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PubMed1998

Nuclear cardiology in the UK: British Nuclear Cardiology Society survey 1994.

This study surveyed practice in nuclear cardiology in the UK in 1994. A questionnaire was sent to 219 centres performing nuclear imaging asking for details of current practice in nuclear cardiology. Replies were received from 192 centres (88%). Activity in performance of myocardial perfusion imaging (MPI) and radionuclide ventriculography (RNV), anticipated changes in activity, differences between regional and district general hospitals, technical imaging parameters and referral sources were surveyed. Of the responding centres, 125 (65%) performed nuclear cardiology. More regional centres (85 vs 55%, P < 0.0003) performed a higher proportion (62 vs 24%, P < 0.001) of nuclear cardiology activity compared with district general hospitals. Nuclear medicine activity was estimated at 9.3 scans/1000/year, of which 8.9% was cardiology (0.82/1000/year; MPI, 0.56/1000/year; RNV, 0.26/1000/year). A comparison with previous surveys showed a significant increase of 24% in nuclear cardiology since 1988, with a strong rise in MPI (350%); however, RNV has fallen by 47%. Myocardial perfusion activity in the UK remains very low (25 and 5% for MPI and RNV respectively) when compared with the average of 2.2/1000/year for Europe and 10.8/1000/year for the USA. In conclusion, MPI has increased on average by 23% per annum (compound rate) since 1988, but in 1994 was still only 32% of the British Cardiac Society target of 2.6 scans/1000/year. Proper resourcing for capital expenditure on new equipment and new staff will be important to maintain momentum in closing the gap. Also important is clinical understanding, as already implemented by including nuclear cardiology in guidelines for specialist cardiology training.

Cardiology↗
PubMed2006

The regulatory background of nuclear cardiology in Europe: a survey by the European Council of Nuclear Cardiology.

PURPOSE: Nuclear cardiology is a well-validated, non-invasive imaging modality that is highly cost-effective as a diagnostic and prognostic tool in the evaluation of patients with known or suspected coronary artery disease. However, the number of procedures in Europe is very far from that which would be expected on the basis of epidemiological data, particularly when comparison is made with the USA. As a preliminary step for future action aimed at improving and increasing nuclear cardiology practice in Europe, the European Council of Nuclear Cardiology performed a survey to identify the regulatory issues and the training components pertaining to the practice of nuclear cardiology. METHODS: a questionnaire was sent to 31 national nuclear medicine societies and to 40 national cardiology societies. The main areas covered by the survey were: (1) the license requirements, (2) the theoretical and practical aspects of training and (3) supervision of the stress test during a nuclear cardiology study. RESULTS: The results show that, in a setting of wide heterogeneity of national regulations, education and professional practice, nuclear medicine is a restricted and closely regulated specialty. This situation guarantees the quality and safe use of radionuclides; at the same time, however, it limits integration of nuclear medicine into the clinical arena. CONCLUSION: Cardiologists should become more involved in nuclear cardiology, to further stimulate the use of this powerful diagnostic and prognostic imaging modality.

Cardiology↗
PubMedDate not supplied

[10 years of nuclear cardiology. (I). Clinical development and technological progress in nuclear medicine at the Ignacio Chávez National Cardiological Institute].

The department of nuclear medicine of the Instituto Nacional de Cardiología started at the right moment (June 2, 1977), when the first cardiological procedures were developed. Unfortunately, it coincided in time with the beginning of the financial crisis. The higher costs of nuclear medicine instruments and operationsdid not allow the evolution of the department according to the original project, as nuclear cardiology demands special tracers and instrumentation, which are expensive and only available abroad. To solve these problems, we planned the creation of our own technology. We created a laboratory for radiopharmacy to elaborate lyophylized ingredients for the "cold" kits for instant labeling with 99Tcm of several tracers. With this, we achieved a substantial decrease in the operating costs, with total independence of commercial firms, and the future of the department was assured. In the field of instrumentation, a new system for tomodensitometric imaging of the thorax has been created by using two external gamma sources 99Tcm, and a digital system for image display and analysis was designed, built and programmed. This system, allowed the development of the quantitative technique of nuclear cardiology. We expect the software menu to be finished within this year. The transit from general nuclear medicine to nuclear cardiology has been slow in this Institute. During the first 8 years, the cardiological studies represented 10.8% of all in vivo studies; this figure increased to 37.8% in 1986. However, the increasing demand of cardiological studies tends to displace other in vivo studies due to oversaturation of the gamma-camera and the digital system. It can be concluded that the evolution of nuclear cardiology has been slow in this Institute, but represents a factual progress based on the creation of a technological substructure with internal resources.

Angiocardiography↗
PubMed1991

Staffing in cardiology in the United Kingdom 1990. Sixth biennial survey: with data on facilities in cardiology in England and Wales 1989.

