bluuebunny/crossref_metadata_2025 huggingface dataset:
Managing chronic heart failure: The evidence for telemonitoring
Authors: Burke Katie
Published: May 2014

Chronic heart failure is a significant public health concern. The prognosis for many patients is often poor, with many experiencing frequent hospital readmissions and an impaired quality of life. Innovative and effective nurse-led management strategies have successfully improved the overall management of patients with heart failure, with the emergence of telemonitoring enabling the early detection of clinical deterioration. Telemonitoring promotes patient participation and self assessment, key elements in the successful treatment of heart failure patients. This paper has reviewed three articles, all randomized controlled trials, exploring the concept of telemonitoring in heart failure. All of the studies provide encouraging results that are both statistically and clinically meaningful. In addition to traditional models of care, telemonitoring as a treatment option may, indeed, play an important role in the delivery of effective patient care.
ECG of the month
Authors: Whitbread Mark
Published: May 2014

Mark Whitbread presents an ECG for you to analyse. The answer and management plan are given on page 350
Personal reflections on becoming a research nurse
Authors: Taraborrelli Patricia
Published: May 2014

Reflecting on the past year Patricia Taraborrelli tells us of the challengesof working as a research nurse and how it has been stimulating, helped develop her role as a cardiac nurse and enabled her to promote best practice.
The Home-HF (heart failure) study
Authors: Rileyis Jillian
Published: May 2014

The Home-HF (heart failure) study of home telemonitoring for heart failure patients started last June in north west London. It is a randomized controlled trial, led by Professor Cowie of Imperial College, London and co-ordinated at the Royal Brompton Hospital. The study is recruiting patients when they are discharged home from three hospitals in the area (Ealing, Hillingdon and West Middlesex University Hospital).
Developing a strategy to screen for ‘dis-ease’
Authors: Kelly Jacinta
Published: May 2014

Although cardiovascular disease is often linked to physical risk factors such as cholesterol and smoking, it can be argued that a person’s psychosocial wellbeing is also a factor. Jacinta Kelly discusses the potential impact of screening for psychosocial risk factors in cardiovascular disease.
Pacing and ICDs: A guide
Authors: McNaughton Amanda
Published: May 2014

Cardiac Pacing and ICDs is a book to be passionate about. The only comparable passion would be shoes and if this book were to be a pair of shoes then they would definitely be my favourite pair.
Clopidogrel and the prevention of cardiovascular events
Authors: Williams Helen
Published: May 2014

Platelet activation and subsequent aggregation are implicated in most cardiovascular events. The oral agent, clopidogrel, is an irreversible inhibitor of the ADP-mediated pathway of platelet activation. It is licensed for secondary prevention of atherothrombotic events in patients suffering from myocardial infarction and acute coronary syndromes, but is also used for a number of off-label indications in particular, the prevention of stent thrombosis following percutaneous coronary intervention. The evidence base to support its use alone or in combination with aspirin therapy for these indications is presented here, alongside some of the key issues and problems related to clopidogrel use in clinical practice, with a specific focus on when treatment should be started, the use of loading doses and the optimal durations of therapy.
The role of coronary artery stents in PCI
Authors: Muggenthaler Martina , Singh Amar , Wilkinson Peter
Published: May 2014

Coronary artery stents are small expandable mesh devices inserted into the coronary arteries as a means to improve the blood flow where a stenosis is seen on angiography. Recent advances in stent technology have included the use of drugs released from the stents themselves (known as drug-eluting stents) to reduce the chances of restenosis after insertion of the stent. The procedure itself is now well established and peri-operative care of such patients is an important part of a cardiac nurse’s practice. Whether drug-eluting stents provide long term improvements over older bare-metal stents remains uncertain, and will require data from further trials. Meanwhile improvements in the form of more effective eluted drugs and less damaging stent design are in development.
Giving views of both sides in cardiomyopathy care
Authors: Stuart-Jones Vicqui
Published: May 2014

The Cardiomyopathy Association’s third national nurses’ conference took place in London on 17 December. Vicqui Stuart-Jones reports on the proceedings
ECG of the month
Authors: Bowbrick Steve
Published: May 2014

Steve Bowbrick presents an ECG for you to analyse. The answers are given on page 487.
Catheter ablation of AF: current perspectives on strategies, technologies and patient care
Authors: Liew Reginald
Published: May 2014

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting a large proportion of the population and up to 9% of people aged 80–89. Catheter ablation of AF has evolved significantly over the past decade and is now an established treatment for patients with symptomatic AF that is resistant to medical therapy. An increasing number of cardiac centres around the world are performing this procedure and consequently clinical specialists managing patients with AF should be aware of the procedure. This article provides an overview of currently used strategies and technologies in AF ablation and also highlights the impact of such treatments on patients lives. The potential role of the clinical nurse specialist in looking after patients undergoing AF ablation is also discussed.
Primary angioplasty: Treatment of choice for STEMI in England
Authors: Astin Felicity
Published: May 2014

