The heart failure service is delivered by five consultants (Professor Paul Kalra, Dr Geraint Morton, Dr Kaushik Guha, Dr Helena Bolam and Dr Kokhoon Tay), 1 heart failure fellow, 1 specialty doctor, 5.5 WTE Trust based heart failure nurse specialists (HFNS), 1 WTE band 3 and 1.8 WTE administrators. There are 12 WTE community based HFNS (employed by Solent and Southern NHS Trusts). Extensive collaboration between the Trust, community providers and local commissioning groups has permitted the development of a seamless heart failure service, spanning primary and secondary care. The successful candidate will contribute to all aspects of the service, including with supporting rapid access heart failure reviews, the ambulatory heart failure service and the HFNS.
A dedicated heart failure diagnostic pathway has been in place since 2014 and all local GPs have access to NTproBNP. The Department provides electronic advice and guidance every weekday to GPs, and rapid access diagnostic clinics stratified according to NTproBNP in accordance with NICE 2018 guidelines. Approximately 1400 patients are seen annually. Increasing numbers of additional patients are seen remotely and managed in primary care in consultation with the GP.
The clinics are supported by HFNS and patients are referred to community services as appropriate. Same day emergency care (SDEC) for heart failure is also available every weekday. There are specialist cardio-oncology and sarcoid clinics approximately quarterly. The community based nurses are supported by a weekly remote video MDT and real time support for urgent cases.
The heart failure service has strong links with palliative care services. Most patients hospitalised with heart failure are reviewed by Trust based HFNS. NTproBNP is available for assessment of inpatients at the Trust. There is a weekly heart failure MDT and virtual board round of these patients who are not on the cardiology ward.
There is an ambulatory day case heart failure service with the capacity to see 4 patients every weekday. This is run by the HFNS and supported by the medical team as needed, and usually results in admission avoidance. We have strong links to advanced heart failure centres with a quarterly MDT. We also provide heart failure specialists services to the Isle of Wight with monthly clinics and MDTs.
There is the facility within the coronary care unit for CPAP, circulatory support with intra-aortic balloon pump, and ultrafiltration for drug refractory fluid overload is available in collaboration with the renal department. Ambitious plans for a modern inpatient heart failure unit are in development. It is recognised that audit and assessment of quality and patient experience are essential for optimal service delivery and the departments data are submitted to the National Heart Failure audit hosted by NICOR. Complex device service The complex device service (CRT and ICD) is provided by the Heart Failure Consultants, supported by our EP colleagues at MDT.
We are a high-volume centre, implanting over 200 ICD/CRT devices (predominantly new implants) and around 550 bradycardia pacemakers per annum. All potential patients for complex device therapy are discussed in a weekly device MDT. NHS England have complimented the exemplary patient-centred and comprehensive service. The majority of candidates are identified by the heart failure service and this post will involve assisting with the assessment of patients for devices, implantation and follow up.
Cardiac Imaging The imaging service is delivered as a joint service with radiology. Cardiac CT on a Toshiba One Vision scanner is established. Cardiac MRI is currently provided at other Trusts and it is anticipated that the service will be repatriated to our Trust within the next few months. Teaching and Research Professor Kalra leads the cardiology clinical research programme.
The department has received local and national acclaim for its successful expansion and delivery of research studies and is particularly strong in heart failure research. Professor Kalra has an honorary chair at Portsmouth University and is chief investigator for the large, multicentre IRONMAN outcome study of IV iron in heart failure. The other consultants lead numerous other research projects with a strong background of ongoing successful publication. We have 2.8 WTE cardiology research nurses and 0.6 WTE clinical trials assistant.
The department successfully recruits high volumes of patients into an appropriate mix of multi-centre commercial, portfolio and investigator initiated studies across a spectrum of cardiovascular disorders. The successful candidate will participate fully in the cardiology department research activities. We have a regular educational sessions for all cardiology medical staff as part of our commitment to CME. These sessions include journal club, case presentations, governance topics, talks from invited speakers and MDT meetings.
The successful candidate will actively participate in these sessions and contribute to the education of medical students and junior doctors during their attachments in cardiology. Other cardiology services We perform 24/7 primary PCI to a population of approximately 1.25 million across West Sussex, the Isle of Wight, Portsmouth City and East Hampshire. Over 1100 PCI procedures are performed annually including 400 primary angioplasties, 50 rotablations and a small number of balloon aortic valvuloplasty procedures. Elective cases are discussed at a weekly revascularisation meeting with visiting surgeons from Southampton and these surgeons also provide our off-site surgical cover.
The EP lab is equipped with an electro-anatomical mapping system (CARTO 3) and we currently perform around 200 electrophysiological studies and ablation procedures per annum using RF and cryoablation. Non-invasive services are well established and we perform around 12,000 transthoracic echos per annum. Transoesophageal, stress and 3 dimensional echo services are performed routinely. The elective cardioversion service is nurse/physiologist led and treats around 250 patients per annum.
There are physiologist led loop recorder implantation, TOE and stress echo services. We see approximately 1600 patients in our Fast Access Chest Pain Clinic, and more than 5500 other new patients per annum. On average, we admit 10 emergency patients every 24 hours. We also run an outreach specialist Pulmonary Hypertension service in collaboration with The Hammersmith Hospital and an outreach GUCH clinic in collaboration with University Hospital Southampton, as well as a specialist valve clinics, ICC clinics (and MDTs) and Marfan aortic clinics

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