HERALD is a growing repository of research and organisational information generated by people working and volunteering in London's Integrated Care Systems.

Please see below for the full list of HERALD organisations. To engage with us as we develop the repository - including submitting items for adding to the collection and becoming a HERALD organisation - contact us via email: heraldrepository@gmail.com

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Recent Submissions

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    WHF Roadmap for Integrated Care in People Living with - or at Risk of - Cardiovascular Disease and Multiple Long-Term Conditions
    Sperling, Laurence; Irazola, Vilma; Partarrieu, Jackie; Raspail, Lana; Banach, Maciej; Banerjee, Amitava; Bukhman, Gene; George, Maria; Toda Kato, Eri; Lopez-Jimenez, Francisco; Macari, Steven; Miranda, Jaime; Mocumbi, Ana; Perel, Pablo; Prabhakaran, Dorairaj; Puente Barragan, Adriana; Sherifali, Diana; Santos, Raul
    Cardiovascular disease (CVD) commonly coexists with multiple long-term conditions (MLTC), including diabetes, chronic kidney disease, obesity, and mental health disorders. This clustering creates a syndemic burden associated with poorer outcomes, polypharmacy, high treatment burden, and rising healthcare costs. Fragmented, single-disease care models are ill-suited to address this complexity. The WHF roadmap for integrated care in people living with - or at risk of - CVD and MLTC provides a structured framework to support the design, implementation, and scale-up of person-centred, coordinated care models globally. Drawing on current evidence, expert consensus, case studies, and stakeholder surveys, the Roadmap outlines the epidemiological and systemic challenges of MLTC and identifies practical strategies adaptable across high-, middle-, and low-income settings. This Roadmap emphasises multidisciplinary teamwork, aligned financing, digital health infrastructure, workforce development, patient partnership, and robust monitoring and evaluation. By shifting from siloed care to integrated, capacity-sensitive approaches, health systems can improve clinical outcomes, enhance quality of life, reduce avoidable hospitalisations, and build resilience in the face of growing multimorbidity.
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    Winter all year round in urgent and emergency care: a large retrospective analysis of routinely collected NHS data across England, 2021-2022.
    Lewis J.; M Jacques R.; Hasan M.; Campbell R.; Simpson R.; Croft S.; Williams S.; Gutteridge C.; Gallier S.; Evison F.; Sapey E.; Dillon A.; Denholm R.; Mayer E.; Davies Q.; Knight J.; Chandrabalan V.; George M.; Phillips T.; Stammers M.; Mason, S.
    Background ‘Winter pressures’ in urgent and emergency care (UEC) are widely accepted but have had little empirical attention. Amidst annually increasing demand for UEC and reports of extreme strain during winter, we aimed to understand the extent and nature of seasonal demand by analysing routine data from Emergency Departments (ED) and acute Admitted Patient Care (APC) episodes across England. Methods This was a retrospective observational analysis using data from 26 hospitals and 22 EDs between 2021-11-1 and 2022-10-31 comparing emergency attendances and acute admissions between winter (October-March) and summer (April-September). Main outcomes included ED waiting times, length of admissions, the number of investigations, treatments and procedures received, and whether the contact was considered avoidable. Using a novel ‘federated’ approach exploiting local relationships with data providers, regional researchers analysed local data and provided summary statistics and analysis results to the lead site. Aggregation of summary results established a picture of seasonal demand across the country, and an understanding of regional variation in seasonal trends. Results 1,549,205 ED attendances (775,810 winter; 50.1%) and 747,685 APC admissions (368,910 winter, 49.3%) were analysed. We found no systematic seasonal differences in the number or nature of presentations. While regional variation existed for many outcomes, no nationally consistent effect of winter was found for any measure. Conclusions Winter pressures in UEC may not be driven by large differences in the number, avoidability or acuity of ED attendances or APC admissions. Rather, UEC may be operating at or near to capacity all year, meaning small fluctuations in demand or in the complexity of presentations may cause significant strain on an over-burdened system. Focus on managing seasonal demand should be modified to address year-round pressure. Effective policy may require structural reconfiguration to better regulate demand.
