Introduction:
Welcome to the Cardiology CASES webpage. We hope you will find the links and videos educationally useful and relevant.
The Pie chart shown below represents the breakdown of cardiology referrals received into CASES from the Pilot launch until 31 January 2017. Around 13% of cardiology referrals were sent back to practices with advice on management that can be carried out in primary care. A further 6% were sent back to practices asking for more information to be included in the referral letter before sending to secondary care.
Dr Andy McCoye, Dr Charles Heatley and Dr Annie Majoka peer review referrals to cardiology. They have established close mentorship links with Prof Chris Newman and Dr John West, Consultants in cardiology ,at Sheffield Teaching Hospitals NHS Foundation trust.
Educational materials and advice
Please contact PCS if you feel you would benefit from receiving CASES information based on individual GP or Practice referrals for reflective learning (please note this can support CPD training and appraisal). You may wish to use the below template:
Videos
Watch Dr Andy McCoye discussing the management of the common cardiology complaint of palpitations. The video covers case examples and advice on who can be treated in primary care and who needs to be referred on as well as giving advice on how to produce a good referral:
Further advice is available on the following website: http://www.heartrhythmalliance.org/aa/uk/
Top Ten hints: Cardiology
1. Palpitations: Ideally do blood tests including TFTs and calcium, ECG and holter/24 hour tape via community providers before referral, and please attach the full report to the referral
2. Cardiac sounding stable chest pain: Ideally do an ECG at earliest possible opportunity and start aspirin, statin and GTN at time of referral if sounds like a good story for angina
3. Breathlessness: Ideally check ECG, CXR, spirometry and blood tests to exclude anaemia and do NTproBNP before referral
4. Syncope: Ideally patients who sound like vasovagal syncope or POTS, encourage a teaspoon of table salt and 2.5litres of fluid per day at time of seeing
5. Atrial fibrillation: Ideally use Sheffield AF guidelines and assess CHADS2VASC and HASBLED scores and anticoagulate at soonest opportunity
6. Hyperlipidaemia: Ideally use the Sheffield lipid guidelines before considering referral to secondary care and refer to biochemistry lipid clinic run by Dr Delaney and colleagues
7. Hypertension: Ideally treatment in primary care unless multiple intolerances, very high BP, very young, secondary cause likely or resistance to treatment. If secondary care referral needed then refer to hypertension medicine clinic run by Professor Jackson and colleagues. (This can be accessed on the electronic referral system with a named clinician search and found in ‘geriatrics’- even if the patient is a young hypertensive)
8. Murmurs: Ideally if a new murmur then investigate with an open access echocardiogram. If referring someone with possible worsening of known valve disease it is helpful to get an up to date echo by same pathway
9. Heart failure: Ideally if new symptoms of suspected heart failure, perform blood tests including NT pro BNP, ECG and chest x-ray and follow Sheffield heart failure pathway
10. Patients with an exacerbation of known coronary artery disease or previous revascularisation: ideally do blood tests to exclude non-cardiac causes of worsening e.g. anaemia and uptitrate or add antianginals at time of referral.
Meet the review team
Dr Charles Heatley
Dr Heatley; BA (Cambridge 1983 , MBChB (Glasgow 1986) MRCP (1989) MRCGP (1990) DRCOG(1990)
Dr Heatley worked in acute medicine in Glasgow for three years following his JHO jobs, including a year in infectious diseases. He has maintained an interest in cardiology. His practice records ECGs in house, which he has analysed throughout his 23 years as GP Partner (at Birley Health Centre), with occasional supervision from consultant colleagues. He set up a Cardiomemo service for rhythm investigation in the Hallam and South Locality and worked on the heart failure pathway. He has contributed a chapter on palpitations to the BMJ/WILEY ABC of Emergency Differential Diagnosis. Dr Heatley is also Lead GP for Elective Care at NHS Sheffield CCG.
Dr Andrew McCoye
Dr McCoye is a GP Principal at the Ecclesfield Group Practice and an active member of the North CCG Locality. He has a particular interest in cardiovascular disease and works as a GP clinical assistant for Sheffield Hospitals Trust in Cardiology. He has been involved in the redevelopment of the chest pain service, and improving Amiodarone prescribing and monitoring. He also worked on the formulation of the Care Home LES and the Concord Health Support Group, delivering advice and support to patients with cardiovascular problems.
Image (below) on GP resource page is reproduced under license obtained from www.123rf.com/profile_woodoo007′>woodoo007 / 123RF Stock Photo
