BCIS are pleased to announce a new document on the website outlining ‘a local governance framework for interventional cardiology centres’

This voluntary guidance describes a comprehensive governance structure including structured mortality review, mortality tracking using Office for National Statistics (ONS) data and peer review for interventional cardiologists. We would anticipate that most centres would score well on this system. The detailed and objective data from this process can be very useful when describing interventional work to your wider hospital, for individual appraisal purposes and when dealing with outside bodies such as the CQC.

The document is available for any centre to use if they wish. In addition to being able to show that you run a good service it explicitly supports clinicians dealing with the increasing burden of high-risk acute work.

Gerald Clesham

Clinical Standards Group lead

Dear BCIS Members,

In the light of the huge interest in this subject, I just wanted to highlight the recent paper in Heart that describes the impact of COVID 19 upon PPCI activity in the UK, and to thank members personally for helping us to get access to their local data earlier than normal.

The excellent outcome of the patients who got PPCI after lockdown, despite inevitable delays,  seems to vindicate the recommendation to persist with this mode of treatment as the default, although more detailed UK data with regard to all MI presentations and their treatment will be available shortly.

As a society, we should be proud of the fortitude shown by the whole multidisciplinary catheter lab team in facing up to this crisis in this way.

Best wishes,

Nick Curzen
BCIS President

Some BCIS members may be aware that there has been some movement in the commissioning of MitraClip last week with the publication of a ‘Prior notification Notice – PIN’ . This is the initial step in the ‘expression of interest’ in becoming a commissioned MitraClip centre.

As the BCIS Structural Working Group we have a responsibility to make sure all interested centres know about this and wish to make sure that this PIN does not go un-noticed by interested Clinicians. NHS Spec Comm have issued this notice:

NHS England and NHS Improvement have published a Prior notification Notice (PIN) to enable commissioning of Percutaneous Mitral Value Leaflet repairs for Primary Mitral Regurgitation in the East of England, Midlands, North East & Yorkshire, and South East regions.

The PIN is published on the Official Journal of the European Community (OJEC) and Contract Finder websites. The OJEC reference: Quote/tender 40570 – “Percutaneous Mitral Valve Leaflet Repair for Primary Mitral Regurgitation”.

Providers will need to respond to the PIN notice/questionnaire if they wish to be included in any further process  for this procurement through registering on the EU Supply website https://uk.eu-supply.com/login.asp?B=UK. 

Deadline: 12 noon on Monday 17th August 2020.

The BCIS Structural Working Group are keen for this to be a fair and transparent process and will keep BCIS members posted of any major developments in this area in the coming weeks and months.

Best Wishes,

Philip McCarthy

Structural Cardiac Intervention Group Chair

Dear Colleagues,

NHSE/I have today published guidance on the provision of cardiology services during the Covid-19 pandemic, with the input and endorsement of BCS & BCIS. There is no doubt that providing care for infected patients is going to dominate our working lives for the next few weeks and quite possibly considerably longer. Accepting this, it is important to bear in mind that while there is no specific treatment for Covid-19, there are life threatening cardiac conditions which cardiologists do know how to treat and for which we have well organised and effective care pathways. We must not lose sight of this fact in the effort to do everything possible for patients severely ill from viral infection. A case in point is PPCI for STEMI. We have a national PPCI programme because there is very strong evidence that it is a more effective treatment than thrombolysis. Patients undergoing PPCI via the radial approach have significantly higher rates of reperfusion, better left ventricular function, fewer complications and are more likely to have a short, uncomplicated hospital stay. The short term investment in getting that patient to a catheter lab without delay is repaid rapidly and permanently. By contrast, giving thrombolysis may seem lower risk, but the clinical dilemmas raised in those (?25%) who fail thrombolysis, in terms of whether they then do go to the cath lab, but also the higher rates of heart failure etc, mean that this is not necessarily an easier option. Our personal view is that this means that PPCI must remain the standard of care for STEMI during the pandemic and that strenuous efforts need to be made to made to preserve PPCI services and to make them as efficient and as effective as possible. There are likely to be situations where it will prove impossible to provide timely PPCI and a patient needs to be thrombolysed but this should not be a default response and remain the exception rather than the rule. We also acknowledge the critical importance of having appropriate PPE available for cath lab staff, and we are actively lobbying about this on behalf of our members.

Finally, we hope that these guidelines are helpful.  We wish members of BCS/BCIS our very best wishes at this time of challenge and stress… we KNOW that you will be up to the task.

Nick Curzen                                                              Simon Ray
President                                                                  President
British Cardiovascular Intervention Society             British Cardiovascular Society

Dear BCIS Members,

It is clear that BCIS members, as well as their colleagues and their patients, are facing an immediate future of unparalleled stress and uncertainty about how we will be able to maintain the highest standards of clinical care. As a group, our reaction to the challenges thrown at us by the Covid 19 pandemic needs to be reasoned, calm, positive and energetic. There has been much discussion and debate about specific approaches to this evolving crisis, and many calls for the leadership of our Society to make a statement.

The hottest issues relate to:

• the appropriate nature and application of Personal Protection Equipment?
• whether there are some categories of patient who should either not be offered treatment that we would normally consider (for example out of hospital arrest ventilated patients) or who should be offered alternative treatments (for example thrombolysis instead of primary PCI for STEMI) in order to preserve cath lab access?
• what happens if a cath lab loses the ability to provide emergency cover?

It is clearly inappropriate for BCIS to attempt to provide proscriptive universal guidance in relation to these and the other contentious issues we all face, because our understanding of the effects of  this pandemic is evolving in a dynamic fashion, and there are significant differences in local Trust policies and guidelines, as well as interventional resources at specific centres. It is also important to note that NHSE/DoH are due to release some clinical guidelines relating to Primary Angioplasty for STEMI imminently.

BCIS offers members our wholehearted support and sympathy and recommend that all our members follow some general principles:

• Adopt, and comply with, national and local policies for testing, self-isolation, PPE compliance… it is a good time to accept expert advice.
• Develop local plans for possible scenarios in which your catheter lab cannot provide emergency cover, whether due to staff absence or inadequate facilities/resources.  We suggest that clinical leads/senior catheter lab staff   have discussions across local networks regarding potential cross cover for emergency patients between local centres, in case this becomes necessary.
• Be cautious about the implications of changing treatment pathways as a reflex response to this crisis.
  • Example 1: providing thrombolysis may seem like a good way of reducing demand upon catheter labs, but what happens to the 25% of such patients who do not reperfuse? They then represent a major, and delayed, emergency dilemma. Even those patients who are successfully thrombolysed have a mandate to undergo angiography +/- revascularisation within 24 hours according to the international guidelines.
  • Example 2: not offering emergency angiography to ventilated OHCA patients with ST elevation… Consider the 45 y.o. who has cardiac arrest at the gym – it is unlikely that most of us would not want to offer cath lab access to them, so make such blanket policies only with great care. We recommend the case by case approach.
• Continue to provide clinical expertise, skilful judgement, calm leadership and dignified assurance.

We sincerely hope these comments are helpful, and wish you our heartfelt support in facing this crisis.

Professor Nick Curzen

BCIS President on behalf of the Officers & Leads for Communications and Clinical Standards