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    Use of pre-operative blood products in abdominal trauma: a planned secondary analysis of the GOAL-trauma study.
    Ng W.H.; Edmiston T.; Smith B.G.; Clarke D.; Kwizera A.; Hobbs L.; Mazzoleni A.; Fareed F.F.I.; Erhabor J.; Mantle O.; Hammer C.; Perkins Z.; Marsden M.; Davies R.J.; Moonesinghe R.; Weiser T.G.; Leather A.; Nordin Servin Y.R.A.; Conway Morris A.; Lakhoo K.; Bass G.A.; Wohlgemut J.M.; Hutchinson P.; Bashford T.; Ng W.H.; Bath M.F.; Kohler K.; Dogjani A.; Tidjane A.; Velez S.E.; O'Flynn C.; Haider F.; Litvin A.; Filho R.; Tientcheu T.; Wong E.G.; Wang R.; Wang J.; Ni Y.; Wang Z.; Tian Z.; Fang M.; Zhou M.; Liu S.; Xie K.; Guo X.; Ke Y.; Ni H.; Luo Q.; Caceres E.; Reyes L.F.; Pino L.; Baderhabusha D.U.; Cissa Wa Numbe B.; Meselhi A.; Elsayed M.M.; Abdelmohsen S.; Elkhouly A.; Abouelnagah G.; Osman A.; Taher H.; Shenkutie W.; Senbu M.; Bayleyegn N.; Merene M.; Gudugbe S.; Amoako J.; Morna M.; Gyabaah E.; SeiduAroza H.; Baloyiannis I.; Bouchagier K.; Mulita F.; Ioannidis A.; Rivera M.; Regis F.; Bains L.; Khajanchi M.; Sartarelli L.; Bollino R.; Fedi M.; Bottari A.; Cammelli F.; Calini G.; Piccolo A.; Visconti D.; Altomare M.; Carenzo L.; Fleres F.; Iwao Y.; Parker R.; Tiong C.K.; Teoh C.X.; Zakaria A.D.; NunoGuzman C.M.; GonzalezOjeda A.; Wakeman C.; Ikwutah E.; Daniyan M.; Adamu A.; Akpo E.; Chukwu I.; Bashiru M.; Akanni B.; Olaogun J.; NomayoOriabure B.; Abiyere H.; Khidri F.F.; Naqi S.A.; Khan T.; Pederzoli R.S.; AbuArish H.; Youssef M.; HuarotoLandeo C.; Carolino Gomes I.; Gatta N.; Negoi I.; Katorkin S.; Alsubaie N.; Goo J.T.T.; Balasubramaniam S.; Hassan M.S.; Mohamed S.A.; Hardcastle T.C.; Naidoo R.; Crawford R.; Moeng M.; Kruger H.J.; SerranoNavidad M.; LandaluceOlavarria A.; Lopes Moreira C.C.; LlaquetBayo H.; Jayasuriya K.; Jayasundara J.A.S.B.; Subasinghe D.; Mithushan J.; Elnour M.; Adel I.; Mohammed L.; Bakhit S.; Elbashier M.; Musa R.; Amin J.; Yassin M.; Babiker A.; Noureldin A.; Abdalazeez A.; Benediktsdottir S.; Hasan L.; Hamad S.; Mansour N.; Homchan O.; Hasnaoui A.; Bouzid A.; Riahi W.; Ergenc M.; Yigit B.; Citgez B.; Yilmaz M.; Aydogdu Y.F.; Guner A.; Karakullukcu H.; Tuncer K.; Sanli A.N.; Demirpolat M.T.; Buyukkasap C.; Yildirim A.C.; Feratoglu F.; Smoliar S.; Roocroft H.; McKnight G.; Hughes M.; Taylor J.V.; Yung E.; Nevins E.J.; OwenSmith S.; Mian A.; AlfaWali M.; Menichetti C.; Jodlowski T.; Khalil O.; Jay S.; ElBoghdady M.; Pratheepan P.; Abouelnaga A.; Brooks A.; Yoong S.; Al Azzawi Y.; Lim Y.S.; Agarwal S.; Petrone P.; Stephens D.; Starr N.; Teichman A.; Dodgion C.; Wolff C.; Egodage T.; Brady J.; Brown J.; Leon D.; Pienovi A.; Saleh R.; Doci K.; Bregaj E.; Mansouri J.; Tabeti B.; Titarelli M.; Avalos Barraza M.M.; Sanchez M.; Caldani E.; Giavarini