For people at risk of, or with suspected or definite cardiac disease, access to healthcare services is by a variety of routes: 

  • Primary care – for prevention, first assessment of non-emergency symptoms and chronic disease management
  • Emergency departments/local ambulance services (LAS) – for suspected cardiac chest pain, disabling arrhythmias, including those associated with loss of consciousness, severe dyspnoea
  • Secondary care – for assessment and management of new and worsening cardiac disease both acute and chronic. Acute medical admitting hospitals should have a high dependency area (cardiac care unit or high-dependency unit) for acutely unwell cases
  • Secondary/tertiary care – although many secondary care hospitals have cardiac catheter laboratories, tertiary units tend to have more facilities. Heart attack centres offer 24-hour primary PCI. Tertiary units also offer services to manage patients with arrhythmias (device implantation and ablation procedures). Many are co-located with cardiothoracic surgical services
  • Quaternary care – subspecialised (quaternary) services exist for patients with congenital heart disease, cardiac transplantation and pulmonary hypertension.