Angiotensin-converting enzyme inhibitors (ACE-Is) are a class of drug used after a heart attack and other causes of the heart muscle to weaken, to treat and prevent heart failure. They stop the body’s ability to produce angiotensin II, a hormone which causes blood vessels to contract, thus dilating blood vessels and increasing the supply of blood and oxygen to the heart.


Acute coronary syndrome covers all episodes that result from sudden and spontaneous blockage or near blockage of a coronary artery, including heart attack and unstable angina.


Atrial fibrillation – a heart condition that causes an irregular and often abnormally fast heart rate. A normal heart rate should be regular and between 60 and 100 beats a minute when you’re resting. In atrial fibrillation, the heart rate is irregular and can sometimes be very fast. In some cases, it can be considerably higher than 100 beats a minute.


Angiogram – an X-ray investigation performed under a local anaesthetic that produces images of the flow of blood within an artery (in this case the coronary artery). Narrowing and complete blockages within the arteries can be identified and this allows decisions to be made regarding treatment, such as primary percutaneous coronary intervention or coronary artery bypass grafting.


Angiography – the technique of producing angiograms.

Aortic Stenosis

Aortic stenosis – one of the most common and most serious valve disease problems. Aortic stenosis is a narrowing of the aortic valve opening and restricts the blood flow from the left ventricle to the aorta. It may also affect the pressure in the left atrium. The condition mainly develops during aging as calcium or scarring damages the valve and restricts the amount of blood flowing through the valve.


Angiotensin II receptor antagonist/angiotensin receptor blocker. ARBs are a group of medicines usually prescribed for those patients who are intolerant of ACE inhibitors. Rather than lowering levels of angiotensin II, they instead prevent the chemical from having any effect on blood vessels.

Angina covers symptoms of chest pain that occur when narrowing of the coronary arteries prevent enough oxygen containing blood reaching the heart muscle when its demands are high, such as during exercise.


Atherosclerosis – a process where the walls of the arteries develop fatty deposits called atheroma.

Atrial Fibrillation

Atrial Fibrillation (AF) is a common abnormal heart rhythm that happens when electrical impulses fire off from different places in the atria (the top chambers of the heart) in a disorganised way. This causes the atria to twitch, and is felt as an irregular heartbeat or pulse.



BB – Beta blockers are a group of medicines which slow the heart rate, decrease cardiac output and lessen the force of heart muscle and blood vessel contractions. They are used to treat abnormal or irregular heart rhythms, and abnormally fast heart rates, help prevent attacks of angina and are a key treatment for patients with heart failure.


BCCA – British Congenital Cardiac Association.


British Cardiovascular Intervention Society.


British Cardiovascular Society.


British Heart Rhythm Society.


Bare metal stents are stents without a coating or covering. They are made of a mesh-like tube of thin wire.


British Society for Heart Failure.


Cardiac Rehabilitation

A programme of exercise and information sessions designed to help patients who have had a heart attack and reduce their risk of a further heart event.

Cardiogenic Shock

This occurs if the heart suddenly can’t pump enough oxygen-rich blood to the body. The most common cause of cardiogenic shock is damage to the heart muscle from a severe heart attack.

Case Mix

Refers to the different types of patients treated by a hospital or an operator.


Central Cardiac Audit Database.


Clinical Commissioning Groups commission healthcare services for patients registered amongst their constituent GP Practices. They manage primary care commissioning and are responsible for commissioning healthcare including urgent and emergency care and elective hospital services.


Coronary heart disease is a group of diseases that includes stable and unstable angina, myocardial infarction and sudden coronary death. It results from the narrowing or blockage of the coronary arteries, usually caused by atherosclerosis.


Clinical Outcomes Publication. COP is an NHS England initiative, managed by the Healthcare Quality Improvement Partnership (HQIP), to publish quality measures at the level of individual consultant doctors.


Clinical Practice Research Datalink


Cardiac resynchronisation therapy is also known as biventricular pacing, and aims to improve the heart’s pumping efficiency by making the chambers of the heart pump together. 25-50% of all heart failure patients have hearts whose walls do not contract simultaneously. CRT involves implanting a CRT pacemaker or ICD (implantable cardioverter-defibrillator) that has a lead positioned in each ventricle. Most devices also include a third lead which is positioned in the right atrium to ensure that the atria and ventricles contract together.


Cardiac resynchronisation therapy with defibrillator.


Cardiac resynchronisation therapy with pacemaker function only.


Call to balloon time in heart attack treatment, is the interval between the call for help to the emergency service and the beginning of the PCI procedure. It is an expression of the overall response of the health care system.


Call to Door in heart attack treatment, is the interval between the call for help to the emergency service and the time the ambulance stops outside the hospital; an expression of the ambulance service response including the prioritisation of the call, the ambulance response time, the diagnosis and treatment at scene and the transport time.


