British Cardiovascular Society
9 Fitzroy Square
London W1T 5HW
Office / Landline:
+44 (0)20 7380 1901
UK, 05-Mar-2013 / British Cardiovascular Society,

With publication of the Cardiovascular Disease Outcomes Strategy and the introduction of the National Commissioning Board in England from April 2013 the landscape for commissioning of services in the NHS is changing. Patients expect high quality care from their doctor within a culture of transparency. From June 2013, interventional consultant cardiologists will be required to publish individual outcome data, a move strongly supported by the British Cardiovascular Society. It highlights the importance of specialist care being at the heart of a modern health service. To support this, the British Cardiovascular Society has published guidelines on the Commissioning of Cardiac Care and produced a report on the Future of Acute Cardiac Care, emphasising the importance and benefits of specialist care.

The principal conclusions of the report on the Future of Acute Cardiac Care were as follows:

• Patients presenting with cardiac conditions managed in specialised cardiac wards have demonstrably better outcomes.

• A significant proportion of these patients are not currently managed within a cardiac service, leading to a greater morbidity and mortality, and cost to the NHS.

• Patients presenting with acute cardiac conditions should be managed by a specialist, multi-disciplinary cardiac team and have access to key cardiac investigations and interventions, at all times.

• All hospitals admitting unselected acute medical patients should have an appropriately sized, staffed and equipped Acute Cardiac Care Unit, where high risk patients with a primary cardiac diagnosis should be managed.

• All high risk cardiac patients must have access to Acute Cardiac Care Units, and access should not be restricted to patients with Acute Coronary Syndromes.

Roughly 30% of all patients admitted to hospital with a medical condition will have a primary cardiac problem which emphasises the need for specialist expertise. There is robust evidence to demonstrate that cardiac patients managed by a specialist team have better outcomes, receive more evidence based treatments and interventions, and are discharged more rapidly than those managed by generalists. Much of this benefit comes from being cared for by a multidisciplinary team with specialist nursing, pharmacy, physiotherapy and other expert input.

From data provided by the National Cardiothoracic Benchmarking Collaborative we are able to estimate that in addition to better outcomes for patients there are cost savings that might be achieved if patients with a primary cardiac diagnosis were cared for in specialist wards rather than on a non-cardiac ward, based largely on reduced length of stay and lower rates of readmission. In one large teaching Trust 5,136 episodes of care with a primary cardiac diagnosis were attributed to non-cardiac specialties and a total spend of £3.88 million. A conservative estimate is that this cost could have been reduced by 15% if these patients had been managed by cardiology teams, a saving of around £583K, translating to a saving of around £5.8 million for the 16 Trusts participating in this collaborative.

So while recognising the central role of expert generalists in the initial assessment and on-going care of acutely ill patients, it is important to emphasise that ready access to specialist care, including specialist nursing skills in a dedicated environment, will be required for many patients admitted with a cardiac diagnosis. Many patients will be best managed within an Acute Cardiac Care Unit for at least part of their admission. How this facility is provided will vary from Trust to Trust but in many cases is likely to require expansion of the existing Coronary Care Unit. It is essential that any such unit functions in tandem with an expanded acute medical workforce. The challenge is to identify the patients that require transfer for specialist care as soon as possible after they are admitted ensuring immediate access to specialists without loss of continuity of care.

BCS Report of the Future of Acute Cardiac Care:
BCS Guidance on Commissioning of Cardiac Services

About the BCS

The British Cardiovascular Society (BCS) was founded in 1922 and plays a pivotal role in the delivery of cardiovascular health across the UK with more than 2,500 members and around 90%, of UK consultant cardiologists. Many specialist registrars, GPs and other medical professionals with an interest in cardiovascular medicine are also members.


For further information
British Cardiovascular Society
BCS Press Office

9 Fitzroy Square
London W1T 5HW

Phone: +0044 207 380 1901
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