The Sixth Biennial Survey of Staffing in Cardiology was conducted in July 1990. This report summarises the data that were collected, together with the results of a survey of facilities in cardiology made in 1989. The total number of cardiologists in the United Kingdom, defined as individuals trained in the specialty and spending at least 40% of their time working in it, is now 323. Six individuals work part time only, making 320 whole time posts. This number has increased over the two years from 1988 to 1990 by 32, of which 23 work only in the specialty and nine as general physicians with a major interest in cardiology. The rate of increase in numbers over the past decade has been reasonably consistent with an average of approximately 4.4% per year. Thirty one districts in England and Wales still have no cardiologist and 13 other districts have little provision with an average of three (visiting) sessions each per week. The population in these 44 districts is 8.3 million. Scotland also has an inadequate distribution of service in the specialty. If recommendations for cardiac surgery and angioplasty made in the Fourth Report of a Joint Cardiology Committee of the Royal College of Physicians of London and the Royal College of Surgeons of England are to be met, we calculate that we need 63 more cardiologists in our major centres. To provide one cardiologist in every district hospital and two for larger districts would require 94 more specialists, making a total shortfall of 157 individuals. We have no excess of senior registrars to provide for a major expansion at consultant level. Time spent within the senior registrar (or academic equivalent) grade has tended steadily to decline and very few now reach the end of their contracts. The need for more individuals to pass through the senior registrar grade will be met in part by a planned reduction in the training period to three years. This will be inadequate, however, because projected retirements show that the number of consultant vacancies will increase sharply from 1997. We believe that additional senior registrar posts must be created if a serious shortfall in service provision by consultants is to be avoided. The provision of non-invasive facilities in cardiology is reasonable. The need for additional equipment for invasive cardiology has not been assessed. The number of physiological measurement technicians varies considerably between regions and is generally inadequate.

Allied Health Personnel↗
PubMed1996

[Quality assurance in invasive and interventional cardiology in Austria in 1994. Commissioned by the Interventional Cardiology Working Group of the Austrian Cardiology Society].

A complete National Database is the prerequisite for quality control, quality management and improvement. In Austria, we have been reaching for this goal since more than three years. 21 094 diagnostic coronary angiographies (CA) and 4934 PTCAs were performed in all 27 centers (out of which 17 perform PTCA) in Austria during the year 1994. This is a reduction of 3.2% concerning CA and an 8.6% increase in PTCA compared to 1993. 48% of all PTCAs were done during the diagnostic study (CA), multivessel PTCA in 11%, direct PTCA for ongoing infarction in 2.3%. Concerning "new devices", 437 stents (182 during the year 1993) were implanted in 1994; also all 73 cases with rotablator, 105 with intracoronary ultrasound, and 26 directional coronary atherectomies (DCA) are documented. Hospital mortality after PTCA was 0.5% (unchanged from the years 1992 and 1993), emergency bypass surgery rate after PTCA was 1.2% (0.7% during the year 1993), and 1.4% of the patients suffered a myocardial infarction in the cathlab (1.2% during 1993). International comparison shows Austria among the top nations with 2637 CA and 617 PTCA per million inhabitants, corresponding to a ratio of 23% PTCA per 100 CA. Risk adjustment (exercise stress test pre PTCA documented in six cath-labs in 1993, compared to 11 in 1994. Type of stenosis (A, B, C) in five labs in 1993 and in 12 labs in 1994) and outcome control (exercise stress test 3 months after PTCA documented in five cath-labs in 1993, compared to 10 in 1994) are subject to constant improvement of our yearly monitor visits and feedback reaction. Austria is the only nation worldwide to support a complete national database with controlled numbers and parameters since more than 3 years, including yearly monitor visits (Internet address for the 1995 data: http@info.uibk.ac.at/gin/org/i_iik.stu/i_iik+ ++.htm) and feedback reports. We experienced no single negative reaction to our activities, but find them necessary for further quality management targets.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

Design and implementation of a nuclear cardiology testing facility in a private-practice cardiology office setting.

Nuclear cardiology services increasingly are being provided in private-practice cardiology office settings. Because training programs are hospital based, trainees in nuclear cardiology may find only limited guidance on how to set up a private-practice nuclear laboratory. Furthermore, there is no literature to date advancing "models" for such facilities that might be useful for practice managers. The purpose of this review is to address common issues related to setting up and administering a nuclear cardiology laboratory in a private-practice cardiology office.

Cardiology↗
PubMed1998

Interventional cardiology in Europe 1994. Working Group Coronary Circulation of the European Society of Cardiology.

