappointing if these issues remain unresolved and the potential value of this type of interventions unfulfilled.Publication Report on the BANCC digital health technology webinar(MA Healthcare, 2021-02-10) SPENCER, CHARLES; South Warwickshire University NHS Foundation Trust; Cardiology; Nursing and Midwifery Registered; Spencer, CharlesAfter attending the second of a series of webinars held by the BANCC, cardiology advanced clinical practitioner and BANCC member Charles Spencer reports on the discussions and learning points that were raised around the theme of digital health and technology.Publication A look at the impact of the advanced clinical practitioner role in the realm of cardiology(MA Healthcare, 2022-11) SPENCER, CHARLES; South Warwickshire University NHS Foundation Trust; Cardiology; Nursing and Midwifery Registered; Spencer, CharlesAs an advanced clinical practitioner, registered nurse, founding member of the cardiology nurse forum Facebook group and podcast, and a recently elected ordinary council member of the BANCC, Charles Spencer explores the impact of the advanced clinical practitioner role in cardiology, expanding on his ‘top topic’ session at the recent British Cardiovascular Society conference in June.Publication Caseload management and outcome of patients with aortic stenosis in primary/secondary versus tertiary care settings-design of the IMPULSE enhanced registry(BMJ Publishing Group, 2019-07) Rudolph, Tanja K.; Messika-Zeitoun, David; Frey, Norbert; Lutz, Matthias; Krapf, Laura; Passefort, Stephanie; Fryearson, John; Simpson, Helen; Mortensen, Kai; Rehse, Sebastian; Tiroke, Andreas; Dodos, Fotini; Mies, Florian; Pohlmann, Christiane; Kurucova, Jana; Thoenes, Martin; Bramlage, Peter; Steeds, Richard; University of Cologne, Germany; University of Ottawa, Ontario, Canada; University Medical Center Schleswig-Holstein, Kiel, Germany; Hopital Max Fourestier, Nanterre, France; Hopital André Grégoire, Montreuil, France; South Warwickshire University NHS Foundation Trust; University Hospitals Birmingham NHS Foundation Trust; Cardiology Practices, Kiel, Germany; Hospital Preetz, Germany; Hohenlind, Cologne, Germany; Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany; Edwards Lifesciences, Prague, Czech Republic; Edwards Lifesciences, Nyon, Switzerland; Cardiology; Medical and Dental; Fryearson, John; Simpson, Helen; Steeds, RickBackground: Severe aortic stenosis (AS) is one of the most common and most serious valve diseases. Without timely intervention with surgical aortic valve replacement or transcatheter aortic valve replacement, patients have an estimated survival of 2-3 years. Guidelines for the treatment of AS have been developed, but studies suggest that as many as 42% of patients with AS are not treated according to these recommendations.The aims of this registry are to delineate the caseload of patients with AS, outline the management of these patients and determine appropriateness of treatments in participating centres with and without onsite access to surgery and percutaneous treatments. Methods/design: The IMPULSE enhanced registry is an international, multicentre, prospective, observational cohort registry conducted at four central full access centres (tertiary care hospitals) and at least two satellite centres per hub (primary/secondary care hospitals). An estimated 800 patients will be enrolled in the registry and patient follow-up will last for 12 months. Discussion: In addition to the primary aims determining the caseload management and outcome of patients with AS in primary, secondary and tertiary care settings, the registry will also determine a time course for the transition from asymptomatic to symptomatic status and the diagnostic steps, treatment decisions and the identification of decision-makers in tertiary versus primary/secondary care hospitals. The last patient will be enrolled in the registry in 2018 and results of the registry are anticipated in 2019. Registration number: NCT03112629. Keywords: aortic stenosis; facilitated data relay; quality of care; surgical aortic valve replacement; transcatheter aortic valve implantation.Publication Florid aortitis following SARS-CoV-2 infection(Oxford University Press, 2020-11) Shergill, Simran; Davies, James; Bloomfield, James; South Warwickshire University NHS Foundation Trust; Cardiology; Medical and Dental; Shergill, Simran; Davies, James; Bloomfield, JamesA case report on a patient with florid aortitis following SARS-CoV-2 infection.Publication Assessing heart disease using a novel magnetocardiography device(IOP Publishing, 