Prioritisation of Cardiology Procedures
Where local arrangements for prioritisation are in place and are working well, they should continue, and this guide used for reference to check if national priorities have changed, and local arrangements need to be revised. The cases in this guide are examples and are not intended to be comprehensive. For some patients, based on clinical presentation and need, individual decisions, which would usually be supported by a multidisciplinary meeting, will need to be made that may affect prioritisation.
Priority 1a – emergency procedures to be performed in <24 hours
LHC + PCI (if indicated) for STEMI / OHCA
LHC + PCI (if indicated) for unstable ACS with ongoing pain, ECG changes or haemodynamic/electrical instability
Pacemaker implantation for heart block or sinus node disease with significant symptoms requiring intervention e.g. recurrent syncope
Priority 1b – procedures to be performed in <72 hours
LHC + PCI (if indicated) for unstable angina or NSTEMI with an intermediate or higher risk of adverse cardiovascular events
Pacemaker implantation for symptomatic heart block
Lead extraction for systemic sepsis
ICD/CRT-D implantation for secondary prevention following cardiac arrest or syncopal VT (required prior to discharge from hospital)
CIED generator replacements for end of life
Ablation for rapidly conducted pre-excited AF in patients with Wolff Parkinson White syndrome
Ablation for VT storm not settled with medical therapy
Priority 2 – procedures to be performed in <1 month
LHC + PCI (if indicated) for unstable angina with a low risk of adverse cardiovascular events
LHC + PCI (if indicated) for patients with high risk non-invasive functional imaging or high risk CTCA, or rapidly progressive exertional angina
Staged PCI after STEMI
Coronary angiography in patients with severe aortic valve disease
TAVI for patients with symptomatic severe aortic stenosis
Permanent pacemaker implantation for asymptomatic heart block or symptomatic sinus node disease
Urgent CIED generator replacements where advisory recommends replacing within this timescale
Urgent CIED generator replacements e.g. for ERI with no underlying rhythm
Primary prevention ICD implantation
CRT implantation for heart failure
Pacemaker and AV node ablation for ventricular rate control for atrial fibrillation
Lead extraction for isolated pocket infection / erosion
AV node ablation for CRT optimisation
Ablation for patients with ventricular tachycardia not controllable with medication
Atrial fibrillation or flutter ablation for heart failure with tachymyopathy
Priority 3 – procedures to be performed in <3 months
LHC + PCI (if indicated) for stable angina without high risk functional imaging or CTCA
CIED generator replacements for patients with a stable underlying rhythm
EPS / RFA for WPW with unclear pathway characteristics
SVT ablation for patients not well controlled on medication
AF ablation for highly symptomatic patients
DC cardioversion for AF or atrial flutter / tachycardia
Insertion of implantable cardiac monitor (loop recorder or ILR)
Percutaneous mitral valve leaflet repair
Priority 4 – procedures to be performed in >3 months
All other cardiology procedures. This would include, CTO PCI for stable angina, ablation for symptomatic AF (excluding highly symptomatic patients), SVT ablation for patients controlled on medical therapy, ventricular ectopy ablation for symptoms.