A.; Groombridge C.; Ban E.; Abdulla A.; Bereshchenko V.; Tereshchenko P.; Marcos I.; Lima R.; Nwenasi N.; Aloys E.; Uchino H.; Grushka J.R.; Davalan W.; Chen C.; Ge F.; Lu K.; Zhang J.; Liu X.; Li X.; Qi Z.; Wang N.; Tang J.; Wang S.; Gao F.; Lu Y.; Du H.; Wu C.; Fu H.; Liu J.; Chen T.; Du M.; Guan J.; Lu Q.; Li Y.; Li J.; Wang Q.; Luo W.; Wang K.; Zhang H.; Dong J.; Gelvez S.; Reyes K.; Tsongo D.; Muhoza J.; Mirindi A.; Birindwa J.R.; Aboelfadl H.; Elasad A.; Elsheikh S.; Elsaied F.; Atef M.; Elnour R.; Elbaloula N.; Shanab E.A.; Adres M.; Mohamed O.; Adam S.; Younes O.; Elboraay T.; Abdelfattah O.; Elfadali M.A.; Jader A.; Ziada A.; Sarhan K.; Sherif M.; Gomaa R.; Mohamed R.; Fouda E.; Elshaboury A.; Alshraiedeh M.; Elhadidi H.; Eldiasti A.; Elkoury E.; Abdelhady H.; Amasha M.; Elbadrawy A.; Nassif M.; Hamed M.; Zahran D.; Abdelaal S.; Abdelfattah O.S.; Shehada W.; Alsharif M.; Elnadi M.; Sharaf O.; Elgliand M.; Badr M.; Hegazi A.; Gohar A.; Elshal A.; Abdelhady M.; Salem E.Y.; Madany M.; Mansour H.; Ashour A.; AbuSuliman A.; Tolba K.; Elgendy M.S.; Ezz M.; Marei M.; Taha H.I.; Younes I.; Abouammar A.; Wael R.; Elmorshdy A.; Ibrahim A.M.; ElBorollosy A.; Elmorshdy S.; Adel A.; ElSaeed N.H.; Essam M.; Abdelraheem E.A.K.; Shaapan M.; Salah M.; Saber E.; Ibrahim M.A.; Mamdouh R.; Mohamadin A.M.M.; Moharb F.; Shaqran O.; Selim Z.; Tanas Y.; Khalil M.; Eldin B.; Gaber Y.; Ibrahim A.; Bekhit D.; Mohamed B.; Farrag A.; Saadawi M.; Mahfouz H.; Sayed N.; El Mahrouki M.; Amgad A.; Elmagdoub D.; Paulo S.; Gebremedhin B.; Eticha A.; Bayissa B.; Urgessa K.; Tasew B.; Yilma Y.; Mude L.G.; Tilahun O.; Buta L.; Mideksa A.G.; Gemechu T.; Tilahun A.; Degefu Y.; Quenin F.; Acquah E.; AbdullKarim I.; Takyi C.; Aryee G.; Wordui T.; Bowan A.; Kumassah P.; AduAryee N.; Naalane N.; Dedey F.; Nsaful J.; Ekor O.; Rahman G.; Nortey M.; Baidoo R.; AmoakoBoateng M.; Enti D.; AgyenMensah K.; Quartson E.; Agyen T.; Ofori E.; Mensah P.; Kudoh V.; Arthur D.; Maison P.; Akum F.; Owusu F.; Affram N.; Tamatey D.; Sarakatsianou C.; Papaspyrou D.; Antzoulas A.; Kitsou K.; Garantzioti V.; Leivaditis V.; Vouchara A.; Katsiafliaka K.; Morales S.; Galindo E.; Meza A.; Colon M.; Cardona E.; Louis K.; Osias R.; Lominy C.; Capois A.; Khan S.A.; Verma V.; Amin S.; Gaikwad A.; Tonini V.; Cervellera M.; Fumagalli M.; Zizzo M.; Luppi D.; Yu H.; Di Donato L.; Leo F.; Cecchi C.; Ripamonti G.; Pesi B.; Piombetti L.; Pagani M.; Pascale G.; Di Salvatore S.; Tasca C.; Giannessi S.; De Vincenti R.; Monati E.; Renzi F.; Vacca L.; Matarazzo F.; Perini D.; Di Bella A.; Fortuna L.; Rottoli M.; Binetti M.; Tescione M.; Sera G.; Pellicano N.; Pangallo S.; Ballauri E.; Santarelli M.; Cimbanassi S.; Cioffi S.; Curreri G.; Ceolin M.; Del Fabbrio D.; Giudici S.; Cecconi M.; Sinicropi T.; Mazzeo C.; Sato