2021-02-23) Beadle, Roger; McDonnell, D; Ghasemi-Roudsari, S; Unitt, L; Parker, S J; Varcoe, B T H; Department of Cardiology, South Warwickshire NHS Foundation Trust; Creavo Medical Technologies, Coventry; School of Physics and Astronomy, University of Leeds; Department of Cardiology; Medical and Dental; Beadle, R; McDonnell, DThe aim of this paper is to present the use of a portable, unshielded magnetocardiograph (MCG) and identify key characteristics of MCG scans that could be used in future studies to identify parameters that are sensitive to cardiac pathology. We recruited 50 patients with confirmed myocardial infarction (MI) within the past 12 weeks and 46 volunteers with no history of cardiac disease. A set of 38 parameters were extracted from MCG features including both signals from the sensor array and from magnetic images obtained from the device and principal component analysis was used to concentrate the information contained in these parameters into uncorrelated predictors. Linear fits of these parameters were then used to examine the ability of MCG to distinguish between sub-groups of patients. In the first instance, the primary aim of this study was to ensure that MCG has a basic ability to separate a highly polarised patient group (young controls from post infarction patients) and to identify parameters that could be used in future studies to build a formal diagnostic tool kit. Parameters that parameterised left ventricular ejection fraction (LVEF) were identified and an example is presented to show differential low and high ejection fractions.Publication Echocardiography in a critical care unit: a contemporary review(Taylor and Francis Group, 2022-01) Mohsin, Muhammad; Farooq, Muhammad Umar; Akhtar, Waheed; Mustafa, Waqar; Rehman, Tanzeel Ur; Malik, Jahanzeb; Zahid, Taimoor; Rawalpindi Institute of Cardiology, Pakistan; Abbas Institute of Medical Sciences, Pakistan; Benazir Bhutto Hospital, Pakistan; South Warwickshire University NHS Foundation Trust; Zahid, TaimoorIntroduction: Echocardiography is a rapid, noninvasive, and complete cardiac assessment tool for patients with hemodynamic instability. Relevant articles were extracted after searching on databases by two reviewers and incorporated in this review in anarrative style. Areas covered: his review provides an overview of the evidence for current practices in critical care units (CCUs), incorporating the use of echocardiography in different etiologies of shock. Expert opinion: In an acute scenario, a basic echocardiographic study yields prompt diagnosis, allowing for the initiation of treatment. The most common pathologies in shocked patients are identified promptly using two-dimensional (2D) and M-mode echocardiography. A more comprehensive assessment can follow after patients have been stabilized. There are four types of shock: (i) cardiogenic shock, (ii) hypovolemic shock, (iii) obstructive shock, and (iv) septic shock. All of them can be readily identified by echocardiography. As echocardiography is increasingly being used in an intensive care setting, its applications and evidence base should be expanded by randomized controlled trials to demonstrate patient outcomes in critical care.Publication Feasibility of novel unshielded portable magnetocardiography: Insights from the prospective multicenter MAGNETO-SCD trial(Elsevier, 2023-03) Lachlan, Thomas; He, Hejie; Miller, Adam; Chandan, Nakul; Siddiqui, Shoaib; Beadle, Roger; Wilson, David; Petkar, Sanjiv; Randeva, Harpal; Osman, Faizel; He, Hejie; Lachlan, Thomas; University Hospitals Coventry and Warwickshire NHS Trust; University of Warwick; University of Leeds; George Eliot Hospital NHS Trust; South Warwickshire University NHS Foundation Trust; Worcester Royal Hospital; Royal Wolverhampton NHS Trust; Cardiology; Medicine; Medical and Dental; Beadle, Roger; He, Hejie; Lachlan, Thomas; Chandan, Nakul; Randeva, HarpalA research letter communicating insights into the feasibility of novel unshielded portable magnetocardiography from the prospective multicenter MAGNETO-SCD trial.Publication Tipping the balance: chronic superior vena cava thrombosis resulting in an aberrant and inefficient venous circuit(Elsevier, 2022-03) Shergill, Simran; Bloomfield, James; Fryearson, John; South Warwickshire University NHS Foundation Trust; Cardiology; Medical and Dental; Shergill, Simran; Bloomfield, James; Fryearson, JohnGiven there was no direct flow into the right atrium from the SVC, we deemed this inefficient venous circuit responsible for her breathlessness, with a small reduction in cardiac function 'tipping the balance' and producing symptoms this late in life. The