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Background. Primary percutaneous coronary intervention (PPCI) is the treatment of choice for patients with ST‐elevation myocardial infarction (STEMI). Delayed reperfusion leads to increased morbidity and mortality. Secular trends in the impact of interhospital transfers (IT) on long‐term mortality in the United Kingdom (UK) have not been previously investigated. We analyzed the impact of IT on 5‐year mortality in STEMI patients admitted to a tertiary care center in the UK (East Midlands North). Methods. Data of STEMI patients admitted to Nottingham University Hospitals NHS Trust from 2011 to 2016 were acquired from the National Institute for Cardiovascular Outcomes Research dataset (NICOR) and then combined with local patient‐level data and mortality data from National Statistics. The baseline characteristics and mortality data of the interhospital transfer (IT) group were compared to those of a gender and age‐matched direct admission (DA) group. Results. Of the total cohort (N = 2386), 29.9% of patients were admitted to the PPCI center via the interhospital transfer (IT) route. Cardiovascular risk profiles in both DA and IT groups were comparable. Five‐year Kaplan–Meier (KM) survival analysis revealed better survival in the direct admission group (83% vs. 77.3%; p ≤ 0.001). In multivariate analysis, increased mortality was associated with severe left ventricular impairment (HR 4.7, 95% CI 2.9–7.6), the presence of cardiogenic shock (HR 3.6 (2.7–4.8)), chronic kidney disease (HR 2.56 (1.4–4.5)), smoking (HR 1.45 (1.1–1.8)), male gender (HR 1.7 (1.4–2.01)), and diabetes (HR 1.4 (1.07–1.8)). The radial access and call‐to‐balloon time less than 120 minutes were also associated with lower mortality (HR 0.52 (0.43–0.63): HR 0.75 (0.61–0.92)). Conclusion. Despite advancements in communication, technology, patient education, transportation systems, and guidelines within the UK's NHS over the last decade, the delays incurred by IT for STEMI patients remain substantial and are associated with a poor prognosis. [ABSTRACT FROM AUTHOR]

Abstract Background The burden of cardiovascular disease (CVD) in Britain is concentrated in inner-city areas such as Sandwell, which is home to a diverse multi-ethnic population. Current guidance for CVD risk screening is not established, nor are there specific details for ethnic minorities. Given the disparity in equitable healthcare for these groups, we developed a 'tailored' and systematic approach to CVD risk screening within communities of the Sandwell locality. The key anticipated outcomes were the numbers of participants from various ethnic backgrounds attending the health screening events and the prevalence of known and undiagnosed CVD risk within ethnic groups. Methods Data was collected during 10 health screening events (September 2005 and July 2006), which included an assessment of raised blood pressure, overweight, hyperlipidaemia, impaired fasting glucose, smoking habit and the 10 year CVD risk score. Specific features of our approach included (i) community involvement, (ii) a clinician who could deliver immediate attention to adverse findings, and (iii) the use of an interpreter. Results A total of 824 people from the Sandwell were included in this study (47% men, mean age 47.7 years) from community groups such as the Gujarati Indian, Punjabi Indian, European Caucasian, Yemeni, Pakistani and Bangladeshi. A total of 470 (57%) individuals were referred to their General Practitioner with a report of an increased CVD score – undetected high blood pressure in 120 (15%), undetected abnormal blood glucose in 70 (8%), undetected raised total cholesterol in 149 (18%), and CVD risk management review in 131 (16%). Conclusion Using this systematic and targeted approach, there was a clear demand for this service from people of various ethnic backgrounds, of whom, one in two needed review from primary or secondary healthcare. Further work is required to assess the accuracy and clinical benefits of this community health screening approach.

