Description of specialty
The specialty of cardiology provides care across the spectrum of cardiovascular diseases from prevention to end-of-life supportive care. While improved treatment and prevention have seen a dramatic fall in mortality in recent decades, cardiovascular disease remains one of the largest causes of death in the UK.
Cardiologists treat patients with conditions relating particularly to:
- atherosclerotic disease of the coronary arteries
- failure of heart muscle function
- failure of heart valve function
- problems with abnormal fast and slow heart rhythms
- inherited cardiac disease – particularly as a cause for sudden cardiac death
- congenital cardiac disease due to abnormal formation of the heart and great vessels in the developing fetus
Cardiology is a multiprofessional discipline with increasing roles for specialist nurses and support from physiologists, cardiac scientists, radiographers and psychologists. A high proportion of the workload relates to emergency and urgent care, balanced with elective care and chronic disease management.
A great deal of cardiac disease prevention and management is carried out by non-specialists in primary care as well as traditional specialist-led care in secondary, tertiary and quaternary environments. Increasingly, specialist care is provided outside of the large hospital setting within communities and closer to patients.
Provision of services is ideally and increasingly organised on a network basis. This means that while not all services may be provided on all sites, through cross cover and collaboration all patients are able to access the full spectrum of cardiac care. This is typified by the network of primary percutaneous coronary intervention (PCI) centres providing 24/7 access to coronary intervention for acute myocardial infarction that covers the great majority of the UK. This network approach also applies to the provision of complex imaging (eg cardiac magnetic resonance imaging) and subspecialty services (eg heart transplantation).
Guidance on the role of cardiologists is also being updated, particularly with the focus on 24-hour and 7-day services. Emergency care is a major part of cardiology practice with primary percutaneous intervention for myocardial infarction and acute care of arrhythmias. Ensuring acutely ill patients have access to cardiology expertise and treatment is essential. Therefore cardiologists need to balance increasing subspecialisation with general support to the acute take. UK-wide provision, often through collaborative working between hospitals, of 24/7 on-site specialty advice and emergency cardiac interventions is a key task over the next few years. Working groups of the British Cardiovascular Society and the British Heart Rhythm Society (BHRS) are progressing these issues and due to report in 2016.