patient opted for conservative management with the risk of intervention outweighing her currently manageable symptoms.Publication Right ventricular function and long-term clinical outcomes after cardiac resynchronization therapy: A cardiovascular magnetic resonance study(Wiley, 2022-09) Zegard, Abbasin; Okafor, Osita; Moody, William; Marshall, Howard; Qiu, Tian; Stegemann, Berthold; Beadle, Roger; Leyva, Francisco; Aston University; University Hospitals Birmingham; South Warwickshire University NHS Foundation Trust; Cardiology; Health Informatics; Medical and Dental; Admin and Clerical; Beadle, Roger; Moody, William; Marshall, Howard; Qiu, TianBackground: Right ventricular (RV) dysfunction has been linked to a poor response to cardiac resynchronization therapy (CRT). We sought to determine whether cardiovascular magnetic resonance (CMR)-derived measures of RV function influence clinical outcomes after CRT. Methods: In this retrospective study, we used CMR to assess pre-implant RV volumes and RV ejection fraction (RVEF) in relation to clinical outcomes after CRT implantation. Results: Among 243 patients (age: 70.3 ± 10.8 years [mean ± SD]; 68.7% male; 121 [49.8%]) with ischemic cardiomyopathy and 122 (50.2%) with nonischemic cardiomyopathy, 141 (58%) after CRT-defibrillation (CRT-D) and 102 (42%) after CRT-pacing (CRT-P), 101 (41.6.0%) patients died, 61 (25.1%) from cardiac causes and 24 (9.88%) from noncardiac causes, over 5.87 years (median; interquartile range: 4.35-7.73). Two (0.82%) patients underwent cardiac transplantation and four (1.64%) had a left ventricular assist device (LVAD). A total of 41 (16.9%) met the composite endpoint of sudden cardiac death (SCD), ventricular tachycardia, or ventricular fibrillation. In univariate analyses, no measure of RV function was associated with total mortality or the arrhythmic endpoint. RVEF was associated with cardiac mortality on univariate analyses (HR per 10%: 0.82, 95% CI 0.70-0.96), but not on multivariate analyses that included left ventricular ejection fraction. Conclusions: There is no relationship between measures of RV function, such as RV volumes and RVEF, and the long-term clinical outcome of CRT. These findings indicate that such measures should not be considered in patient selection.Publication Severe aortic stenosis management in heart valve centres compared with primary/secondary care centres(BMJ Publishing Group, 2023-01) Rudolph, Tanja K.; Messika-Zeitoun, David; Frey, Norbert; Lutz, Matthias; Krapf, Laura; Passefort, Stephanie; Fryearson, John; Simpson, Helen; Mortensen, Kai; Rehse, Sebastian; Tiroke, Andreas; Dodos, Fotini; Mies, Florian; Deutsch, Cornelia; Kurucova, Jana; Thoenes, Martin; Bramlage, Peter; Steeds, Richard P.; IMPULSE enhanced investigators; South Warwickshire University NHS Foundation Trust; et al.; Cardiology; Medical and Dental; Fryearson, JohnObjective: Current guidelines recommend use of heart valve centres (HVCs) to deliver optimal quality of care for patients with valve disease but there is no evidence to support this. The hypothesis of this study is that patient care with severe aortic stenosis (AS) will differ in HVCs compared with satellite centres. We aimed to compare the treatment of patients with AS at HVCs (tertiary care hospitals with full access to AS interventions) to satellites (hospitals without such access). Methods: IMPULSE enhanced is a European, observational, prospective registry enrolling consecutive patients with newly diagnosed severe AS at four HVCs and 10 satellites. Clinical characteristics, interventions performed and outcomes up to 1 year by site-type were examined. Results: Among 790 patients, 594 were recruited in HVCs and 196 in satellites. At baseline, patients in HVCs had more severe valve disease (higher peak aortic velocity (4.3 vs 4.1 m/s; p=0.008)) and greater comorbidity (coronary artery disease (CAD) (44% vs 27%; p<0.001) prior myocardial infarction (MI) (11% vs 5.1%; p=0.011) and chronic pulmonary disease (17% vs 8.9%; p=0.007)) than those presenting in satellites. An aortic valve replacement was performed more often by month 3 in HVCs than satellites in the overall population (52.6% of vs 31.3%; p<0.001) and in symptomatic patients (66.7% vs 43.2%, p<0.001). One-year survival rate was higher for patients in HVCs than satellites (HR2.19; 95% CI 1.28 to 3.73 total population and 2.89 (95%CI 1.64 to 5.11) for symptomatic patients. Conclusions: Our data support the implementation of referral pathways that direct patients to HVCs performing both surgery and transcatheter interventions. Trial registration number: NCT03112629.