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Report reveals that poor out-of-hours care puts heart patients at avoidable risk

Posted: 26/10/2016

A recent report by the British Cardiovascular Society (BCS) has warned that poor out-of-hours care and a lack of consultants on wards is leading to potentially avoidable deaths.

The study revealed widespread gaps in the care given to patients between 6pm and 8am on weekdays and over the weekend, with some hospitals operating without any cardiologists at all on Saturdays and Sundays.

Heart disease is the leading cause of death in the UK, with around 70,000 deaths and 180,000 patients suffering a heart attack each year. Cardiovascular disease accounts for around a third of all UK hospital admissions and many of these patients require urgent specialist investigation, such as echocardiography and coronary angiography. However, the study found that out-of-hours services vary widely and that there were clear delays in delivering urgent cardiovascular care. For example, the National Institute for Health and Clinical Excellence (NICE) quality standards advise that patients who suffer the most common form of heart attack (a non-ST elevation heart attack), should undergo angioplasty within 72 hours, however, the national audit carried out by BCS found that less than 50% of patients actually receive this intervention in this time frame.

The study further highlighted that there is a shortage of cardiologists in the UK compared to other European countries. In addition, a national shortage of cardiac physiologists was identified which is a major barrier to improving out-of-hours services at weekends.

It was also revealed that access to cardiovascular out-of-hours care varies widely across NHS hospitals. In some hospitals, typically the larger district general hospitals, on-call rotas are operated, however the report found that not only were the roles and responsibilities of the on-call cardiologists ill-defined and limited, but in some cases there was no out-of-hours access to a consultant cardiologist at all. In 2015 there were 1,389 cardiologists practicing, of which only 54% contributed to cardiology on-call rotas.

Of the 129 junior doctors and consultant cardiologists surveyed and interviewed, all of the consultants said that patients were suffering delays at weekends, and 38% of junior doctors said that new cardiology admissions and referrals were not routinely seen by a consultant cardiologist within 24 hours at weekends.

Dr Sarah Clarke, consultant cardiologist and BCS President, commented on the findings: “Patients should be able to access high quality services whatever time of day or night, or whatever day of the week they present to the healthcare system.”

Medical Director of the British Heart Foundation, Professor Sir Nilesh Samani, said that the report “presents us with the opportunity to address these inadequacies and take action to ensure that heart patients receive the same high quality standard of care wherever and whatever time they go to hospital".

Philippa Luscombe, partner in the Penningtons Manches clinical negligence team, commented: "The findings of this report demonstrate that changes to the way out-of-hours care is provided need to be made. Cardiovascular disease is the leading cause of death in this country and it is vital that patients with cardiac symptoms are treated in a timely and consistent manner."

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