Chronic total occlusions – complete or almost complete blockage of a coronary artery for 3 months or more. Coronary CTO is caused by a heavy build-up of atherosclerotic plaque within the artery.


Cerebrovascular accident is the medical term for a stroke. A stroke is when blood flow to a part of your brain is stopped either by a blockage or the rupture of a blood vessel.


Cardiovascular disease is a general term for conditions affecting the heart or blood vessels. It’s usually associated with a build-up of fatty deposits inside the arteries – known as atherosclerosis – and an increased risk of blood clots. There are different types of CVD including coronary heart disease and other causes of heart damage such as valve disease.



Drug-eluting stents are metal stents that have been coated with a pharmacologic agent (drug) that is known to suppress restenosis: the reblocking or closing up of an artery after angioplasty due to excess tissue growth inside or at the edge of the stent.


A group of medicines which help to remove extra fluid from the body by increasing the amount of water passed through the kidneys. Loop diuretics are often used in heart failure patients to ease symptoms of oedema and breathlessness.


Door to balloon time – In heart attack treatment– the interval between the time the ambulance stops outside the hospital (or the patient ‘self-presents’ at the hospital) and the beginning of the PCI procedure. This is an expression of the ‘hospital’ response, though the performance of an ECG before arrival at hospital and early warning by the ambulance service can alert the receiving hospital and so reduce this interval.



Echocardiography is a diagnostic test which uses ultrasound to create two dimensional images of the heart. This allows clinicians to examine the size of the chambers of the heart and its pumping function in detail, as well as examine valves and the myocardium (heart muscle).


Ejection fraction. The left ventricle is the heart’s main pumping chamber that pumps oxygenated blood through the ascending (upward) aorta to the rest of the body, so ejection fraction is usually measured only in the left ventricle (LV). An LV ejection fraction of 55 percent or higher is considered normal.

Elective Patients or Elective Surgery or Procedure

Elective patients or Elective surgery or procedure – surgery that is scheduled in advance because it does not involve a medical emergency. A stable condition is one in which the condition of the patient is not expected to change in the near future.


European Society of Cardiology is a professional association for cardiologists across Europe, which aims to facilitate improved diagnosis and treatment of cardiovascular disease in Europe. It runs numerous education and training events, and edits and publishes nine journals on cardiology. The ESC has produced numerous Clinical Practice Guidelines, which the audit uses, along with NICE guidance, as a benchmark for good practice.



Hospital episode statistics. Hospital Episode Statistics (HES) is a database containing details of all admissions, A and E attendances and outpatient appointments at NHS hospitals in England. Initially these data are collected during a patient’s time at hospital as part of the Commissioning Data Set (CDS). This is submitted to NHS Digital for processing and is returned to healthcare providers as the Secondary Uses Service (SUS) data set and includes information relating to payment for activity undertaken. It allows hospitals to be paid for the care they deliver. This same data can also be processed and used for non-clinical purposes, such as research and planning health services. Because these uses are not to do with direct patient care, they are called ‘secondary uses’.


Heart failure is a syndrome characterised by the reduced ability of the heart to pump blood around the body, caused by structural or functional cardiac abnormalities. The condition is characterised by symptoms such as shortness of breath and fatigue, and signs such as fluid retention. Acute heart failure (AHF) refers to the rapid onset of the symptoms and signs of heart failure, often resulting in a hospitalisation, and more common with a first presentation. Chronic heart failure (CHF) describes more stable symptoms, often following effective treatment for acute heart failure, or a more insidious deterioration, where the slow development of symptoms can more easily be missed. People with heart failure are characterised by periods of stability (CHF) when at best they are rendered asymptomatic, and a susceptibility to acute deteriorations or episodes of AHF. Effective treatment of the underlying cause and regular informed review will minimise or even abolish these episodes.


Heart failure with preserved ejection fraction. Heart failure can occur with impaired filling of the left ventricle when the heart muscle is thickened, often as a result of long standing high blood pressure.


Heart failure with reduced ejection fraction is the most common type of HF due to left ventricular systolic dysfunction, where there is impaired contraction of the left ventricle.


Hypoplastic left heart syndrome is a birth defect that affects normal blood flow through the heart. As the baby develops during pregnancy, the left side of the heart does not form correctly. Hypoplastic left heart syndrome is one type of congenital heart defect.


Healthcare Quality Improvement Partnership (HQIP) was established in April 2008 to promote quality in healthcare, and in particular to increase the impact that clinical audit has on healthcare quality improvement. HQIP is an independent organisation led by the Academy of Medical Royal Colleges, The Royal College of Nursing and National Voices.



