The impact of COVID-19 is known to be worse in patients with certain co-morbidities including smokers, those with diabetes, chronic lung diseases, heart failure and high blood pressure. As a consequence, it is essential that you practice the Government’s advice regarding self-isolation, staying at home and practicing social distancing.
Acute Cardiology Service
We are still endeavouring to provide as comprehensive and acute cardiology service as possible.
Heart Attacks: The “999” service for people who have chest pains or need admitting with a possible heart attack or heart problem will be given the same standard of treatment as always at Noble’s Hospital.
Patients will need to attend via the Emergency Department. You can be reassured that most patients with heart attacks can be treated with medication successfully, so will not need to be considered for any active intervention across. However, only patients free of COVID-19 and with an emergency indication or high-risk indication requiring intervention will be able to be transferred to Liverpool for stenting etc.
Pacemakers: Patients requiring urgent pacemaker implantation or emergency generator changes will be transferred to Liverpool as long as they are COVID-19 negative.
Heart Failure: Patients requiring admission with breathlessness and unstable heart failure will be assessed to rule out COVID-19 as well as receiving treatment for their heart failure.
Outpatient and non-urgent Cardiology Service
Cardiorespiratory Investigations: (Open-access ECG, echocardiograms, heart rhythm analysis, myocardial perfusion imaging, exercise stress tests etc.) As part of the need to minimise personal contact and ensure social distancing, the range of heart investigations available during this period has been severely curtailed. There is therefore no open-access ECG service now.
Only investigations for conditions which are considered to have a life-threatening implication or indication are being done. All other non-urgent investigations are on hold until the crisis is over. Pacemaker follow-ups are increasingly being done remotely and patients will be contacted if there are any issues identified.
Cardiology Outpatient Clinics: We have many patients booked into 13 clinics per week at the moment. However, due to lack of consultant staff these are being reduced to 5 clinics per week.
New Patients: All ‘new’ referrals to the cardiology service are being triaged to bring to clinic only those who cannot be postponed or have a management plan based on a telephone or video consultation.
All patients who have current bookings are being contacted by phone by a consultant to assess their well-being and need for a face-to-face consultation. Most patients will be seen in clinic, but only as long as the indication for their original referral is still present.
Review Patients: All booked review patients will be contacted by telephone. Those who are on a regular review and who are well will be reappointed 6-12 months in the future. Only those review patients who are deemed in urgent need of being seen will be brought up to one of the clinics.
COVID-19 and Medication
ACE- inhibitors and angiotensin receptor blocker drugs (Ramipril, Perindopril, Losartan, Candesartan, etc.) used for the treatment of blood pressure and heart failure - there has been a lot of public concern that these drugs might make the person taking them more susceptible to Coronavirus. This theoretical risk is because such drugs increase the expression of the ACE-2 receptor to which the COVID-19 binds. However, because there is no proof that this makes one more susceptible, the current recommendations from the cardiological experts are that such medication should be continued. Indeed, some experts are suggesting there may be a protective effect from such drugs. Research is underway to prove this one way or the other. Until such time as there is clear evidence of harm it is recommended to stay on them.
The risk from stopping them is that your blood pressure or heart failure may become unstable and result in the need to be admitted to the hospital and thus increase your risk of exposure
We will get through this and business as usual will be resumed, but not for some months. In the interim, if you are concerned for your health, please contact your GP in the first instance. Your GP can phone or email us to expedite your review and we can of course then telephone you to discuss any issues.
Cardiac services in Noble's hospital are currently led by Consultant Physician/Cardiologist, Dr Nigel Harrison and his team comprising of Staff Grade Doctor, Specialist Cardiac Nurses and Physiologists. For the size of island population Noble's hospital provides general cardiology services together with wide range of non-invasive investigations.
The services are divided into outpatients and inpatients activities:
- General Cardiology Clinics
- Rapid Access Chest Pain Clinics
- and clinics for rapid access of patients with suspicious heart failure or arrhythmias
The clinics are led by the Consultant and/or Staff Grade with the input of supervised Specialist Cardiac Nurses (Rapid Access Chest Pain Clinics, Heart Failure Clinics). There is a regular Pacemaker Follow up clinic run by physiologists and supervised by consultant cardiologist. Also, regular follow up of patients with complex pacing devices (defibrillators, biventricular pacemakers) is currently provided by visiting a consultant cardiologist from Liverpool Heart & Chest Hospital (LHCH).
Cardiac tests and procedures in Nobles hospital are predominantly focused on non-invasive cardiology with a wide range of tests:
- (ECG) and BP Holter monitoring,
- Treadmill test,
- Tilt test,
- Transthoracic and Transoesophageal echocardiography (visual example),
- Stress echocardiography (visual example),
- Myocardial Perfusion Scan and
- Cardiopulmonary testing.
The majority of tests are done within Cardiorespiratory Unit (CRU) that is strategically located close to Medical Outpatients hence this allows an easy access to all tests. Certain procedures (Transoesophageal echocardiography, DC cardioversions visual example) are realised in Coronary Care Unit as day cases.
Cardiac Rehabilitation is provided on behalf of the Consultant cardiologist by a team headed by a Clinical Nurse Specialist in Cardiology & Cardiovascular Rehabilitation. The team is multidisciplinary and also includes a nurse, physiotherapist, occupational therapist, dietician and pharmacist. They provide exercise, education and psychological support/stress management for people who have had a variety of cardiac events. They have close links with Liverpool Heart & Chest Hospital in order to provide rehabilitation to patients who have had treatment in Liverpool in a timely manner. The aim of the programme is to reduce their risk of subsequent cardiac problems and to promote their return to a full and normal life.
The main tertiary centre in terms of cardiac care is Liverpool Heart & Chest Hospital (LHCH) www.lhch.nhs.uk. The patients are referred either as outpatients or inpatients. Inpatients transfers are provided with well organised Air Ambulance Service from Ronaldsway airport.
Nobles hospital and its management is committed to improve quality of care of cardiac patients on the island.