Cardiology Department

The Cardiology Department in the Trust enjoys a 99% approval rating when patients were asked if they would recommend the department at Basildon and Thurrock University Hospital*.

There several distinct areas of the department which operate as a team to ensure that the patient received the very best care possible. This ethos extends to the rest of the hospital as staff are readily available for advice and assessment of patient symptoms as appropriate.

A weekly MDT meeting is held for discussion of cardiac patients between the Cardiologists, Surgeons and Anesthetists. This enables them to decide on the most appropriate treatment and management pathway for some individual patients.

The areas within the Cardiology Department are:-

• James Mckenzie Ward

• Cardiac Rehabilitation Programme

• Cardiac Physiology

*source – Dr Foster patient tracker as at 22/9/11

James Mackenzie Ward

DGH cardiology patients are cared for within James Mackenzie Ward which is separated into acute cardiology and cardiac rehabilitation.

One of the unique qualities of the ward is that we are able to admit our patients with cardiology problems and care for them from admission through to discharge, without the need to transfer them to another area. This gives patients the best possible continuity of care that we can provide.

At present, we have four consultant cardiologists Dr Aggarwal, Dr Phen, Dr Barbagallo and Dr Kabir. We also have Dr Iyer who is responsible for the cardiac patients with predominately medical problems on the ward.

The type of patients treated in James Mackenzie are patients presenting with Acute Coronary Syndromes (ACS) such as unstable angina, NSTEMI and post primary PCI transfers back from the CTC. The ward also admits patients with heart failure to either initiate or titrate their medications to improve their symptoms.

The average length of stay on the ward is 3 days.

The ward employs several Cardiac Nurse Practitioners (CNP), the duties include:-

• Coordinating the ward

• Provide advice and support to both junior Drs and nurses

• Caring for cardiac patients in the hospital

• Clinical audits both local and national

• Facilitating tests and investigations

• Electronic referrals to the CTC.

On every shift, a CNP is roistered supernumerary so that they can be bleeped as required to review patients with pre-existing cardiac problem or a new cardiac problem anywhere in the hospital.

The CNP will also visit AMU and A&E on a regular basis to check on the Symphony system and review those patients who are admitted with chest pain or patients who are referred by their GP with cardiology problems. They will review and triage the most appropriate patients to James McKenzie Ward under the management of the cardiology team.

James Mackenzie staff also provide a nurse led, day case, cardioversion service for out-patients; we are proud to have been the first in the country to start this service.

The ward has an outpatient cardioversion list on alternate weeks in Basildon University Hospital Day Unit. There are plans to install the Symphony System in the ward; this will facilitate the CNPs in their role of managing the bed status and admitting cardiac patients more efficiently to the ward

Cardiac Rehabilitation Programme

The rehabilitation process is an integral part of recovery and starts whilst the patient is in hospital with continuing support following discharge and continues for many weeks after. It is offered to patients who have had CABG, valve surgery, heart transplants, PPCI, NSTEMI and elective PCI.

All PPCI patients automatically have a NLC follow up within two weeks if they have declined to attend the rehabilitation programme.

There are four phases of the rehabilitation process which The Essex Cardiothoracic Centre facilitates. Patients attending cardiac rehab have a continuous assessment including routine bloods and any other tests that may be deemed necessary.

A discharge letter is sent to the GP for all patients.

Phase I - Whilst the patient is in Hospital

A member of the Cardiac Rehabilitation Team will visit the patient on the ward prior to transfer to the local hospital or discharge home.

We will discuss with the patient and their family the event, recovery, lifestyle modification and answer any questions, queries or worries that may arise.

Supply relevant literature to take home and read along with details of the local cardiac support group.

Phase 2 – at home

If the patient lives in the area normally served by Basildon Hospital the patient will be contacted by phone to enquire how they are progressing. It also provides an opportunity for the patient to ask questions and if necessary arrange an appointment to attend a nurse led clinic appointment.

If the local hospital is not Basildon the patient's details will be forwarded to the Cardiac Rehabilitation service on discharge.

The local Cardiac Rehabilitation Service will then contact the patient for further support and follow up.

Phase 3 – an Exercise and Education Programme

If the patient lives locally they will be invited to attend a structured exercise and education programme either at the purpose built air conditioned gym within The Essex Cardiothoracic Centre or if preferred a home based programme called the Heart Manual. These programmes can last form 6 – 8 weeks and attendance can be once or twice a week depending on your individual needs.

Patients out of our area will be offered very similar programmes depending on what their local service provides.

Phase 4 – in the community - exercise

Continuous programmes of exercise within the community are supported by cardiac rehabilitation and a transfer letter completed for each patient requesting to attend.

