The distance is the first thing Declan Keane mentions, before the diagnosis and before the surgery. Two hours each way, and the cattle do not know you have had a heart attack.
The shared-care clinic puts a specialist on a scheduled video link into the local practice, with the practice nurse physically in the room and the monitoring data already on screen.
Risk factor work is unglamorous and continues indefinitely. It is also, by a wide margin, the part of the pathway with the most evidence behind it.
We lose more people to missed follow-up than to the event itself. Not dramatically. Slowly.
Illustrative composite
Acute care was never the weak point. The ambulance was fast, the intervention was routine, and discharge came in five days. What almost failed was everything after.
“Everyone tells you about the operation,” he says. “Nobody tells you the operation is the short part.”