K.; Otoki K.; Baraka D.; Ang R.M.Z.; Zulkifli M.N.F.; Sheng K.C.; Wong M.T.Y.; Aziz N.; Lim P.J.H.; Koay C.C.E.; Teoh Y.X.; Chik I.; Zakaria Z.; Satar M.H.S.; Mazlan M.R.; BravoCuellar L.; OrozcoCamacho J.; NavaFranco A.; IbarraTapia M.; LopezOrtega F.; RomoPerez F.; ContrerasArias R.; AlejoRivera M.; VazquezSanchez S.J.; FuentesOrozco C.; McCombie A.; Dasril J.; Teo Y.; Fagbenro A.A.; Shafer K.; Iji L.; Gana S.; Bashir M.; Ajayi A.; Gundu I.; Mukoro G.D.; Ukwubile L.; Okeke C.; Jimoh A.; Nduka V.; Bwala K.; Ningi A.; Oriakhi S.; OdionObomhense H.; Ekpemo S.; Okpokiri K.; Makama A.A.; Aminu H.; Ahmad Z.; Mustapha M.; Segunfunmi O.; Boladuro E.; Eni U.; Obi C.; Kwentoh N.L.; Idowu D.; Magbagbeola M.; Adolphus O.; Oriabure E.; Fatudimu S.O.; Oloruntoba O.; Eghonghon R.; Omorogbe S.; Shaikh S.; Narsani A.K.; Ujjan I.; Munir A.; Memon A.I.; Hameed F.; Khatoon S.; Talpur A.; Kumar S.; Yousfani A.; Dal N.; Naz S.; Akbar M.; Bhatti A.M.; Amir N.; Khaskheli S.A.; Iqbal N.; Aamir A.; Shamsi G.; Awais G.; Tasleem I.; Iodhi N.; Ahmed I.; Fatima R.; Asif S.; Haroon H.; Jawaid A.; Muneer J.; Ahmed H.; Washdil M.; Hilal A.; Ishaq M.; Ialani S.; Kumar Y.; Shehzad M.N.; Nadeem S.; Ahmed N.; Ahmed S.; Gulzar S.; Khan G.; Jaffer Z.; Gul A.; Khan M.; Faraz A.; Obaid M.; Pirhay H.; Faheem K.; Shafique M.; Nafees R.; Soares Barboza de Toledo L.C.; Silva de Sousa A.L.; Qneiby B.; Jabari R.; Farash R.; Oweidat M.; Matar R.; Shaldan M.; PicassoArias C.; Strong C.; Feliciano F.; dos Santos L.; Monteiro D.; Alves S.; da Cruz D.; Oprita B.; Dumitru E.; Lichman L.; Davydova O.; Andreev P.; Alyahya R.; Alrwais A.M.; Almadi N.H.; AlShahwan N.; Aladawi M.; Aldeligan S.H.; Alotaibi A.; Lee J.; Gunasekaran S.; Ong M.W.; Lee D.J.K.; Lim W.W.; Teo L.T.; Tan R.L.; Hashi A.S.; Omar A.A.; Mohamed A.N.; Abdi A.M.; Salad A.H.; Abdishakur A.E.; Ganchi F.; Naidoo S.; Moodley K.; Wain H.; Reddy N.; Laher N.; Wineberg D.; Pretorius R.; Pswarayi R.; Laney E.; Lusawana O.; Mushtaq A.; Bogiages I.; Viljoen F.; Mohammed F.; Jacks G.; Mohlala L.; Nyatsambo C.; Mathibela S.; Nortje A.; Makhadi S.; Pratt T.; de Kock K.; Patel M.Q.; Parker M.; Buitendag J.J.P.; Oosthuizen G.V.; Martinez de Carneros C.; Quinto Llopis S.; Cruzado L.; SainzLete A.; EstravizMateos B.; ZevallosQuiroz J.C.; Augusto Ponce I.; Garcia Dominguez A.; Lizarazu Perez A.; Rodriguez Gonzalez A.; MunozCampana A.; CamposSerra A.; Bandara L.; Gunasekara K.; Jayarathne G.; Arachchi Y.; Priyangani M.; Wimalge S.; Desman R.S.C.; Gunarathne K.; Wimalasena G.; Rohana V.; Ranathunga S.; Harikrishanth S.; Jeyaruban J.; Mohammed M.; Mohamed A.; Zeinalabedeen L.; Mahmoud A.; Mohamed M.; Eltahir M.; Ahmed G.; Ahmed M.; Mohammed I.A.O.; Ibrahim S.A.A.; Aziz E.A.H.; Homida M.; Mahdi F.S.; Issak M.; Hafiz M.; Makki H.; Awad N.; Elhassan A.; Amin