Cardiac Physiology

The Cardiac Physiology Service at Basildon & Thurrock University Hospitals NHS Foundation Trust is based at The Essex Cardiothoracic Centre and provides an extensive variety of cardiac investigations across both tertiary and secondary care domains including the main Basildon University Hospital site and Orsett Hospital. In order to deal with increased service demands, in both number and technical & clinical complexity, the physiology team has grown in the past 5 years from 23 posts to its current 43 posts

The team is led by Mags Long, Principal Cardiac Physiologist, who has overall responsibility for service delivery. She is supported by four very experienced Heads of Department, each with operational responsibility for a clinical sub-specialty service and line management of a designated team of physiologists.

Toni Latham is also the Training Co-ordinator for the team. A fundamental element of the departmental Training & Education strategy is to ensure that all student, basic grade and senior physiologists have the opportunity to be trained and participate in all specialties of cardiac physiology. They are roistered on a rotational basis, leading to fulfilment of required competency attainments and begin to specialise only at chief grade (Band 7). This organisational arrangement has been very effective in producing high quality, multi-skilled physiologists. The team also support the training and education of colleagues from other disciplines including junior medics and specialist nurses.

To become a registered Cardiac Physiologist involves an intensive programme of study and clinical training. This traditionally takes four years as an employed student with on-the-job training and day release to a university programme leading to attainment of a BSc. in Clinical Physiology (Cardiology) and also professional body (SCST) practical examinations. Post-qualification, Physiologists are actively encouraged to gain accreditation status, by way of sitting national and internationally recognised examinations in areas such as echocardiography, device management and electrophysiology.

In addition to the physiologists, the service also comprises of an excellent team of support staff including Cardiographers and Associate Practitioners (APs). Cardiographers carry out investigations such as 12 lead ECG recording and the fitting of long term ECG recorders and also assist Physiologists in exercise treadmill testing. All Cardiographers are encouraged to attain the professional body's Certificate in Electrocardiography. APs follow a 2 year training programme leading to Foundation degree in Clinical Physiology. This vocational degree programme requires the completion of a clinical skills logbook and a professional examination. On qualifying, APs are able to lead exercise treadmill testing, analyse and report on ambulatory ECG recordings, and assist Physiologist in advanced techniques.

Dr Rajesh Aggarwal, MB ChB, MD, FRCP

Dr Rajesh Aggarwal qualified in 1987 from the University of Edinburgh and trained in Cardiology at a number of leading UK Cardiothoracic Centres. He was BHF research fellow at the University of Leicester from 1994-1996 where he worked and published extensively on the development of drug-eluting coronary stents.

He was appointed Consultant Cardiologist (Interventional Cardiology) at the Trust in January 1999 and has played a key role in numerous service developments in Cardiology including the Trust's successful bid to host the Essex Cardiothoracic Centre in 2002.

Dr Aggarwal has an interest in all aspects of adult Cardiology with sub-speciality accreditation and a particular interest in Interventional Cardiology

Dr Pat Phen, PhD FRCP

Consultant Cardiologist with extensive experience in treating a broad range of adult cardiac conditions.

He was appointed as a Consultant at the Trust in 2004 after having completed his cardiology training at a number of prestigious London teaching hospitals and the BHF research fellowship at the National Heart & Lung Institute, Imperial College London.

He has sub specialty expertise in device therapy for Cardiac Rhythm Management including the implantation of permanent pacemakers ICDs and CRTs, which he carries out at the Trust.

In addition he also has expertise in advanced echocardiographic techniques including 3D and Speckle Tracking strain imaging. He holds regular CCU ward rounds and cardiology clinics as well as performing diagnostic cardiac catheterisation and coronary angiography. Dr Phen is currently the lead clinician for cardiology at the Trust.

Dr Rossella Barbagallo, MD

Consultant Cardiologist with special interest in Imaging and Heart Failure. Heart failure lead at the Trust. Specialised at the Postgraduate School of Cardiology, University of Catania, in Italy. She holds general cardiology clinics at Orsett Hospital, Basildon University Hospital and The Essex Cardiothoracic Centre.

Dr Alamgir Kabir, PhD

Consultant Cardiologist with special interest in interventional cardiology, pacing and adult congenital heart disease at The Essex Cardiothoracic Centre. He has an interest in structural intervention. He is dually accredited in cardiology and general internal medicine. He was awarded a PhD in cardiology for his work on ischemic preconditioning in 2006.

He has a strong commitment to clinical teaching. He has been teaching for MRCP since 1999.