Felicity Astin outlines the implications for cardiac nursing of the findings of the final report from the National Infarct Angioplasty Project, just published in October.
Developing a new cardio and vascular health strategy for 2010
Authors: Cater Slade
Published: May 2014

Slade Carter outlines the aims of the Cardio & Vascular Coalition, which has been formed to lobby for a comprehensive strategy on cardiovascular disease for 2010 to 2020.
Pharmacology in arrhythmia care’
Authors: Tagney Jenny
Published: May 2014

The first edition of this text was printed in 1997 and intended for `non-experts’, with just a hint of bias against electrophysiology doctors.
Being open with patients and families when things go wrong
Authors: Shuldham Caroline , Haxby Elizabeth J
Published: May 2014

Patient safety incidents occur and patients also suffer complications from treatment. In these situations it is vitally important that staff, including nurses, are open with the patient and family about what has happened and what can be done to ameliorate the consequences and prevent recurrence. This includes apologizing and explaining, beginning as soon as possible after the event. Investigation and root cause analysis are essential in understanding what went wrong and as more information becomes available this has to be communicated to the patient and family involved. Nurses have to continue caring for them, as well as participating in the process of being open. They need to be open and honest during investigation, communicate sympathetically and honestly with the patient and family and take all possible action to remedy the situation. This, together with listening to the perspective of those who have suffered harm, is par t of the duty of care owed to patients.
ECG of the month
Authors: Regan Claire
Published: May 2014

Claire Regan presents an ECG for you to analyse. The answer and management plan are given on page 578
Holistic approach to care
Authors: Butler Jane
Published: May 2014

Only recently have cardiologists and palliative care teams started to work together in the field of heart failure. While there are many excellent palliative care texts and cardiology texts on the market there has not been until now a specific text incorporating both specialities to this level. ‘Supportive Care In Heart Failure’ is one of a series of textbooks from Oxford University Press on supportive care. Unlike the concept of palliative care, which grew out of care for the dying patient, (specifically from cancer), ‘supportive care’ is not restricted to the dying patient.
We all need to help organ donation
Authors: Jones Ian
Published: May 2014

During my younger years I worked in a heart transplant unit. Throughout these early nursing days I was reminded, on a daily basis, how human beings have the ability to consider the needs of others when they themselves are suffering. The lives of my patients were being saved by ordinary people who, when faced with the death of a loved one, were able to consider the pain of others. This is arguably one of the most altruistic acts that anyone can perform.
A change of perspective
Authors: Stuart-Jones Vicqui
Published: May 2014

I seem to have been looking at a lot of maps over the past few weeks. Granted, some of them were for practical purposes (getting to the meetings I was attending, finding my way to Manchester town centre to kill time before my train home). But those were not the ones that made the biggest impression.
Home blood glucose monitoring
Authors: Hill Jill
Published: May 2014

Jill Hill discusses the benefits of home measurement of blood glucose levels, features of the equipment involved and the importance of patient education
More technical than the title might suggest
Authors: Oldroyd Carol
Published: May 2014

Electrocardiographs are a frequently performed investigation in cardiovascular assessment and there is currently an abundance of books on the market aimed at enhancing the practitioner's interpretation skills on a variety of levels.
Top-to-toe guide to CVD signs
Authors: Neal Julia
Published: May 2014

This book is a short collection of the key physical signs of cardiovascular disease that can be seen on examination. It begins with an introduction to the subject about the relevance of general observations such as weight and height. Subsequent chapters go through all possible physical signs working from face to feet. For each sign there is a colour photograph, a description of its significant features, an explanation of how it may be used in diagnosis and its likely cause. The chapter on hands is particularly comprehensive and informative, as you would expect with the wealth of potential information that is available from signs there.
Nurse-facilitated suspected arrhythmia clinic: auditing the initial 12 months’ experience
Authors: Lapper Andrew , Smallwood Andrew
Published: May 2014

Objective: Specialist nursing services focused on delivering care to patients with a suspected arrhythmia are evolving. An audit was undertaken to characterize the population of patients referred to a nurse-facilitated suspected arrhythmia outpatient clinic during the fi rst year of its operation, to assess effectiveness of the clinic in identifying those requiring further treatment, organizational implications of such a clinic and to form a baseline against which future audits can be compared.

Methods: Retrospective data were collected from all patients newly referred and assessed in a nurse-facilitated suspected arrhythmia from July 2006 to July 2007.

Results: 192 patients were referred to this clinic. New referrals were predominantly female (60%); an age range of 19–91 years and were largely Caucasian (88%). The most common symptom prompting referral was palpitations (71%). Depending on clinical history, 82% of referred patients had cardiac monitoring. Following investigation atrial fi brillation (persistent or paroxysmal) was identifi ed in 26% of the referred patients and signifi cant paroxysmal supra-ventricular tachycardia in 5%. The remainder demonstrated atrial ectopy (17%), ventricular ectopy (13%), other arrhythmias (1%), with no arrhythmias identifi ed in 38% of the cohort.

