Cardiovascular disease (CVD) is the world’s number one killer, and conditions affecting the heart or blood vessels, such as heart attack, stroke, and heart failure, kill more than 20.5 million people every year (World Heart Federation, 2024). Every year on 29th September, World Heart Day raises awareness and mobilises international action against CVD to improve patient care.
In England, the NHS’ Long Term Plan identifies CVD as a clinical priority and the single biggest condition in which lives can be saved over the next 10 years. Consultant Connect services already supports over half the NHS across England, Scotland, and Wales with cardiology-related patient care via:
Enhanced Advice & Guidance
Available via Telephone, Photo or Messaging, our rapid Enhanced Advice & Guidance service connects clinicians with specialists at the touch of a button for comprehensive support on patient management. In some regions*, clinical Advice & Guidance is provided by out-of-area NHS consultants on our National Consultant Network (NCN) to back up existing lines or provide a service where a local one is not available.
‘I saw an elderly patient because she was breathless. She was last seen by her local cardiology team 18 months previously with some narrowing of the aortic valve. I found that she had fluid retention, including swollen ankles, and a heart rhythm disturbance, which was atrial fibrillation (AF).
‘I was aware that AF in an elderly patient with heart problems creates a very high risk of blood clots in the heart, which can cause a stroke. Therefore, I needed to start blood-thinning drugs as soon as possible. Still, I wasn’t sure of the interaction with the patient’s abdominal aortic aneurysm, which would be life-threatening if ruptured.’
Dr Cristina Guallar, GP in Southwark, South East London ICB.
‘I reassured Dr Guallar that the benefit of blood thinners outweighed the risk and that this should be started today with a drug that would work immediately. Additionally, it seemed likely that the patient’s breathlessness was caused by a further narrowing of her aortic valve that had put pressure on the heart and resulted in rhythm disturbance and inefficiency of the heart, resulting in fluid retention. Accordingly, I advised Dr Guallar that a very early assessment by the local cardiology clinic was mandated. I suggested that she contact the local cardiology department requesting that the patient be seen within 7-10 days to evaluate whether she was suitable for some form of aortic valve operation to relieve her symptoms and prolong life. Without this phone conversation, it is likely that the referral would have been through the standard route and could have taken many months. During this time, the patient would have been at risk of stroke and may have died from her narrowed aortic valve.’
Dr Patrick Davey, NHS Consultant Cardiologist who provides Advice & Guidance on the NCN.
Referral Triage
Our clinically-led Referral Triage and Validation service supports Trusts needing additional temporary capacity for referral triage. The service uses the clinical expertise of NHS consultants across 17 specialties, including cardiology. Working remotely as ‘virtual locums’, they follow local pathways and protocols, and, under the leadership of the local clinical leads, support with triaging and validating waiting list backlogs in bulk and/or new referrals as they come in.
To date, we’ve triaged over 12,000 cardiology referrals across five NHS Trusts. Where applicable, cardiology referrals were sent straight to test, with the results reviewed again by the consultant before deciding if an appointment was needed or if the referrals could be returned to primary care with a management plan. As a result, 40% of referrals were safely returned to primary care with comprehensive and detailed advice, and 60% were directed to the right place, the first time.
‘We are very much here to support and help with waiting times and add value. We’re not trying to do anything outside everyday practice or established guidelines. We don’t take risks or compromise quality; our goal is to practice safely. Yes, it’s nice when you see a reduction in the number of patients attending the clinic, but ultimately, it’s about adding quality in a secure manner.
‘Conducting triage this way allows us to identify patients unnecessarily waiting a long time and who clearly need a diagnostic that can be quickly provided and reported. Additionally, some patients have evidently urgent conditions that we can identify and upgrade. You can’t underestimate the value of having a good support system. I’ve identified a few patients with immediate life-threatening problems who have been on cardiology waiting lists. As a result, I contacted the Consultant Connect Team and the local specialty manager in the middle of the night, and received a response straight away. In doing so, we may have saved those patients’ lives.’
Dr Stephen Cookson, NHS Consultant Cardiologist triaging referrals on the NCN for out-of-area NHS trusts.
* Please note that service features differ depending on locality.
If you would like to discuss how we can help support your NHS area’s cardiology provision, please contact us on hello@consultantconnect.org.uk or call 01865 261467.
