Provision of services for the diagnosis and treatment of heart disease in England and Wales. Third report of a Joint Cardiology Committee. Royal College of Physicians of London and the Royal College of Surgeons of England.

The principal conclusions of the report are as follows. Cardiology continues to change rapidly. In the five years since the issue of the Second Report of the Joint Cardiology Committee in 1980 the specialty has been affected principally by the increase in coronary artery surgery and the increasing importance of non-invasive techniques of diagnosis, particularly echocardiography. The burden of heart disease in Britain shows some decline recently, but this falls short of that which has occurred in other countries. The vital role of the initial assessment of patients to ensure the efficient use of limited resources falls upon physicians and paediatricians in district general hospitals. Each district general hospital should have at least one physician, practising general medicine but having a special expertise and training in cardiology. He should undertake echocardiography, stress testing, ambulatory monitoring, emergency pacing, rehabilitation, and cardiac intensive care, with the necessary facilities and staff. He will also play an important part in the follow up of patients assessed and treated at cardiac centres. Paediatricians should continue to evaluate children with heart disease and their training should include periods at cardiac centres. Cardiac centres currently undertaking invasive investigations and cardiac surgery need to expand to cope with demand. A target figure of 750-1000 coronary artery bypass operations annually is suggested. This implies three or four surgeons and six cardiologists per centre. Other staffing should be based on these figures. Smaller centres are not necessarily non-viable but should be encouraged to expand or merge. Funding should be clarified so that regional contributions to regional services are identified and not lost in district budgets. Expensive capital equipment should be regionally funded whether sited in cardiac centres of district general hospitals. (7) Supraregional centres for the cardiac problems of infants under the age of one year have been identified ans should receive supraregional funding. Their staffing and equipment should be appropriate to the exceptional demands of this work. If such a centre is sited within an existing cardiac centre the staff will be additional to those needed for the adult work. Facilities for older children should continue to be provided, as at present, at all cardiac centres. (8) Cardiac transplantation should be funded supraregionally. (9) The medical audit of cardiac work should be supported by the Department of Health and Social Security (DHSS). (10) Research remains a high priority, and cardiac centres should be provided with the facilities, and staff with the contracts and time, to undertake it. (11) A revision of this report is recommended within five years.