Conclusions: This audit demonstrates that a nurse-facilitated suspected arrhythmia clinic is an effective way of identifying patients with suspected heart rhythm abnormalities. From an organizational standpoint this clinic helps to reduce the burden on general cardiology clinics and helps meet NHS targets. A clear need for further published evidence is highlighted.
Principles of good care in the dying stage of heart failure
Authors: Flynn Maria , Connolly Michael , Booth Katie
Published: May 2014

This paper is the second of two that consider the broad philosophy and principles of supportive and palliative care as applied to patients living and dying with heart failure.

Care of the dying patient is an important and integral part of health care but the disease trajectory of heart failure presents challenges in the diagnosis and management of the dying stage. There are national frameworks to guide best practice in the care of the dying and it is widely recognized that the practice of intensive supportive and palliative care can facilitate a ‘good death’. Excellent interpersonal and communications skills are necessary to help patients and their families deal with the psychological and emotional aspects of dying.

This paper discusses the care and management of dying in heart failure and considers the nature and practice of psychological support for patients and their families. The implications of patients dying with ICDs and pacemakers are highlighted. The use of the Liverpool Care Pathway in caring for a dying patient and their family is also discussed.
Working as a ventricular assist device nurse
Authors: Hipkin Mandy , Allibone Liz
Published: May 2014

Mandy Hipkin is a clinical nurse specialist working in the ventricular assist device team at the Royal Brompton and Harefield NHS Trust. Here she talks with Liz Allibone about the challenges and opportunities of her role working with heart failure patients.
Living through peripartum cardiomyopathy
Authors: Mapp Debra
Published: May 2014

Debra Mapp relates her personal experiences of developing peripartum cardiomyopathy, a form of heart failure as a result of pregnancy. A version of this article was first published in CMA News, the newsletter of the Cardiomyopathy Association.
Diuretics in heart failure part 2: Considerations in practice
Authors: Khatib Rani
Published: May 2014

This is the second part of a review of the use of diuretics to relieve oedema, congestion and dyspnoea in heart failure, and will deal with the practical aspects of a diuretic regimen. The dose, frequency and logical combination of diuretics should aim to eliminate clinical evidence of fluid retention, prevent recurrence of fl uid retention, and not lead to dehydration. Renal function, serum electrolytes and weight should be closely monitored. Heart failure patients on long term diuretic therapy are likely to develop diuretic resistance, especially as the disease progresses. Different measures can be considered to deal with this. Diuretic dose self adjustment has a lower rate of hospitalization and mortality and should be part of heart failure education programmes.
Mapping out the changing roles of cardiac nurses
Authors: Jones Ian
Published: May 2014

Ian Jones outlines a new project being under taken for the British Association of Nurses in Cardiovascular Care to add to the understanding of the CCU nurse role.
ECG of the month
Authors: Regan Claire
Published: May 2014

Claire Regan presents an ECG for you to analyse. The answer is given on page 488.
Prevention better than cure?
Authors: Tagney Jenny
Published: May 2014

Further to another successful Heart Rhythm Congress in Birmingham in October where we heard more about the national launch of the GRASP AF tool to assist in assessing stroke risk from atrial fibrillation in primary care (see the NHS Improvement website for further details: www.improvement.nhs.uk ), National Stroke Day was held on 29th October.
Organ donation in the UK: A question of ‘give’ or ‘take’?
Authors: McDermott Anne , Crouchen Nicky , Hardy Jo
Published: May 2014

Organ transplantation and the availability of donor organs has been a hot topic in the news in recent months. Anne McDermott, Nicky Crouchen and Jo Hardy discuss the current system of organ donation and the implications of a system of presumed consent.
User-friendly guide to ECGs in paced patients
Authors: Bowden Tracey
Published: May 2014

This text provides a comprehensive, in-depth insight into the paced ECG. Whether you are a novice at caring for the paced patient or a more experienced practitioner, a nurse, or a cardiac physiologist, this text covers a variety of aspects and would be an incredibly useful resource.
It’s not like it looks on TV, you know
Authors: Stuart-Jones Vicqui
Published: May 2014

One of the type of news stories usually prefaced with ‘And finally…’ caught my eye as this issue went to press. A 22-yearold woman from Wales, Louise Morris, was able to perform cardiopulmonary resuscitation on her 55-year-old father until paramedics arrived, thanks to watching a popular TV medical drama (BBC News Online, 2009).
ECG of the month
Authors: Regan Claire
Published: May 2014

Claire Regan presents an ECG for you to analyse. The answer and management plan are given on page 593
Heart disease and poverty: The risk factor that dare not speak its name?
Authors: Jones Chris , Pierce-Hayes Ian
Published: May 2014

Coronary artery disease continues to make a deep impression on the UK population in terms of both mortality and morbidity. Considerable public policy is aimed at reducing the impact of this disease, through modification of the risk factors thought to contribute to its development.

We seek to argue that there is a risk factor for coronary artery disease which is commonly ignored by both public and professionals, despite a strong body of evidence pointing to a major role in the aetiology of the condition. This risk factor, namely poverty, contributes to many of the other recognized risk factors such as poor diet, smoking, family history and obesity.

