This Transform Clinical Reference Group (CRG) covers specialised cardiology, including the use of complex invasive devices and cardiac surgery as well as transplantation.

Scope

This clinical reference group covers:

• the diagnosis and treatment of fast heart rhythms using cardiac electrophysiology studies
• the use of devices to treat abnormally fast, life threatening heart rhythms
• services to treat people with inherited cardiac diseases
• the use of a tube (catheter) to treat specific heart problems which might otherwise have required open surgery (invasive cardiology)
• opening narrow coronary arteries with a balloon catheter as the first treatment following specific types of heart attack (primary percutaneous coronary intervention)
• magnetic resonance imaging of the heart
• cardiac surgery includes provision of surgical interventions for coronary artery disease requiring surgical revascularisation and valve disease requiring surgical valve repair or replacement.

Membership

• Chair: Simon Ray, Consultant Cardiologist at Manchester Foundation Trust and representative of Getting it Right First Time (GIRFT)
• Yasmin Stammers and Lydia Ball, Lead Commissioners
• Dawn Adamson, Clinical member and Deputy CRG Chair
• Peter Braidley, Clinical member
• Farzin Fath-ordoubadi, Clinical member
• Richard Till, Clinical member and representative of British Heart Rhythm Society
• Yaver Bashir, Clinical member and representative of British Heart Rhythm Society
• Andrew Chukwuemeka, Clinical member
• Gerry Carr-White, Clinical member and representative of Association of Inherited Cardiac Conditions
• Christina Bannister, Clinical member (Nursing)
• Angeline Walker, Public Health Lead
• Maggie Kemmner, Cardiac Pathways Improvement Programme
• Alexandra Severns, Cardiac Pathways Improvement Programme
• Sarah Cooper, Clinical Policy Unit
• Kate Turner, Specialised Services Devices Programme
• Catherine Fowler, Patient and Public Voice representative
• John Ainley, Patient and Public Voice representative

Affiliates

• Saul Myerson, representative of British Society of Cardiovascular Magnetic Resonance
• David Hildick-Smith, representative of British Cardiovascular Intervention Society

Products

A key part of the CRG’s work is the delivery of the ‘products’ of commissioning. These are the tools used by the 10 Hub Commissioning Teams to contract services on an annual basis.

Service specifications

Service specifications are important in clearly defining the standards of care expected from organisations funded by NHS England to provide specialised care. The specifications have been developed by specialised clinicians, commissioners, expert patients and public health representatives to describe both core and developmental service standards. Core standards are those that all funded providers should be able to demonstrate, with developmental standards being those which may require further changes in practice over time to provide excellence in the field.

The following service specifications fall within the scope of this CRG:

• Cardiology: Implantable cardioverter defibrillator and cardiac resynchronisation therapy (adult)
• Cardiology: Electrophysiology and ablation services (adult)
• Cardiology: Inherited cardiac conditions (all ages)
• Cardiology: Primary percutaneous coronary intervention (adult)
• Cardiology: Cardiac magnetic resonance imaging (adult)
• Cardiac surgery (adult)
• Ventricular assist devices (VADs) as a bridge to heart transplantation or myocardial recovery (all ages)
• Heart transplantation service (adult)

Policies

A commissioning policy is a document that defines access to a service for a particular group of patients. A NICE Technology Appraisal Guideline on the same topic will replace, or be incorporated into, a commissioning policy as appropriate. These are important documents that are developed to ensure consistency in access to treatments nationwide.

The following policies fall within the scope of this CRG:

Commissioned

• Clinical commissioning policy: Catheter ablation for paroxysmal and persistent atrial fibrillation (adults)
• Percutaneous patent foraman ovale closure for the prevention of recurrent cerebral embolic stroke in adults (around the age 60 years and under)
• Percutaneous mitral valve leaflet repair for primary degenerative mitral regurgitation in adults
• Left atrial appendage occlusion for patients with atrial fibrillation and relative or absolute contraindications to anticoagulation (adults)
  • Left atrial appendage occlusion commissioning through evaluation report
  • National Institute for Health and Care Excellence (NICE) left atrial appendage occlusion commissioning through evaluation report
• Transcatheter aortic value implantation (TAVI)

Not routinely commissioned

• Everolimus for prevention of organ rejection following heart transplantation
• Extra corporeal membrane oxygenation service for adults with cardiac failure
• Renal denervation for resistant hypertension
• Personalised External Aortic Root Support (PEARS) for surgical management of enlarged aortic root

Policy statements

• Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR) for symptomatic, severe aortic stenosis (adults) to support elective performance

Other related links

• Cardiac clinical network specification

Get involved

If you are interested in the work of the internal medicine NPOC or its CRGs, you can register as a stakeholder.  For details on our latest consultations please visit NHS England » Consultations

Get in contact

For any questions or queries relating to the work of the internal medicine NPOC or any or its CRGs, please contact: england.npoc-internalmedicine@nhs.net