HNY Policy and Pathway Repository - Humber

The Community Diagnostic Cardiology Service provided by Hull & East Yorkshire Hospitals NHS Trust aims are:

• To enable you to manage patients with greater confidence in the community
• To provide advice and guidance from Consultant Cardiologists or experienced Cardiac Physiologists
• To allow a more seamless service for our patients

The service will provide echocardiography and 24-hour ambulatory ECG monitoring for specific indications. All the investigations will be reported by our experienced Cardiac Physiologists with advice and guidance provided by either Cardiac Physiologists or Consultant Cardiologist. When onward referral for a Consultant Cardiologist opinion is required, this will be made by the service without the need for additional referral from the General Practitioner.

Ambulatory ECG

Those in the amber and red groups on the following palpitations guideline.

Palpatations

Echocardiography

• Investigation of patients with suspected heart failure (please refer to the Heart Failure Pathway). It is possible that this may become available as part of the service in due course. 
• Patients already under active cardiology follow up in secondary care.
• Screening echocardiogram for first degree relatives of index cases with dilated or hypertrophic cardiomyopathy (please refer to Inherited Cardiac Conditions clinic).

The aim of this service is to provide access to Cardiology Diagnostic Test to enable management of patients in primary care thus avoiding the need to follow traditional referral pathways.

Ambulatory ECG

• For ECG-Symptom correlation in patients with recurrent palpitations WITH
  • Normal cardiovascular examination AND
  • No adverse features (as listed above) AND
  • No major ECG abnormality (first degree HB, AF, RBBB are permitted). If unsure of relevance of other ECG findings please submit copy with an online A&G consultation.

To assess adequacy of ventricular rate control in patients with atrial fibrillation where there is a concern (e.g. resting heart rate >90/minute).

Echocardiography

• New murmur deemed to be clinically significant (with or without symptoms).
• New onset atrial fibrillation where there is a suspicion of significant structural heart disease (please note that echocardiography is not indicated if it will not alter patient management, as per current NICE guidance).
• Screening echocardiogram for first degree relatives of index cases with bicuspid aortic valve in whom family screening has been recommended.

Referrals

Referrals will be made through NHS electronic referrals system (ERS)

Information To Include

12-lead ECG – for all referrals

Thyroid function test – for ambulatory ECG

CHA2DS2VASC score – for those in atrial fibrillation

• Community diagnostics Cardiology GP communication which includes information relating to NHS e-RS
• Community diagnostic service ECG and Echo