One possible reason for the relative down-grading of poverty is that, whereas matters of lifestyle point to the patient’s responsibility in preventing disease, poverty presents more difficult social problems in its prevention.
Transcatheter aortic valve implantation: A review of clinical outcomes
Authors: Davies Kelly , Lucas Rebecca
Published: May 2014

Aortic stenosis is a growing health problem in the ageing population of the western world. Large numbers of these patients are deemed unsuitable for traditional aortic valve replacement surgery. It is well documented that severe aortic stenosis has a profound effect on a persons’ quality of life and functional ability. A less invasive treatment for this debilitating condition has been recently introduced;: transcatheter aortic valve implantation (TAVI). This article explores the current research evidence related to the clinical outcomes following this procedure. As well as easily measurable clinical outcomes, consideration is given to the effect that this procedure has on a patient’s quality of life.
Advances in arrhythmia management
Authors: Postigo Angel Iglesias , Hall Angela
Published: May 2014

Angel Iglesias Postigo and Angela Hall present some of the highlights from this year’s Heart Rhythm Congress 2009, held in Birmingham over 18–21 October.
A question of timing?
Authors: Stuart-Jones Vicqui
Published: May 2014

We recently covered the issue of advanced decisions to refuse treatment as part of our series on consent to treatment (Haxby and Shuldham, 2008). Those of you caring for patients requiring supportive and palliative care may already be aware of the recently published guideline relating to good practice in advanced care planning, commissioned by the British Geriatric Society (Royal College of Physicians et al, 2009). If not, I would encourage you to take a look.
On arrhythmia nurse specialists
Authors: Griffiths Angela , Meldrum Nicola , May Susie
Published: May 2014

We are writing in response to the article ‘The skills, knowledge and educational needs of BHF arrhythmia care coordinators’ by Susie May (Jan 2009, Vol 4 issue 1 pp22-32). Whilst we welcome the promotion of the specialist nurses’ role in arrhythmia management, we do not feel this particular study is truly representative of the existing service within the UK.
A collaborative voice for nursing research?
Authors: Thompson David R
Published: May 2014

David R Thompson discusses the arrival of the new Academy of Nursing, Midwifery and Health Visiting Research, and the implications for cardiac nurses.
Homocysteine and CVD risk: Is it relevant or redundant?
Authors: Windrum Kathrine
Published: May 2014

Homocysteine is an amino acid produced in the body as part of protein synthesis for key functions. High levels of homocysteine in the blood have been linked with cardiovascular disease (CVD) as well as other health problems. B vitamins play a role in the conversion of homocysteine to other amino acids in the body, and so since the mid-1990s research has been ongoing into whether supplementation with B vitamins and folic acid, with the specific aim of lowering homocysteine levels, could have a role in primary or secondary prevention of CVD.

This article reviews the metabolism and pathophysiology of homocysteine, the origin of the ‘homocysteine hypothesis’ and outlines the results of key observational and interventional studies.
Chest X-ray case study 3
Authors: Ash-Miles Janice , Callaway Mark
Published: May 2014

Janice Ash-Miles and Mark Callaway present a chest X-ray for you to analyse. The answers and discussion are given on page 241
Atrial fibrillation—so what? Changing clinical practice
Authors: Bennett Michelle
Published: May 2014

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, if left untreated it is a significant risk factor for stroke and other morbidities. Approximately 12 500 strokes each year are sttributable to AF and the annual cost to the NHS and personal social services budget is estimated to be around £148 million. The SAFE study identified that when GPs record manual pulses during routine consultations the incidence of AF diagnosis is significantly increased, ultimately leading to a reduction in the incidence of stroke.

On 1 May 2007 the Wrexham primary care AF model pilot was launched. Working in partnership across organizational boundaries, changes were made to existing templates in some GP surgeries. A manual pulse check was added to all chronic disease management templates, and a stroke risk stratification tool was added to AF templates to ensure patients are correctly stratified for appropriate use of a thromboprophylactic agent, which in turn would reduce the incidence of stroke. Seven new AF patients were found by opportunistic checks during the pilot and 68 patients found to be on inappropriate or no thromboprophylaxis, which prompted further review by the GPs.
Challenges and collaboration in cardiovascular care
Authors: Stuart-Jones Vicqui
Published: May 2014

Vicqui Stuart-Jones presents some highlights of events at the 9th annual spring meeting of the ESC Council on Cardiovascular Nursing and Allied Professions, held on April 24–25 2009
A field guide to cardiovascular organizations part 2: Professional
Authors: Olson Kate
Published: May 2014

Kate Olson presents a guide to the main organizations that play a par t in the shaping of cardiovascular ser vices across the UK. This second article in the series looks at the key professional bodies representing nurses and other health professionals working in cardiovascular care
Weighty issues
Authors: Stuart-Jones Vicqui
Published: May 2014