M.; Daffalla A.; Omer A.; Alhadi M.; Mostafa M.; Eljizoly O.; Musa A.; Abdallah M.; Fakhri G.; Ahmed A.; Mohammed A.; Kollind M.; Marchesi S.; Aldirani A.; Almahjaa A.; Abdulkareem M.; Kallas E.; Alfandi A.; Hejazi A.; Alnaser B.; Alnaser A.; Sandouk J.; Sara S.; Ballan K.; Joha H.; Kassis S.; Abboud W.; Ahmad M.; Hamdan A.; Chandacham K.; Jirapongcharoenlap T.; Chotirosniramit N.; Trigui R.; Gaidi O.; Saidani A.; Belhaj A.; Zebda H.; Menif A.; Khelili R.; Bayir C.; Acar O.; Bozlakoglu E.; Yavuz E.; Alici G.; Meric S.; Bugdayci N.; Sayar A.; Ergin A.; Saylar A.; Barcin A.; Altinel Y.; Gulcicek O.; Cakir O.; Ozsahin H.; Ersavas C.; Aydogdu G.K.; Saracoglu K.; Dundar N.; Eyuboglu K.; Tekcan R.; Bodur M.; Aktas M.; Erdem B.; Calik A.; Kodalak A.; Oruc A.; Usta M.; Alkas B.; Rahimi M.; Cekic A.; Pehlivan D.; Rizaoglu I.; Mwinyi A.; Canakci B.; Shehada M.; Topaloglu S.; Karaaslan A.; Ercan G.; Poyrazoglu Y.; Cuhadar M.; Ozkan O.; Agcabay R.; Tuncer G.; Farsak S.; Tugmen C.; Polat N.; Kebapci E.; Yildirim M.; Goret N.; Gundal M.; Unlu S.; Tekel E.; Ozpek A.; Tosun H.; Yesilova B.; Dikmen K.; Gobut H.; Yavuz A.; Zeren S.; Sonmez Y.; Gulsen T.; Zenciroglu M.; Kyrylo P.; Kostiantyn P.; Ivan P.; Orchard P.; Fyfe J.; Dowell H.; Braun O.; Creed M.; Strong P.; Sweeney F.; Mitchell N.; McClure I.; Parry D.; Gbadegesin O.; CarringtonWindo E.; McKenna M.; Mundell S.; Hall L.; Gasson S.; Crudge E.; Eglinton A.; Davenport R.; Vulliamy P.; Perkins Z.B.; Ugas O.; Holt L.; Jenkinson H.; Tan J.; Ramsay G.; Adepoju O.; Cummine R.; Tariq S.; Mohammad A.; Wilson L.; Musbahi A.; Coates R.; Horne S.J.; Preda N.; Luvisetto F.; Zhang Z.; Saqib I.; Matzakanis G.; Pearce P.; SanchezThompson N.; Scurr C.; Bernstein A.; Gonsalves M.S.; HoqueUddin M.S.; Abbott I.; Dada O.; Jamil S.; Read H.; Horner D.; Doonan R.; Stafford A.; Battle C.; Thavayogan R.; Quinn O.; Powar M.; Ling S.; Gourgiotis S.; Shinwari H.; Mohandas S.; Eldoadoa M.; Ismail R.; Melia G.; Gandhi N.; Blackburn L.; Merchant T.; Robinson J.; Mackie S.; Wong Y.S.; Lee Q.; Moris D.; Nicholson C.P.; Provencher S.; Cook J.; Baltazar G.; CorderoBermudez K.; Walker L.E.; Abou Chaar M.K.; Koch R.; Faktor K.; Chang A.; Englert Z.; Kyaw C.; Pirozzi N.; Moko L.; Chernock B.; Marshall E.; Gellings J.A.; Krizo J.; Molinari J.; Hancin E.; Armento I.; Hu P.; Uhlich R.; Barnes E.; Rawal A.; Falade O.; Nishijima D.; Leshikar D.; Delgado E.; Al Wageeh S.; Al Yafrosi A.; Minthor L.; Cardelli S.; Chiew Meng W.; Johan S.; Ihedoro I.E.; Waryah A.M.; Chavez D.; Manivannan T.; Abdalla M.A.M.; Itaimi A.; Uprak T.K.; Ulusahin M.; Riley C.V.; Hussein H.; Nicol,L.
