Janet A

Background Since 2018 NHS Ayrshire and Arran (NHSA&A) has offered a specialist nurse-led hypertrophic cardiomyopathy (HCM) clinic, providing assessment and education to those with clinically stable HCM, and those genetically at risk of HCM. Though there is growing evidence on the safety of exercise in this population, an HCM diagnosis often leads to concern around the risk of physical activity and exercise participation.1 2Aims This study aimed to explore perceptions of physical activity and exercise in those with established HCM.Methods A physiotherapist conducted telephone interviews with six NHSA&A HCM clinic attendees. All had been diagnosed with HCM several years prior to the clinic being established. None had ever accessed a cardiovascular prevention and rehabilitation programme (CVPRP) or specialist exercise professional. Interviews were semi-structured and focused on ‘Given your HCM diagnosis, what are your thoughts on physical activity and exercise?’ with additional prompts used to guide discussions. All were audio-recorded, and took 20-30 minutes. Qualitative data generated were transcribed and thematically analysed.Results Of the six (mean age 62.7 [SD10.17] years, 3 female/3 male; average time since diagnosis 11.2 [SD 5.26] years), five reported being physically active and recognising the health benefits of this. Only one participant regularly engaged in structured exercise. Much of the discussions focused upon physical, psychological and social limitations to being active, with psychological limitations most prevalent and underpinning all interviews ([figure 1][1]). Participants highlighted how they valued the nurse-led HCM clinic support, and how this had been lacking in the period immediately following their diagnosis.![Abstract 10 Figure 1][2]Abstract 10 Figure 1 Participants’ physical, psychological and social limitations to being activeConclusion Following HCM diagnosis, there is a need for early reassurance and clear individualised physical activity advice. Expansion of the nurse-led clinic service to enable access to an individually-tailored multidisciplinary CVPRP may reduce physical, psychological and social barriers to safely and effectively facilitate long-term structured exercise participation in this population.[1]: #F1 [2]: pending:yes

Background In 2017 the West of Scotland Inherited Cardiac Conditions (ICC) service received British Heart Foundation funding to develop local nurse-led hypertrophic cardiomyopathy (HCM) clinics across Scotland, including within NHS Ayrshire and Arran (NHSA&A). Those with stable HCM, and family members at risk of HCM, can attend for clinical/risk assessment, and individually-tailored lifestyle advice/education. When the clinics were first established, the characteristics of those attending were largely unknown.Aims This project aimed to profile the NHSA&A HCM clinic caseload. Specifically, the project aimed to describe the cohort at point of referral, plus examine clinical outcomes over five years.Methods Data were collected from the first n=100, from April 2018. At point of referral, data were collected on demographics and co-existing morbidities, and diagnostic information and symptoms. For the period April 2018-March 2023, data were collected on mortality, unscheduled care usage and medical/surgical interventions.Results The first n=100 comprised n=80 with established HCM and n=20 at risk of HCM. [Table 1][1] shows point of referral data. Over five years, in those with established HCM, there were ten deaths (cardiovascular disease [CVD] was the primary cause for six). There was one non-CVD death in those at risk of HCM. Those with established HCM accrued 134 admissions (65 due to CVD) totalling 576 bed days. Those at risk of HCM accrued two non-CVD admissions totalling 13 days. In those with established HCM, n=10 underwent septal myectomy/ablation, a further n=4 valve surgery, and n=14 had a cardiac device inserted. No one at risk of HCM required medical/surgical intervention during the time period.View this table:Abstract 11 Table 1 Point of referral data for first 100 individuals accessing the serviceConclusion These data highlight substantial differences in initial presentation and clinical outcomes between those with established HCM and those at risk. The data have informed service development and enhanced its ability to anticipate and respond to the needs of the whole clinic caseload.[1]: #T1

The standard of beauty just got more inclusive.

Not like, physically. They're not going to Scunthorpe.

"I think this Loki probably understands his inner turmoil more than the Loki we saw in Ragnarok."

They knew exactly what to do with those tossed salads and scrambled eggs.

The special celebrates the achievements of Black British actors.

"He's in a place where he's not in control"

We saw it coming and it still hurt.

Virtual support methods have been shown to be an effective aid in cancer survivorship. Here, the authors created a culturally tailored information and support system for Asian American breast cancer patients and showed these resources improved quality of life.