Hearts and minds

There is a strong cardiovascular flavour to this edition of ClinMed. In part that reflects the outstanding continuing medical education (CME) section on cardiology curated by our specialist associate editor, Tevfik Ismail. The articles cover highly prevalent clinical topics, with state-of-the art reviews of heart failure¹ and atrial fibrillation² standing alongside updates on ventricular tachycardia³ and pulmonary hypertension,⁴ which are all written with relevance to the practising clinician to the forefront. The inclusion of the ever-popular exam-format self-assessment questions also serve as a continuing draw.

There is also a review⁵ of the contentious topic of the association between the SARS-CoV-2 vaccine and myocarditis/pericarditis. With billions of doses of the vaccines having now been administered worldwide, their safety profile is now well-understood. What remains to be determined is the long-term impact of any complications which do occur. The paper highlights the areas of uncertainty and points to the need for an international consensus on vaccination strategy for the small numbers of individuals affected by a vaccine-associated myopericarditis. Meanwhile, Induruwa and colleagues from Cambridge present a retrospective series looking at rates of atrial fibrillation and anticoagulation in people with COVID-19 compared to other respiratory tract infections.⁶ With approximately 1 in 10 hospitalised patients with COVID-19 having atrial fibrillation, they identify the factors that leave people at increased risk of cardio-embolic stroke following SARS-CoV-2 infection.

Optimising acute stroke care by mechanical thrombectomy is another hot button issue in terms of improving accessibility of service provision. Ramadan and colleagues in a tertiary centre present their audited experience and propose a protocol for use by other stroke service providers.⁷ Completing the cardiovascular theme are two of the cases in this edition.^8,9

We know that acute physicians are a core readership of ClinMed, and we are therefore delighted to publish a study by Lyall and colleagues¹⁰ related to the topic of the sustainability of physicians' careers. Acute medicine units (AMUs) are consultant-led facilities which are currently under huge pressure due to the volume of work and bed pressures across the health service. The authors examine the effect of physician experience on the rate of early safe discharge in two large AMUs in Scotland between 2017 and 2020. The findings are worth reading for yourself and stress the importance of minimising clinician burnout and early retirement. Retention of staff is critical to service delivery as this super paper points out.

This article pairs nicely with one by Tait and colleagues¹¹ looking at the experience of doctors in their first years of practice. The RCP has pioneered Structured Judgement Review (SJR) methodology to standardise the analysis of case notes following a death in hospital and utilise these as a critical learning opportunity. While most often considered the preserve of senior clinicians, the paper highlights the opportunities for such learning to doctors in the early years of their career. For those unfamiliar with SJR methodology, the paper presents the underpinning structure of these reviews.