In the third part of Kate Olson’s guide to the organizations shaping cardiovascular care in the UK (see pp292-8) she discusses the role of patient support groups and user groups. The rallying cry of one of the best-known of these, the Heart Care Partnership—‘Nothing about us without us’—came to mind when I saw that a Member of the European Parliament, Magor Imre Csibi, the UK’s National Obesity Forum (NOF) and the Belgian Obese Patients Organization have launched an online survey to find out what obese and overweight patients across Europe would want to see tackled in the proposed European Obesity Day, scheduled for 16 May 2010. You can see the survey yourself at www.obesityday.eu .
Modernising Scientific Careers: The next steps for cardiac physiologists
Authors: Campbell Brian
Published: May 2014

Brian Campbell discusses the implications for clinical cardiac physiologists of the proposed new training pathways for health care scientists in England
Coming to terms with the need for a pacemaker
Authors: Jenns Nicola
Published: May 2014

Nicola Jenns describes her experience with supraventricular tachycardia, complications following ablation and life with a pacemaker
Should more cardiac nurses be honoured?
Authors: Tagney Jenny
Published: May 2014

As this is the first issue following the British Cardiac Society conference, I would like to extend a warm welcome to all new subscribers who signed up to receive the journal while visiting the joint British Association of Nursing in Cardiovascular Care (BANCC)/BJCardN stand.
Managing anaemia in chronic heart failure
Authors: Vickers Morag
Published: May 2014

Anaemia is common in chronic heart failure (CHF) and when present the individual is more debilitated and at an increased risk of death. The causes are complex and result in complicated pathophysiological processes which are difficult to manage. The development of anaemia in heart failure leads to a process of terminal decline. Therefore it is important that health care professionals dealing with these patients have an understanding of the aetiology and possible treatments. The purpose of this article is to provide an explanation of the causes of anaemia, and discuss treatment and management options based on clinical trials related to anaemia in chronic heart failure
Chest X-ray case study 4
Authors: Ash-Miles Janice , Calloway Mark
Published: May 2014

Following on from their introduction to chest X-ray interpretation, Janice Ash-Miles and Mark Calloway present a series of chest X-rays for you to analyse. The answers and discussion are on page 336
Understanding a systematic review
Authors: MacInnes Douglas
Published: May 2014

Douglas MacInnes gives an over view of the process of per forming a systematic review, how it is communicated and what to consider when making judgments about the information it contains.
Current concerns in cardiology
Authors: Wrigley Martha J , Cope Emma , Hamper Caroline , Hollowell Zoë , Lewis Charlotte
Published: May 2014

Martha J Wrigley, Emma Cope, Caroline Hamper, Zoe Hollowell and Charlotte Lewis report back on some of the topical presentations from a recent study day in the South-East
Comprehensive pacing text
Authors: Bowden Tracey
Published: May 2014

This new edition does not disappoint. It provides the reader with a comprehensive, in-depth explanation of most aspects of cardiac pacing. Technological advances in device therapy and results of clinical trials have prompted this revised edition. Cardiac pacing and ICD therapy have developed enormously in recent decades. Both are areas which can be daunting for the novice in this field; both are important aspects of clinical electrophysiology. The intended target audience is specialists in the fields of cardiology and/or electrophysiology.
Considering complex problems
Authors: O’Donovan Kate
Published: May 2014

There are many nursing and medical cardiovascular textbooks on the shelves but this third particular text adopts a different slant compared with the traditional textbooks. First, it assumes that the reader possesses an insight into and knowledge of the pathophysiology, symptoms and management strategies associated with the different cardiovascular conditions.
Special cases?
Authors: Stuart-Jones Vicqui
Published: May 2014

While I was perusing my copy of the programme for the British Cardiovascular Society conference a couple of months ago, trying to plan which sessions to attend, I wished I had a crystal ball.
Echocardiography case study 1
Authors: Burchell Amy , Nightingale Angus
Published: May 2014

Following on from the review of corroborative echocardiographic techniques (Oxborough, 2008), Amy Burchell and Angus Nightingale present a case illustrating the assessment of aortic stenosis in the context of poor left ventricular function. Answers and discussion are on page 389.
Concise assessment of CVD risk
Authors: Davies Siân
Published: May 2014

This book sets out to provide a comprehensive and practical exploration of the complexities surrounding risk stratification and risk management by comparing and contrasting various global risk assessment tools and guidelines.
Anticipating patient concerns around travel
Authors: Hay Rebecca , Peardon Louise
Published: May 2014

Rebecca Hay and Louise Peardon discuss some of the key concerns that patients calling the Chest Hear t & Stroke Scotland Advice Line have about travelling with a hear t condition, and suggests sources of information for nurses and patients
Cardiac resynchronization therapy: Biventricular pacing for heart failure
Authors: O’Donovan Kate
Published: May 2014

Heart failure is a chronic progressive syndrome, which impairs quality of life and is associated with frequent hospitalizations and a high mortality rate despite optimal medical therapy. Ventricular dyssynchrony is characteristic of systolic heart failure in some of the patients and is recognized as an interventricular conduction abnormality on the ECG, commonly in the form of left bundle branch block. This contributes to abnormal ventricular contraction pattern, which further reduces cardiac output and exacerbates symptoms.