BACKGROUND Indices of arterial stiffness are accepted as independent markers of cardiovascular disease (CVD), having both positive prognostic and diagnostic implications. The utility of stiffness index (SI) derived from digital volume pulse (DVP) analysis in CVD risk screening is not established. METHODS Using a representative sample of individuals from local communities (West Midlands, UK), we determined the performance of SI in the discrimination of increasing CVD risk. Arterial stiffness was measured by DVP photoplethysmography (PCA 2; Micro Medical) using a direct, standardized approach. CVD risk assessment was performed in accordance with the Joint British Society guidelines (JBS2). RESULTS Of our cohort of 247 individuals (51% male; mean age 55.2 (s.d. 10.3) years), 187 were apparently healthy and 60 had established CVD risk factors (diabetes mellitus: 33%, hypertension: 77.8%, hypercholesteremia: 61%). On univariate analysis, SI was strongly associated with CVD risk (the European Society of Cardiology (ESC) based HeartScore) (Pearson correlation coefficient (R): 0.56, P = 0.001) and increased in an ordinal fashion from "low risk" to "medium risk" to "high risk" to "very high risk" (pseudo R2 = 0.30; P < 0.001). In receiver operator characteristic curve analysis, SI was the best discriminator between low to medium risk and high-risk categories (area under curve (AUC): 0.76 (95% CI 0.64-0.88), P < 0.001) when compared to total cholesterol, plasma glucose, systolic blood pressure, and waist-to-hip ratio and had the utility to discriminate the individuals with known CVD risk factors such as diabetes and hypertension. CONCLUSION Noninvasive measurements of arterial stiffness may aid the optimal stratification of CVD risk in an apparently healthy population. [ABSTRACT FROM AUTHOR]

Background: The burden of cardiovascular disease (CVD) in Britain is concentrated in inner-city areas such as Sandwell, which is home to a diverse multi-ethnic population. Current guidance for CVD risk screening is not established, nor are there specific details for ethnic minorities. Given the disparity in equitable healthcare for these groups, we developed a 'tailored' and systematic approach to CVD risk screening within communities of the Sandwell locality. The key anticipated outcomes were the numbers of participants from various ethnic backgrounds attending the health screening events and the prevalence of known and undiagnosed CVD risk within ethnic groups. Methods: Data was collected during 10 health screening events (September 2005 and July 2006), which included an assessment of raised blood pressure, overweight, hyperlipidaemia, impaired fasting glucose, smoking habit and the 10 year CVD risk score. Specific features of our approach included (i) community involvement, (ii) a clinician who could deliver immediate attention to adverse findings, and (iii) the use of an interpreter. Results: A total of 824 people from the Sandwell were included in this study (47% men, mean age 47.7 years) from community groups such as the Gujarati Indian, Punjabi Indian, European Caucasian, Yemeni, Pakistani and Bangladeshi. A total of 470 (57%) individuals were referred to their General Practitioner with a report of an increased CVD score - undetected high blood pressure in 120 (15%), undetected abnormal blood glucose in 70 (8%), undetected raised total cholesterol in 149 (18%), and CVD risk management review in 131 (16%). Conclusion: Using this systematic and targeted approach, there was a clear demand for this service from people of various ethnic backgrounds, of whom, one in two needed review from primary or secondary healthcare. Further work is required to assess the accuracy and clinical benefits of this community health screening approach. [ABSTRACT FROM AUTHOR]

Percutaneous left atrial appendage occlusion aims to reduce the risk of stroke in patients with AF, particularly those who are not good candidates for systemic anticoagulation. The procedure has been studied in large international randomised trials and registries and was approved by the National Institute for Health and Care Excellence in 2014 and by NHS England in 2018. This position statement summarises the evidence for left atrial appendage occlusion and presents the current indications. The options and consensus on best practice for pre-procedure planning, undertaking a safe and effective implant and appropriate post-procedure management and follow-up are described. Standards regarding procedure volume for implant centres and physicians, the role of multidisciplinary teams and audits are highlighted., Competing Interests: Disclosure: TRB has received honoraria from Boston Scientific, and is a member of the Clinic Events Committee for Boston Scientific Clinical Trials. PAC has received honoraria from Abbott, and is Chair of the British Cardiovascular Intervention Society Structural Heart Disease Research Group. BC has received honoraria from Abbott Medical and support from Boston Scientific to attend meetings. GJC has received payment for expert reports for coroners' inquests in the UK, is a Data Safety Monitoring Board member for the ORBITA CTO trial, and is honorary secretary of British Cardiovascular Intervention Society. DG has received honoraria from Abbott Medical. DH has received honoraria from Abbott, Boston and Eclipse. JK has received grants and honoraria from Boston Scientific and Abbott Vascular, and is Immediate Past Chair of the ESC Council for Stroke. JDN has received honoraria from Abbott Medical UK. All other authors have no conflicts of interest to declare. This joint British Cardiovascular Intervention Society and British Heart Rhythm Society position statement is accompanied by a secondary publication in Arrhythmia & Electrophysiology Review, the official journal of the British Heart Rhythm Society (https://doi.org/10.15420/aer.2024.08)., (Copyright © The Author(s), 2024. Published by Radcliffe Group Ltd.)