    Background Haemorrhage remains the leading cause of death in patients with abdominal trauma. However, variation remains globally in the standards of transfusion practice. The aim of this study was to characterise global pre-operative transfusion practices for patients undergoing trauma laparotomy and identify any associations between transfusion strategies and mortality.MethodsThis was a planned secondary analysis of the Global Outcomes After Laparotomy for Trauma (GOAL-Trauma) study, an international multicentre prospective observational study conducted at 187 hospital centres across 51 countries. Patients of any age with a blunt or penetrating traumatic injury who underwent a laparotomy within 5 days of presentation were eligible. Patients were excluded if they were undergoing a repeat laparotomy at the recruiting centre within 30 days of the index procedure. Eligible participants were recruited between April 1, 2024, and Dec 31, 2024 during select 30-day periods and were followed up until discharge, death, or 30 days post-operatively (if still hospitalised), whichever came first. Pre-operative blood product usage was recorded from time of injury until index procedure. Countries were stratified by Human Development Index (HDI) and the primary outcome was post-operative in-hospital 30-day mortality. Comparative regression analyses between blood component groups were performed, comparing high versus low transfusion ratios of fresh frozen plasma (FFP) to packed red blood cells (PRBC). The GOAL-Trauma study was registered with ClinicalTrials.gov, NCT06180668.FindingsOverall, 721 (40.8%) of 1768 patients received any type of pre-operative blood product. Those in the upper HDI tertile received the highest proportions of blood components, across PRBC, FFP, and platelets (p < 0.0001). Whole blood usage was nearly double in the lower HDI tertile compared to middle and upper HDI tertiles (p < 0.0001). Tranexamic acid use was low across all HDI tertiles (529 of 1768 patients, 29.9%). No difference in overall 30-day post-operative mortality risk was observed between those in the high-ratio and low-ratio FFP:PRBC cohorts (OR = 1.52, CI: 0.89-2.64).InterpretationOur findings show significant disparity in the usage of pre-operative blood products for trauma patients globally. With ongoing equipoise regarding the optimum balance of blood products for pre-operative resuscitation in trauma, this work informs future research to support the development of global guidelines for blood transfusion practices in trauma and highlights the need for reciprocal learning across income settings.FundingRoyal College of Surgeons Ratanji Dalal Research Fellowship and the Engineering and Physical Sciences Research Council. Copyright © 2026 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/
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    Wearable cardioverter-defibrillator in patients with non-ischaemic cardiomyopathy: a meta-analysis.