Data from clinical trials have demonstrated that by pacing the right and left ventricle simultaneously, as in cardiac resynchronization therapy, ventricular contraction improves with a resultant reduction in symptoms and an improvement in cardiac output and quality of life in the majority of patients. This article provides an overview of ventricular dyssynchrony and the effect cardiac resynchronization therapy has on ventricular function and on quality of life and symptoms.
Pulse check as a screen for atrial fibrillation
Authors: Madoc-Sutton Hazel , Pearson Eileen , Upton Jane
Published: May 2014

The aim of this study was to assess whether practice nurses are missing opportunities to identify atrial fibrillation by not palpating the pulse. A questionnaire survey of practice nurses attending training at Education for Health was conducted between June and August 2007. A total of 105 nurses completed the questionnaire. Of those who used an electronic sphygmomanometer to measure blood pressure, 24% did not palpate the pulse. Pulse palpation is a quick and easy method of screening for atrial fibrillation.
NSF for CHD: What next? The patient perspective
Authors: Timmis Ken
Published: May 2014

Ken Timmis shares his views on the steps that need to be taken to improve prevention and treatment of cardiovascular disease.
Alcohol and the NHS Health Check programme: Could we be left with a hangover?
Authors: Holmes Mark , Waterall Jamie
Published: May 2014

Alcohol misuse costs the NHS in the order of £2.7 billion per year; the total annual cost to the UK economy has been calculated at up to £25.1 billion. This article will examine if the Department of Health’s NHS Health Check programme policy launched in April 2009 has missed an important opportunity to contribute to tackling the growing health and economic burden of alcohol misuse. The authors believe that alcohol ‘identification and brief advice’ (IBA) should be a standard requirement for this programme. Consequently the article also provides a practical over view of the principles of IBA.
ECG of the month
Authors: Regan Claire
Published: May 2014

Claire Regan presents an ECG for you to analyse. The answer is given on page 89
Hypothesis testing: To doubt or not to doubt?
Authors: Delaney Laura
Published: May 2014

In the second of our articles on inferential statistical analysis, Laura Delaney looks at how it is used to test hypotheses—to test statements about the population being studied
Improving sleep quality for patients after cardiac surgery
Authors: Conway Aaron , Nebauer Monica , Schulz Paula
Published: May 2014

Research has consistently described that patients after cardiac surgery experience disturbed sleep yet there has been limited investigation into methods to improve this experience. Complementary therapies may be a method of addressing this issue.

Aim: To determine if using progressive muscle relaxation improves self-rated sleep quality for patients following cardiac surgery.

Methods and Results: Thirty-five participants’ quantitative data on sleep quality were obtained via questionnaire during their first postoperative week after cardiac surgery. Qualitative data were obtained through written responses to open-ended questions. No significant differences in sleep quality scores were found between pre and post-intervention of progressive muscle relaxation using the Wilcoxon Signed Ranks Test. However, the qualitative analysis discovered the intervention aided some participants in initiating their sleep by diversion of thought, inducing relaxation or alleviating pain and anxiety.

Conclusions: Qualitative findings suggest that progressive muscle relaxation may help patients who have undergone cardiac surgery initiate their sleep.
Head-up tilt table testing: What it involves and why it is requested for syncope
Authors: Perry Graham
Published: May 2014

The tilt test is a medical procedure that is used to diagnose common causes of fainting or syncope. It is per formed to reproduce symptoms experienced by the patient of dizziness or light-headedness with or without a loss of consciousness often suspected to be associated with a drop in blood pressure or positional tachycardia. Syncope can be caused by various health issues, some that pose a serious risk to the individual and others less so. Therefore it is important to determine the cause of the symptoms. A tilt table test is considered positive if the patient experiences symptoms associated with a drop in blood pressure or cardiac arrhythmia. Normally an individual’s blood pressure will not drop dramatically while standing, owing to the body’s own compensatory response to this posture i.e. a slight increase in heart rate and constriction of blood vessels in the legs.
Effectiveness of a one-stop nursefacilitated clinic in managing patients with palpitations
Authors: Smallwood Andrew , Lapper Andrew
Published: May 2014

Objective: The purpose of this study was to evaluate the effectiveness of a ‘one-stop’ nurse-facilitated suspected arrhythmia clinic using a quantitative methodology. This was achieved by determining the frequency and reasons for re-referral of patients to a local hospital who were previously found not to have a significant arrhythmia after attending the nurse-facilitated clinic.

Method: All new referrals to a nurse-facilitated suspected arrhythmia clinic from July 2007 to July 2008, who were not positively diagnosed as having a significant arrhythmia, were subject to an electronic search of the trust’s patient management system. Patients identified as having been re-referred into hospital had their medical notes examined to determine if the reason for referral was due to a suspected or proven arrhythmia.

