Cardiology Services provide general hospital care to patients within the EH&SSB area and tertiary referral services for the Province. These are two separate but interrelated areas, acute cardiology and procedural cardiology. All inpatient beds are on Ward Floor 9.

Included in the acute side is a 22-bedded ward for general cardiology and 6 coronary care beds with central monitoring. The six coronary care beds are in single rooms with bathroom facilities and the general ward consists of 2 six bedded bays, 2 four bedded bays and two single rooms also with bathroom facilities. The ward has also day room facilities for patients.

The procedural area is equipped with a 23 bedded five-day investigation ward for patients requiring invasive cardiac investigation or treatment. It is equipped with telemetry monitors cabled to a central station. It has the same structure as the acute ward with three single rooms. The department has two fully equipped cardiac catheterisation laboratories and an imaging room in which routine pacing and electrophysiology can be undertaken.

Medical Staff

There are five consultant cardiologists in the department, Dr DB O'Keeffe, Dr EW Chew, Dr SG Richardson (Clinical Director), Dr N Herity, and Dr C Hanratty.
Currently there are 15 non-consultant grade members of staff:

• one associate specialist;

• two staff grade cardiologists;

• four specialist registrar posts;

• five senior house officers on rotation;

• three junior house officers on four month rotation.

Specialist Services

Cardiac Rehabilitation, Outpatient Liaison and Secondary Prevention Services
The aim of these services is to promote recovery and improve quality of life for patients with ischemic heart disease by identifying and treating physical and psychological needs, enabling the patient and partner to take control of their own lives, so that they may achieve and maintain their optimum state of health.

The objectives are;

• improve patients’/families’ understanding of their condition and treatment

• improve management of their condition and secondary prevention issues

• optimise medical therapy

• reduce anxiety/ depression and improve quality of life

• improve fitness and confidence to undertake physical activity.

Outpatient Liaison and Secondary Prevention Services exist to ensure that clinical standards and targets advocated in national guidelines are met, particularly in those patients who do not attend the cardiac rehabilitation programme. It also ensures that they are offered:

• information about their health status, desirable adjustments to their lifestyle and possible problems that they may experience in coping with their disease

• increased access to other professions allied to health such as smoking cessation and dietetic services

• the opportunity to provide formal teaching and education sessions to outpatient staff in order to create a more 'cardiology aware' environment resulting in staff that feel more confident in providing information to patients attending cardiology outpatients

• a contact number for patients, when appropriate, so that they can address any queries or concerns that they may have regarding their outpatient consultation.

This clinic exists to provide improved accessibility and timeliness of examination and investigation for patients at risk of coronary events. Patients who develop recent non acute symptoms of angina or suspected angina can be referred to the services by their General Practitioner. It is also available for patients that are known to have coronary artery disease but are experiencing worsening symptoms. The service strives to see those referred within 24-72 hours.

Chest Pain Team

The primary aim of the Chest Pain Team is to raise the quality of care and expedite the treatment and appropriate care for patients presenting to the Trust with acute chest pain which is cardiac in nature. Where appropriate the team also aims to reduce the thrombolysis door-to-needle time and work toward the reduction of pain-to-needle time.

In addition, there is an ongoing audit of the care pathway for patients presenting to the A&E Department with possible cardiac pain to ensure ongoing clinical effectiveness and service improvements. They work in partnership with other health care professionals and departments within the Trust to achieve these overall aims.

Heart Failure Team

The heart failure service exists to:

• ensure continuity of care for heart failure patients

• to promote greater uptake of proven pharmacological treatment

• to ensure more timely up-titration of evidence-based anti-failure therapy

• to reduce re-hospitalisation rates thus reducing costs

• to identify and treat patients who would benefit from devices such as bi-ventricular pacemakers/implantable cardioverter defibrillators.

Patients within the service are reviewed daily when in hospital and fortnightly when discharged until optimal treatment is achieved. In addition to this, there is a 24-hour helpline where patients may access advice and support from the heart failure team and from senior medical staff. This helpline is unique in Northern Ireland. It reduces needless hospital attendances to the A&E Department and inpatient admissions. The ad-hoc drop-in service available during working hours to the heart failure office is also unique and prevents needless admissions leading to a more efficient use of resources and greater patient satisfaction.

Patients living in the South and East Belfast Trust (SEBT) area receive follow-up after discharge by our community heart failure service which has been developed to provide seamless care for patients and their families.

Procedural Services
Referrals to this centre come from a variety of sources such as:-

• via the Accident & Emergency Department

• via transfers from other hospitals and wards.

Belfast City Hospital receives patients transferred from hospitals throughout the North of Ireland for specialist cardiac investigation and treatment. Inpatients in other wards are assessed by and transferred to the cardiology department if clinically indicated.

• Via outpatient clinics - most referrals to BCH cardiology clinics are made by GPs in the BCH catchment area. Some are also received from GPs and consultants in other hospitals throughout Northern Ireland

• via rapid access Chest Pain Clinic

• via direct access services for GPs

• GPs refer patients directly for: i) exercise stress testing. ii) echocardiography
iii) 24-hour ambulatory ECG recording
iv) 24-hour ambulatory blood pressure monitoring.

As a regional service, the Unit undertakes a variety of investigations including non-invasive:

• echocardiography:- transthoracic, transoesophageal, and pharmacological stress (also services Downe and Lagan Valley Hospitals)

• 24-hour blood pressure monitoring

• exercise stress testing (also services Downe and Lagan Valley Hospitals)

• nuclear cardiology

• ambulatory ECG Monitoring

• Tilt Table Testing.

• coronary angiography and percutaneous coronary intervention, including stenting

• cardiac pacing: permanent and temporary

• cardiac electrophysiology and therapeutic radio frequency ablation

• implantation of cardiac defibrillators

• misc: cardiac biopsy/valvuloplasty

For those requiring interventional treatment, admission is arranged in response to patient need and where medically appropriate, the service is capable of delivering both investigative and treatment facilities during one admission period. Efforts are taken to involve our service users in arranging our service delivery. The Unit is acutely aware of the concerns patients have when undergoing cardiac procedure and endeavours to provide timely, appropriate information to patients ahead of their admission where this is possible. Open communication channels exist for patients to gain further information, reassurance or help to make admission and discharge arrangements more convenient for our service users and their carers. We have a procedural co-ordinator whose role it is to provide a help line service for patients due for admission, to ensure their individual needs are taken into consideration and their worries addressed.

Close links with other services such as the Northern Ireland Ambulance Service exist to ensure the best service overall for our patients and other service users.

Resuscitation Training

The aim of this service is to:

• provide basic and advanced life support training for staff employed in the Belfast City Hospital (BCH) Trust

• To monitor algorithm adherence at cardiac arrest

• audit outcome at cardiac arrest

• provide CPR training for outside agencies.