Dr Rohin Francis after a Glenfield Hospital nurse practitioner led a whole TAVI procedure.

Cardiology Policy

Glenfield Hospital’s Nurse-Performed TAVI Uproar

Glenfield Hospital Cardiology – a leading NHS heart center just outside Leicester in the UK – set cardiology channels ablaze earlier this week with a since-deleted celebratory tweet announcing that one of its advanced nurse practitioners performed a whole TAVI procedure (aka TAVR in the U.S.) as the first operator.

While Glenfield Cardiology proclaimed it a “momentous day for Glenfield, UHL and the whole world,” most of CardioTwitter saw it quite differently, highlighted by two prominent Twitter threads that combined to accumulate over 1.6M views, 575 retweets, and 2,200 likes.

CardioTwitter’s many NP-led TAVI/TAVR critics…

• Were in disbelieve that this actually happened
• Disagreed with choosing TAVI, given its complexity and specialization
• Reminded that being a TAVI operator also includes handling planning, patient management, and complications
• Questioned why cardiologists must go through years of training and costly boards to perform the same procedure
• Criticized the impact decisions like this have on physician training
• Worried that this is a turning point in NP cardiology scope creep

Although massively outnumbered, CardioTwitter’s handful of NP-led TAVI/TAVR defenders…

• Noted that this NP was likely talented and Glenfield is a solid institution (even critics agreed with these points)
• Reminded that NPs are already expanding their role in the cath lab and other areas of cardiology
• Suggested that TAVI is a team effort, and an NP with the right capabilities and training could be the first operator if they worked alongside a physician

The threads also revealed widespread confusion about Glenfield and the NHS’s motives…

• Few seemed to agree with Glenfield’s suggestion that NPs would improve TAVI access
• Some suggested that this is part of a larger conspiracy to shift more procedures to “mid-levels,” prioritizing costs over patient care
• Some theorized that health systems are shifting procedures to NPs to prepare for future physician shortages 
• Others argued that this “was done purely for clout,” which seems more problematic than any of the above theories

The Takeaway

Regardless where you stand on the role of NPs in cardiology, these Twitter responses make it very clear that most cardiologists aren’t ready for NPs to lead complex procedures and aren’t comfortable with the potential motivations behind this decision. Even if Glenfield’s first NP-led TAVI seems like an isolated event, these Twitter treads provide a helpful (and concerning) glimpse into what to expect if NPs’ scope continues to expand to more advanced areas of cardiology.

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• Scranton Cardiology Hack: Northeastern Pennsylvania’s Commonwealth Health Physician Network-Cardiology (also known as Great Valley Cardiology) notified more than 181k cardiology patients that hackers might have gained access to their personal and health information (e.g. names, address, DOB, SSNs, bank info, insurance info, diagnoses/medical info). The cardiology group identified the hack in early April and promptly secured its network, and has since been working with a forensic group to assess the breach. 

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