Results: 302 patients were referred to the nurse-facilitated suspected arrhythmia clinic from July 2007 to July 2008. 58% (n=175) had no significant arrhythmia detected. This cohort included patients with atrial and ventricular ectopy (20%), sinus rhythm with pauses (1%), no arrhythmias detected (38%) and not recorded (1%). 5% (n=8) were re-referred back into the hospital system with a further suspected arrhythmia and 1% (n=2) diagnosed with an arrhythmia.

Conclusions: These findings suggest that a ‘one-stop’ nursefacilitated suspected arrhythmia clinic is effective at identifying people with a significant arrhythmia and can safely refer back to a general practitioner or on to cardiology services. This article adds detail and outcome data to previously published articles about this aspect of nurse-facilitated care.
What’s in the news?
Authors: Tagney Jenny
Published: May 2014

By the time this issue is published, we will be in a media frenzy either in the final buildup towards a general election, with predictions, claims, counter-claims and promises or in the aftermath, with the inevitable postmortem of ‘what-if’s’, ‘if only’s and ‘next time’s. Health care in general and nurses in particular are likely to receive a reasonable amount of attention in all parties’ campaigns as, whichever party is leading the country over the next 4 years, times will be tough. Indeed, prior to the election, Sir David Nicholson (NHS Chief Executive) issued a guidance letter for Strategic Health Authority executives advising caution when speaking to the press as the NHS ‘was likely to be a high profile issue’ during the campaigning.
The ARITMO project: Arrhythmia-related risks of drugs
Authors: Sturkenboom Miriam , Molokhia Mariam
Published: May 2014

Miriam Sturkenboom and Mariam Molokhia, on behalf of the ARITMO Consortium, explain how this project, using anonymized medical data from more than 27 million European patients, will provide a drug risk assessment to allow more informed treatment and decision-making by clinicians.
Understanding behaviour change
Authors: Randell Kate , Kennedy Susan
Published: May 2014

The title of Thirlaway and Upton’s book, ‘The Psychology of Lifestyle’ could potentially mislead cardiac nurses into thinking it is too theoretical for them. However, inside the covers they will find an excellent resource. It is not the easiest of reads, with long paragraphs, detailed analysis of research evidence and few diagrams or illustrations to break the prose. Nevertheless for health-care students and practitioners this book provides the key concepts for delivering evidence based approaches to improving lifestyles.
Editor at large
Authors: Stuart-Jones Vicqui
Published: May 2014

As I write this, I’m reacclimatising from the hottest weekend of the year so far, and looking forward to this year’s British Cardiovascular Society conference (7–9 June). It isn’t all that often that I get out of the office…not with my editor’s hat on, that is. Most of my interaction with readers and authors is through the computer screen or the telephone. I was rather amused to be told at one conference that I was taller than someone was expecting. There’s only so much you can tell from a head shot.
Modernising Scientific Careers: The UK Way Forward
Authors: Ashton Lisa
Published: May 2014

Lisa Ashton discusses the latest developments in the proposed career pathways for cardiac physiologists, and the potential implications for cardiac services
Patient-based approach
Authors: Hatchett Richard
Published: May 2014

I liked this book, particularly because I could answer a fair amount of the questions while passing time on a long train journey. The text presents a series of 26 case studies ranging from the differing acute coronary syndromes, to pericarditis, aortic stenosis, bacterial endocarditis and complete heart block. Each is offered in the same layout, commencing with a brief scenario and a series of questions augmented by additional data including good quality 12-lead ECGs. The questions and answers all conclude with a case review and key points.
Legal aspects of practice: Prescribing
Authors: Gagan Mark
Published: May 2014

Mark Gagan sets out the legal basis to prescription of medicines in England and Wales
NICE guidance on chest pain
Authors: Linden Belinda
Published: May 2014

Belinda Linden provides an overview of the NICE clinical guidance on assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin.
Safe and sustainable paediatric cardiac surgical services
Authors: Cook Kerry
Published: May 2014

Kerry Cook explains how the programme to restructure children’s heart surgery services offers an opportunity for children and young people’s cardiac nursing services to change
Self-monitoring and management of oral anticoagulation
Authors: Linden Belinda
Published: May 2014

As part of our series keeping you up-to-date with developments in evidence-based practice, Belinda Linden presents a summary of the recent Cochrane Collaboration systematic review of studies relating to patient self-management of an oral anticoagulation regimen
An introduction to cardiac magnetic resonance imaging
Authors: McDermott Shaunagh , O’Neill Ailbhe , Ridge Carole , Quinn Martin , McCreery Charles , Keane David , Dodd Jonathan D
Published: May 2014

Recent technological developments in cardiac magnetic resonance imaging (MRI) have resulted in the rapid acquisition of images of the heart with high spatial and temporal resolution and excellent myocardial tissue characterization. Cardiac MRI allows the noninvasive assessment of cardiac function, myocardial perfusion and viability, detection and characterization of inflammatory heart disease and other cardiomyopathies and congenital heart disease. This article will review the basic cardiac sequences and common indications for MRI in cardiology.
Comparing home-testing of INR with high-quality testing in the clinic
Authors: Linden Belinda
Published: May 2014

