ObjectiveTo document UK rates of exercise treadmill testing, functional stress testing and CT coronary angiography (CTCA). Specific aims were to determine how rates have changed in the context of changing guideline recommendations within the UK and to identify regional inequalities in the utilisation of testing modalities. Secondary objectives were to compare these trends with national data on revascularisation.Methods159 acute National Health Service trusts were served Freedom of Information (FOI) requests to provide total numbers of CTCA and functional imaging tests for each financial year from 2011–2012 to 2016–2017.ResultsThe FOI requests yielded data from 88% of Trusts, increasing from 81.9% in 2011–2012% to 92.1% in 2016–2017. Exercise treadmill tests (ETTs) were performed by over 97% of Trusts. ETT was the most commonly performed diagnostic test in the UK across the study period despite declining by 8.4%. Utilisation of non-invasive stress imaging tests increased by 80.9% during the same period. Myocardial perfusion scintigraphy and stress echocardiography increased by 25.8% and 73.9%, respectively. The 268% increase in CTCA scans was yet greater. Trends in test utilisation during the study period showed important regional differences between devolved nations. Comparably, only small changes in rates of invasive coronary angiography and revascularisation have been reported during the study period.ConclusionNon-invasive imaging in UK Trusts has increased substantially since 2010 with only a small decline in use of the ETT and minimal changes in rates of invasive coronary angiography and revascularisation in the same time period.

Background: Inter-hospital communication frequently requires mediation via a switchboard. Identifying and eliminating switchboard inefficiencies may improve patient care. Methods: All 175 acute hospital switchboards in England were contacted six times. Call contents and duration were recorded. No clinician calls or bleeps were connected. Results: The mean delay before contacting a switchboard operative was 55±46 seconds. 115 hospitals (66%) used automated switchboards; 34 of these (30%) had infection control messages. Robot operators introduced an additional 40 second delay versus humans (mean 70.3±28 versus 29.8±23 seconds, p<0.0001). Multivariate analysis identified robot operators (HR 5.1, p<0.0001) and infection control messages (HR 2.9, p=0.003) as predictors of delays over 60 seconds. Conclusions: There are significant avoidable delays in contacting switchboard operatives across England. Quality improvement is underway.

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Boosted protease inhibitors (PI/b) have played an instrumental role in decreasing mortality among people living with HIV (PLWH). 1 However, this class of antiretrovirals has been associated with disadvantages such as drug-drug interactions (DDIs). 1 The cytochrome P450 3A4 (CY-P3A4) inhibitors ritonavir and cobicistat are used to boost PI concentrations to improve efficacy, administration frequency, and genetic barrier to resistance. However, potentially dangerous DDIs may occur during coadministration of comedications with PI/b, especially in ageing populations affected by polymorbidity and polypharmacy. 2 This is especially true for certain drugs, such as anticholinergic drugs or drugs with narrow therapeutic indexes. 3 Second-generation integrase strand inhibitors (INSTIs), namely dolutegravir (DTG) and bictegravir (BIC) are also characterized by a high genetic barrier to resistance 4 and have been used as replacement agents for PI/b in clinical trials including subjects with nucleoside reverse transcriptase inhibitors (NRTI) resistance. [5][6][7][8] Importantly, they are not enzyme inducers or inhibitors, and their DDI potential is substantially lower than PI/b. 4 The switch from PI/b to INSTIbased regimens can potentially reduce DDIs and the risks associated to polypharmacy.