Introduction: The role of the arrhythmia nurse is increasingly vital in cardiovascular care. This survey aimed to delineate the current landscape of arrhythmia nursing in the UK, focusing on roles, responsibilities, qualifications and professional development requirements. Methods: A national online survey was conducted between October 2023 and March 2024, disseminated through professional bodies including the Arrhythmia Alliance, British Association for Nursing in Cardiovascular Care, British Cardiovascular Society and British Heart Rhythm Society. The survey was a scaled-up iteration of a 2022 pilot audit and gathered data on demographics, qualifications, work environment, clinical responsibilities, leadership, teaching, research involvement and perceived development needs. Results: 102 responses were received. 69% of arrhythmia nurses operate at band 7, with significant experience (many over 20 years qualified). 35% have a master's level qualification. Over half are non-medical prescribers, and most possess advanced life support qualifications and electrocardiogram interpretation skills. While most are British Heart Rhythm Society members, few hold British Heart Rhythm Society accreditation. Roles are diverse, encompassing various clinics (e.g. atrial fibrillation, syncope) and procedures (e.g. implantable loop recorder implantation, direct current cardioversion), with many nurses undertaking multiple roles. Leadership and teaching are common responsibilities. Areas identified for further development include specialised training, accessible online courses and dedicated study time and budgets, which are currently lacking for many. Discussion: This survey highlights the advanced and multifaceted nature of the arrhythmia nurse role. There is a clear need for standardised competency pathways, greater support for professional accreditation, and dedicated resources for continuous professional development to meet the evolving demands of arrhythmia care. The findings provide a foundation for workforce planning and the development of targeted educational initiatives. Conclusions: Arrhythmia nurses are a highly skilled and integral part of the cardiac and advanced practice team. Addressing the identified needs for structured training, accreditation support and development opportunities is crucial for optimising patient care and advancing the specialty. Further qualitative research is planned to explore these findings in greater depth.
This third article in a series on generative artificial intelligence in the health and medical sciences examines the potential and risks around using artificial intelligence (AI) to facilitate communications between clinicians and patients, as well as among clinicians. The emerging evidence indicates that AI can help clinicians communicate more clearly and reduce workload, but that the risk of reduced accuracy and nuance mean that clinicians need to be closely involved in drafting AI-supported communication. The article also looks at the ways in which teaching in nursing and health sciences more generally is responding to these developments, and the ways in which students and practitioners can use AI to develop, but not replace, their professional communication skills.
Background: Subcutaneous furosemide offers an alternative to intravenous therapy for decompensated heart failure, but evidence for the standard formulation in integrated care models is limited. Aim: Evaluate the feasibility, safety, tolerability and clinical outcomes of standard subcutaneous furosemide within a nurse-led acute-community heart failure service. Methods: Eleven patients received nurse-prescribed subcutaneous furosemide with daily community monitoring and heart failure nurse oversight. Weight, NT-proBNP, renal function and hospital admission were analysed. Results: NT-proBNP decreased by 43.6% (median 2734 to 1542 pg/ml; P =0.083). New York Heart Association class improved (median 3 to 2; P =0.003) and weight decreased (81.0 to 77.0 kg; P =0.012). Electrolytes remained stable, renal function improved in eight patients, and no infusion-site reactions occurred. Hospital admission was avoided in 10/11 patients (90.9%). Conclusions: Standard subcutaneous furosemide was feasible, safe and well tolerated within a nurse-led integrated pathway, supporting community-based diuresis as an alternative consideration to IV therapy.
Pre-emptive focus on prehabilitation interventions such as exercise, nutrition, modifying risk factors and psychological preparation to withstand cardiovascular surgery are proactive approaches to improve patients’ postoperative recovery. In this comment, Queiróz et al make the case that digital innovations may assist in greater prehabilitation engagement and sustainability leading to better patient outcomes, experiences and less burden on the healthcare system.
This case report discusses the complex management of an elderly patient with severe left ventricular systolic dysfunction and coexisting idiopathic pulmonary fibrosis, presenting with fluid overload and persistent hypotension. The case has raised awareness of the complexities associated with a dual diagnosis, as well as the care collaboration by members of the multidisciplinary team, when being managed in the primary care setting.
This article is the first in a series examining the way in which generative artificial intelligence is changing practice and training in the health and medical sciences. Here, we look at the increasing role of generative AI in simulation, and the use of chatbotdriven role-play activities to build and maintain communication skills. It explores potential and current practice, as well as some of the risks and ethical issues, and provides practical guidance for upskilling.
In this month's Research Roundup presented by the British Association for Nursing in Cardiovascular Care (BANCC), Kavunku and Lotto examine three recent studies exploring the growing cardiovascular effects of extreme heat and air pollution. The studies consider the future burden of heat-related cardiovascular disease, the association between extreme heat and social vulnerability, and the association between fine particulate air pollution and outcomes in people with valvular heart disease. The implications for cardiovascular nursing practice are discussed, and full references are provided for those wishing to examine the evidence in greater detail.
Dilatation of the inferior vena cava may indicate a preclinical stage before the appearance of physical signs of cardiac function deterioration. The aim of this case study was to explore the relationship between inferior vena cava diameter fluctuations and the onset of physical signs associated with cardiac decompensation in a 97-year-old home-dwelling patient with heart failure. The patient's vital signs, physical findings and inferior vena cava measurements were assessed at the same time of day over four visits at 2-week intervals. The maximum inferior vena cava diameters (cm) were 1.0 at the first observation, 1.5 at the second, and 1.7 at both the third and fourth observations. Bilateral lower-limb oedema was observed at the third visit, which had extended to the trunk by the fourth visit. The temporal relationship between inferior vena cava dilatation and the appearance of oedema suggests that inferior vena cava enlargement precedes the overt signs of fluid retention. These findings imply that serial assessment of inferior vena cava diameter may offer early detection of cardiac functional decline in home-based heart failure management.
In this month's editorial, consultant editor, Tracey Bowden, examines the evolution of artificial intelligence in cardiac care from familiar electrocardiogram interpretation algorithms to newer systems that handle communication, documentation, and patient education. It introduces a new series launching in the current issue on generative artificial intelligence in health sciences education and practice, emphasising the need for cardiac practitioners to actively engage with artificial intelligence integration rather than become passive recipients of imposed technology. The author, Stian Reimers, argues that practitioners must develop the knowledge and critical judgement to determine how artificial intelligence can support – not replace – skilled cardiac care while maintaining clinical expertise and therapeutic relationships.
Myocardial infarction is a major cause of mortality and morbidity, with smoking being a major risk factor. However, a large proportion of patients continue to smoke following a myocardial infarction, suggesting that there are significant barriers to smoking cessation. This review aimed to understand the perceived barriers to, and facilitators of, smoking cessation among patients who have experienced a myocardial infarction and the health professionals involved in their care. A search of six electronic databases was conducted in April 2023: MEDLINE, EMBASE, CINAHL, PsycINFO, The Cochrane Library and Web of Science. The review followed the Joanna Briggs Institute guidance for mixed-methods systematic reviews, using the convergent integrated approach. Quantitative data were added to qualitative data and synthesised. Fifteen studies were included in the review (13 qualitative, one mixed-methods and one quantitative). Five key themes were identified: motivation for change; smoking as an identity; support; impact of health professionals; and lack of knowledge of smoking cessation interventions. These findings were used to present recommendations for health professionals and policymakers to provide more effective support for patients to quit smoking following myocardial infarction.