This section presents a synopsis of a selection of recently published articles of interest to those nurses working in the field of cardiovascular nursing. The aim of this round-up is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
Radiation exposure from myocardial imaging
Authors: Linden Belinda
Published: May 2014

This section presents a synopsis of a selection of recently published articles of interest to those nurses working in the field of cardiovascular nursing. The aim of this round-up is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
Piloting a computerized clinical decision support system in the rapid access chest pain clinic
Authors: Johnson Rachel , Ruffles Katie , Denaxas Spiros , Tagney Jenny , Feder Gene
Published: May 2014

Making a diagnosis in patients with stable chest pain can be challenging. Rapid access chest pain clinics (RACPCs) assist diagnosis, providing timely assessment for patients with new onset suspected angina. However there is evidence that some patients assessed at the chest pain clinic may be labelled incorrectly as having non-cardiac chest pain. Recent NICE publications include guidance on diagnosis and investigation choice for patients suspected of having stable angina. The Optimising the Management of Angina (OMA) study aims to improve the outcome of patients attending chest pain clinics with a complex intervention that includes a computerized clinical decision support system (CDSS) based on the NICE guidance. This article describes the pathway used by the NICE guidance and how it has been used to inform a decision support tool, and our experience of piloting the tool in RACPCs.
ECG of the month
Authors: Regan Claire
Published: May 2014

Clare Regan presents an ECG for you to analyse. The answer is given on page 611.
Consent and mental capacity issuesn heart failure
Authors: Jones Chris , Lackey Joanne , Williams Barry
Published: May 2014

The physical effects of heart failure have been widely researched and reported. Hitherto the psychological manifestations of this condition have received less attention. However, there is a growing body of evidence that points to the serious effect that heart failure has on intellectual performance. Heart failure causes patients problems in memory, attention and expression.

Even though evidence relating to cognitive dysfunction has accumulated there is still little consideration in the literature to the implication of this decline for capacity or consent issues. Indeed many research papers that investigate the phenomenon treat the question of gaining consent in a way that is, arguably, superficial.

This article aims to describe the phenomenon in heart failure, discuss the possible causes of the process and consider the relevance of the Mental Capacity Act 2005 in defining patients’ capacity to make judgements regarding care.
In-hospital resuscitation: 2010 guidelines in practice
Authors: Bowden Tracey
Published: May 2014

This article outlines the key changes in practice arising from the updated 2010 resuscitation guidelines in relation to in-hospital resuscitation, including prevention of cardiac arrest. It is useful for any health-care professionals with a responsibility to provide direct care to patients within acute and critical care environments to have knowledge of the advanced life support algorithm to enable them to anticipate the needs of the team and be effective participants.

One of the main themes of the updated guidelines is to ensure that continuous, effective chest compressions are maintained throughout the resuscitation attempt and interruptions are kept to a minimum.
Using patient experiences to develop a pre genetic service around family needs
Authors: Oliver J , Goodfellow J , Smyth L , Bourne R , Brennan P , Farrer M
Published: May 2014

Objective: A genetics service wanted to gain an insight into the experiences of families with an inherited cardiac condition in order to design a new pilot service around family needs.

Design: A focus group was held to understand from a family perspective what was important within the service.

Interventions: Five families that had already been through the service were invited to share their experiences.

Results: Three families attended. The facilitators noted the main points of what was discussed. The common themes were the time taken from the diagnosis or death of the family member to getting help and support. The lack of awareness of where to get the help required. Families felt unsupported after a sudden death.

Conclusions: The families welcomed the opportunity to share their stories and the chance to improve the service for future users. An action plan was devised to include what they saw was important in a service.
Dronedarone in the management of atrial fibrillation
Authors: Linker Nicholas J , Nelson Katharine E
Published: May 2014

Atrial fibrillation is an abnormal heart rhythm involving disorded electrical activiy in the atria, leading to irregular contraction of the ventricles. Overall heart rate is usually faster than in sinus rhythm. At present, drug therapy continues to be the mainstay of treatment for atrial fibrillation, and may consist of rate control or rhythm control (plus stroke prophylaxis). Dronedarone is a relatively new antiarrhythmic drug, developed as an alternative to amiodarone. This article discusses its characteristics and potential role in management of AF.
Music in the catheterization laboratory can be beneficial
Authors: Linden Belinda
Published: May 2014

This section presents a synopsis of a selection of recently published articles of interest to those nurses working in the field of cardiovascular nursing. The aim of this round-up is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
A bleeding risk score for cardiac patients awaiting surgery
Authors: Linden Belinda
Published: May 2014

This section presents a synopsis of a selection of recently published articles of interest to those nurses working in the field of cardiovascular nursing. The aim of this round-up is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
Long-term benefits of home-based exercise training after surgery
Authors: Linden Belinda
Published: May 2014

This section presents a synopsis of a selection of recently published articles of interest to those nurses working in the field of cardiovascular nursing. The aim of this round-up is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.