Background Increasing evidence exists suggesting that cardiac contractility modulation therapy (CCM) improves symptoms in heart failure patients if various selection criteria are fulfilled. The aim of this study is to analyse an unselected sample of heart failure patients to establish what percentage of patients would meet the current criteria for CCM therapy. Methods All patients admitted to two district general hospitals in the UK in 2018 with a diagnosis of heart failure were audited for eligibility for CCM therapy. The selection criteria were (a) ejection fraction (EF) 25%‐45%, (b) QRS duration less than 130 ms, (c) New York Heart Association (NYHA) class 3‐4 and (d) treated for heart failure for at least 90 days and on stable medications. Exclusion criteria included: (a) significant valvular disease, (b) permanent or persistent atrial fibrillation, (c) biventricular pacing system implanted or QRS duration more than 130 ms and (4) patients not suitable for device therapy as a result of palliative treatment intent. Results A total of 475 patients were admitted with heart failure during the study period. From this group, 24 (5.1%) patients fulfilled the criteria for CCM therapy. The mean age and ejection fraction were 70.8 ± 10.2 and 32.5% ± 7.4%. The majority of patients were men (71%) and had an ischaemic cardiomyopathy (75%). If patients with atrial fibrillation were included, an additional 18 (3.8%) patients potentially may be eligible for CCM. Conclusion Only 5.1% of all patients presenting with heart failure might benefit from cardiac CCM. This is a small proportion of the overall heart failure population. However, this population has no other current option for device therapy of their condition.

Background Post‐infarction ventricular septal defect (PIVSD) carries a very poor prognosis. Surgical repair offers reasonable outcomes in patients who survive the initial healing period. Percutaneous device implantation remains a potentially effective earlier alternative. Methods and Results From March 2018 to May 2022, 11 trans‐arterial PIVSD closures were attempted in 9 patients from two centers (aged 67.2 ± 11.1 years; 77.8% male). Two patients had a second procedure. Myocardial infarction was anterior in four patients (44.5%) and inferior in five cases (55.5%). Devices were successfully implanted in all patients. There were no major immediate procedural complications. Immediate shunt grade postprocedure was significant (11.1%), minimal (77.8%), or none (11.1%). Median length of stay after the procedure was 14.8 days. Five patients (55%) survived to discharge and were followed up for a median of 605 days, during which time no additional patients died. Conclusion Single arterial access for percutaneous closure of PIVSD is a good option for these extremely high‐risk patients, in the era of effective large‐bore arterial access closure. Mortality remains high, but patients who survive to discharge do well in the longer term.

Magnetic resonance imaging is being increasingly used to optimize the diagnostic process for low back pain and to manage the risk of missing life-threatening pathology. The aim of the study was to examine the care pathway of low back pain with respect to the utilisation of CT and MRI service utilisation. A descriptive, retrospective, cross-sectional study was performed. A random sample of 1000 primary care patients presenting with low back pain who underwent lumbar spine radiography within a specified period was explored. 20% (n=198) of patients who underwent lumbosacral spine X-ray were referred for MRI investigation. Subsequently, 15 (7.6%) patients underwent joint infiltration whilst 6 (3%) patients underwent neurosurgical intervention during 2 years of follow-up. Such findings provide information for policy makers about the utility of MRI and CT scans.

The knowledge gained from this pilot shows that it is feasible to recruit, train and utilise the unique skills of patients as volunteers to support other (newly diagnosed) patients to accept their chronic, life changing condition, make informed choices about their treatment while empowering them.We have the proof of principle that PEs can meet the needs of renal units, working within the NHS Trust volunteer/ governance framework. This initiative is low cost, demonstrating new ways of working and managing, empowering patients and utilizing non -clinical workforce through effective leadership.

Downloaded from with specified PACES teaching was created (e.g table 1). This included some specialised clinics that were consultant led (rheumatology and ophthalmology) aimed at providing consultant led teaching to PACES candidates. One PACES candidate was allocated to each clinic day providing 1-to-1 focused teaching, while the bedside sessions were open for everyone. A WhatsApp group was also created consisting of all candidates preparing for PACES and instructors, which encouraged all members to share interesting cases deemed good for PACES teaching and also facilitated organising unscheduled teaching.