An implantable cardioverter defibrillator is a small device that’s placed in the chest or abdomen. Doctors use the device to help treat irregular heartbeats called arrhythmias.

Interventional Centre

A hospital equipped with catheter laboratories and trained staff to perform percutaneous coronary interventions, (normally available around the clock). An interventional centre is also known as a Heart Attack Centre or PCI hospital.



Lesions – build-up of atheromatous debris on the internal walls of the artery that can be stable and unstable.



Myocardial Ischaemia National Audit Project (MINAP) is a national clinical audit of the management of heart attacks.


Mineralocorticoid receptor antagonists are a group of diuretic medicines, whose main action is to block the response to the hormone aldosterone, which promotes the retention of salt and the loss of potassium and magnesium. MRAs increase urination, reduce water and salt, and retain potassium. They help to lower blood pressure and increase the pumping ability of the heart.



National Audit of Cardiac Rhythm Management


National Adult Cardiac Surgery Audit.


National Audit of Percutaneous Coronary Intervention.


National Cardiac Audit Programme.


National Congenital Heart Disease Audit.


National Heart Failure Audit.


National Health Service.


National Health Service Blood and Transfusion.


National Infarct Angioplasty Project was a feasibility study looking at how far primary angioplasty can be rolled out as the main treatment for heart attack in place of clot-busting drugs.


The National Institute for Health and Care Excellence is the official body in England which provides national guidance and advice to improve health and social care.


National Institute for Cardiovascular Outcomes Research.


National Service Framework was published in 2000 and was a 10 year strategy setting quality standards for coronary heart disease care, aiming to reduce coronary heart disease and stroke related deaths.


Non ST elevation myocardial infarction is a heart attack that occurs without ST segment elevation on the ECG. It usually means a coronary artery is partly blocked, so emergency treatment to restore the blood flow may not be needed, but the long-term prognosis is actually worse than for STEMI.



Percutaneous coronary intervention is a technique to re-open a blocked coronary artery, also called angioplasty. Primary PCI means it is carried out as an emergency treatment for a heart attack, in which case it must be performed as soon as possible after the STEMI is diagnosed to prevent loss of a heart muscle.


A pacemaker is a small electrical device used to treat some abnormal heart rhythms.


Primary Percutaneous coronary intervention (PPCI) is also known as primary angioplasty. It is used as an emergency treatment for patients who have had a heart attack.


Partial Risk Adjustment in Surgery 2 model.


Percutaneous transluminal coronary angioplasty is also known as angioplasty and is a procedure used to treat the narrowed coronary arteries of the heart and angina in patients. Nowadays, the expression PCI is used.



A randomised controlled trial is a type of scientific (often medical) experiment which aims to reduce bias when testing a new treatment.


Reperfusion – the treatment that improves the blood supply to the heart, including PCI or thrombolysis, when a vessel has been suddenly blocked by a blood clot.


Revascularisation is the restoration of perfusion (blood flow) to a body part or organ that has suffered ischemia (inadequate blood supply). Cardiac surgery and angioplasty are the two primary means of revascularisation.



Society for Cardiothoracic Surgery in Great Britain and Ireland.


Sinus node disease, also called sinus dysfunction, or sinoatrial node disease is a group of abnormal heart rhythms (arrhythmias) caused by a malfunction of the sinus node, the heart’s primary pacemaker.


ST-Elevation Myocardial Infarction

A heart attack characterised by a specific abnormal appearance on the ECG (ST-segment elevation) which usually means a coronary artery is completely blocked.


Metal mesh tubes used to open up a narrowed or blocked coronary artery to restore blood flow to the heart.



Transcatheter aortic valve implantation is a non-surgical alternative to open heart surgery to replace the aortic valve.

Tertiary Centre

A hospital that provides tertiary care, which is health care from specialists with specific expertise in a given field, in a large hospital after referral from primary care and secondary care. All major paediatric heart surgery, electrophysiology and most new transcatheter procedures are undertaken at tertiary centres.


Transposition of the Great Arteries is a condition characterised by the aorta arising from the right ventricle and the pulmonary artery from the left ventricle, and it is often associated with other cardiac abnormalities (e.g. ventricular septal defect). Newborns with transposed great arteries are very likely to die without an arterial switch operation. The operation, as the name implies, involves switching the aorta and pulmonary arteries back to their correct positions.


An intravenous medication used to break down a clot in a coronary artery to restore the blood flow to the heart. Formerly the standard treatment for STEMI but now primary PCI is preferred as it is more effective.


Unstable Angina

A sudden episode of chest pain, caused by a lack of oxygen supply to the heart, which is unpredictable and can occur when the patient is at rest. It is a type of acute coronary syndrome and should be treated as an emergency.