The working group Coronary Circulation of the European Society of Cardiology conducts an annual survey of cardiac interventions in Europe with the support of the national societies of cardiology. A detailed questionnaire about cardiac interventions performed during 1994 was mailed to all members of the European Society of Cardiology. Incomplete or absent data from eight national members precluded their inclusion in the final analysis. Thus, this report summarizes the cardiac interventions performed during 1994 in 29 of 37 members of the European Society of Cardiology, representing a total population of approximately 490 million inhabitants. CORONARY ANGIOGRAPHY: A total of 922,687 coronary angiograms were reported during 1994, representing an increase of 22% compared with 1993 and of 35% compared with 1992. The mean incidence of coronary angiograms was 1881/10(6) inhabitants, ranging from 4417/10(6) inhabitants in Germany to 35/10(6) inhabitants in Romania, Germany, France, Great Britain, and Italy with 50% of the European population performed 73% of all cardiac interventions. CORONARY ANGIOPLASTY: During 1994, a total of 224,722 coronary angioplasty (PTCA) procedures were reported in Europe, an increase of 22% compared with 1993 and of 52% compared with 1992. Adjusted per capita, the mean incidence of coronary angioplasty was 458/10(6) inhabitants, ranging from 1091/10(6) inhabitants in Germany to 6/10(6) inhabitants in Romania. On average, the ratio PTCA per coronary angiogram was 0.24, ranging from 0.37 in the Netherlands to 0.06 in Cyprus. Ad hoc PTCA accounted for 22% of all PTCA cases. The majority (81%) of PTCAs were restricted to a single vessel. Major complications were reported in 2% of patients undergoing PTCA, including death (0.3%), myocardial infarction (1.0%) and need for emergency coronary artery bypass grafting (0.7%). CORONARY STENTING: Coronary stents were utilized in 21,599 coronary interventions during 1994, an increase of 235% compared with 1993 and thus representing the fastest growth in interventional cardiology. The number of European countries employing stents during coronary angioplasty grew from 14 during 1993 to 24 during 1994. Elective use (38%) became the most frequent indication for coronary stenting during 1994, replacing bail-out stenting as the primary indication during 1993. OTHER NEW DEVICES: Other new interventional therapeutic devices were employed in 8827 cases. Only the Rotablator was used more frequently during 1994 as compared with 1993. All other new therapeutic devices showed a decline. Coronary ultrasound was utilized in 3032 interventions and coronary angioscopy in 304 cases during 1994. NON-CORONARY INTERVENTIONS: Valvuloplasty remained the most frequent non-coronary intervention in Europe during 1994 with a total of 2622 mitral. 609 pulmonary and 506 aortic valvuloplasties. CATHETERIZATION FACILITIES: The number of facilities per 10(6) inhabitants performing invasive cardiac procedures in Europe during 1994 ranged from 7.7 in Iceland to 0.2 in Romania (European mean 2.9). The number of trained operators per 10(6) inhabitants ranged from 24 in Germany to 0.4 in Romania (European mean 10). During 1994, a mean of 701 coronary angiograms and 170 PTCAs were performed per catheterization facility in Europe (range: 1052 coronary angiograms and 293 PTCAs per facility in Norway to 218 coronary angiograms and 37 PTCAs per facility in Romania). CONCLUSIONS: The number of both coronary angiograms and coronary angioplasties continues to grow at an annual rate of approximately 20% in Europe. There is a wide range in the amount of revascularization procedures performed between western and eastern European countries. However, countries with the lowest numbers of coronary angiograms and coronary angioplasties, e.g. Romania, also show the fastest annual growth. About one quarter of all patients undergoing coronary angiography are subsequently revascularized by coronary angioplasty. (ABSTRACT TRUN

Angioplasty, Balloon, Coronary↗
PubMed2002

European Society of Cardiology and American College of Cardiology guidelines for redefinition of myocardial infarction: how to use existing assays clinically and for clinical trials.

BACKGROUND: The European Society of Cardiology and American College of Cardiology guidelines for redefinition of myocardial infarction suggest that the cutoff value for diagnosis of acute myocardial infarction (AMI) be the 99th percentile of the reference population at a level measured with imprecision (coefficient of variation) > or =10%. No current commercially available troponin assay meets this requirement. Accordingly, questions have been raised about how to implement cutoff values from the guidelines. The Clinical Outcomes Utilizing Revascularization and Aggressive druG Evaluation (COURAGE) trial asked for recommendations concerning the use of troponin assays for the trial. METHODS: Cutoff values for the various assays were obtained from package inserts or from direct communication with manufacturers. RESULTS: The cutoff value with > or =10% imprecision was above the 99th percentile of the reference range for all assays. For the present, we suggest that this value be used for clinical and clinical trial purposes. It will account for analytic variability and individual biological changes. We provide recommendations for clinical practice and clinical trials concerning how to make the diagnosis of AMI in patients with ischemic symptoms and patients who undergo percutaneous coronary intervention and coronary artery bypass surgery. CONCLUSIONS: This is a first attempt to define cutoff values on the basis of the European Society of Cardiology and American College of Cardiology guidelines. These criteria will provide increased consistency until assays improve to allow full implementation of the guidelines.

Angioplasty, Balloon, Coronary↗