    Providencia R.; Salih A.; Aidelsburger P.; Elayi C.S.; Narayanan K.; Piot O.; Casolo G.; Metra M.; Boveda S.; Marijon E.; Duncker, D.
    BACKGROUND: Optimisation of medical therapy is recommended for patients with newly diagnosed non-ischaemic cardiomyopathies (NICM) before consideration of a primary preventive implantable cardioverter-defibrillator (ICD). During this optimisation period, patients face a potentially elevated risk for sudden cardiac death (SCD) that can be countered with a wearable cardioverter-defibrillator (WCD). This systematic review aims to assess the risk for SCD in patients with newly diagnosed NICM. METHOD(S): A systematic review was performed in Medline, Embase and Cochrane Library last updated on March 2025. Studies with patients aged >=18 years with newly diagnosed NICM (<=90 days) who were recipients of WCD were included. Study selection, study quality assessment and data extraction were performed by two reviewers independently. Data on percentage of patients with appropriate WCD shocks (as proxy for sustained ventricular arrhythmia, potentially leading to SCD), inappropriate WCD shocks and device implantation were pooled by random-effects model. RESULT(S): 50 non-controlled observational studies were included, comprising a total of 10 066 patients with NICM. The percentage of appropriate shocks was 1% (87/7708; 95% CI 1% to 2%) in patients with NICM, 2% (16/1049; 95% CI 1% to 2%) in patients with myocarditis, 3% (7/183; 95% CI 0% to 20%) in peripartum cardiomyopathy, 2% (2/102; 95% CI 0% to 7%) in Takotsubo syndrome and 1% (8/594; 95% CI 1% to 3%) for congenital/inherited or genetic cardiomyopathy. Inappropriate shocks ranged from 0% to 1%. At the end of follow-up, between 6% (Takotsubo syndrome) and 43% (congenital/inherited or genetic cardiomyopathy) of patients received an ICD. CONCLUSION(S): Patients with NICM face a significant risk of SCD during the drug optimisation period before deciding if they qualify for ICD implantation. Results of this meta-analysis are based on non-comparative studies; however, the assessment of an appropriate shock delivered and recorded by the WCD is highly reliable. PROSPERO REGISTRATION NUMBER: CRD42024555879. Copyright © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.
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    Using Statistical Process Control through the Making Data Count approach to visualise data in NHS Trusts: a mixed-methods study.
    Kroll N.; Potts, H. W. W.
    IntroductionEnglish National Health Service (NHS) Trust Hospital board members are collectively responsible for ensuring high-quality care and organisational performance. Integrated performance reports support boards by tracking key performance indicators, supporting quality improvement and providing assurance to NHS England. Statistical Process Control (SPC) charts can support leaders to distinguish signals (special cause variation) from natural fluctuations in data (common cause variation). The Making Data Count (MDC) Programme has effectively increased the use of SPC methodology in NHS Trusts. This study explored board members' experiences of MDC and SPC, and SPC use in public board meetings.Methods14 semistructured interviews were conducted with executive directors and non-executive directors across five NHS Trusts. 13 board meetings were observed, and quantitative data were coded and extracted to evaluate if SPC outputs supported assurance and decision-making.ResultsBoard members generally expressed positive views towards the MDC Programme and SPC, recognising their value as a supporting tool to monitor interventions, guide investigations and highlight performance issues. Board members noted insufficient training and instances of inappropriate use or overuse of SPC charts. The observations showed that of the 99 statements made by board members, 71 (72%, 95% CI 62% to 88%) were supported by a relevant SPC chart. Unsupported or unverifiable claims made by executive directors were more likely to be statements of improvement (p=0.054). Six decisions were made for further investigative work, and all six were supported by an SPC chart.ConclusionsMDC SPC charts are seen as a helpful tool, and their outputs are used reasonably effectively in a board environment. However, consistent and repetitive training is necessary to optimise SPC use and prevent misuse or overuse. Training may only partially prevent misuse of SPC charts due to managers' tendency to try to demonstrate improvement to other staff members. Copyright © Author(s) (or their employer(s)) 2026. No commercial re-use. See rights and permissions. Published by BMJ Group.
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