Glenfield Cardiology Walks Back ANP ‘Lead Operator’ Tweet

Glenfield Cardiology, the world-renowned cardiology department at the center of a controversy over whether advanced nurse practitioners (ANPs) should be taking the lead in TAVI procedures has finally spoken up about its now-deleted tweet.

By issuing more tweets.

University Hospitals Leicester (UHL), of which Glenfield is a part, has not issued a formal statement, although the hospital’s communications department has repeatedly told TCTMD that “senior leadership” is working on a response and wants “to have the most complete possible statement to do justice to such an important development.”

As reported by TCTMD last week, @GHCardiology posted a photo congratulating an ANP for performing a TAVI procedure as first operator—"Momentous day for Glenfield, UHL and the whole world”—then deleted the tweet. Screencaps went viral on #CardioTwitter, touched off a firestorm on Twitter and Reddit, and left professional cardiology societies scrambling to draft their reactions.

Today, the Glenfield Cardiology account tweeted a three-part acknowledgement walking back their original congratulations and stipulating that their “nursing colleague” was not the lead operator: “Last week, a story about a nursing colleague's role in a TAVI procedure was shared from this account. We are aware of and understand the concerns this has raised in the cardiology community. We want to make clear that the lead operator for the procedure was a consultant structural interventionist. However, we are looking into the circumstances, including a review of clinical governance. We regret the public scrutiny a dedicated colleague has faced as a result of our post, and apologise for the upset caused.”

The ANP referred to as “John” in the original tweet has been identified as John Steele, who is also mentioned by name in a December 2022 tweet as “operator & implanter for three core TAVI valve designs.” Steele is the cath lab manager for Glenfield Cardiology, according to a press release issued by UHL in 2019. He’s listed as the author of the Transcatheter Aortic Valve Implantation (TAVI) Standard Operating Procedure (SOP) for UHL Cardiology Cath Labs.

Of note, that SOP does not carve out a role for an ANP as an operator. It expressly specifies that all TAVI procedures involve “a lead cardiologist, a second operator, one valve loader [although two is ‘preferred’], one radiographer, two trained nurses, and one electrophysiologist.” The SOP goes on to say that the second operator be “a consultant or appropriately trained specialist registrar,” both of which are terms that refer to physicians in the UK.

John Steele is listed as a Registered Nurse (Adult) in the Nursing and Midwifery Council (NMC) website, but no advanced degrees are listed in his NMC record (an ANP requires a master’s degree). Asked for confirmation of the ANP’s credentials, the UHL communications manager has said he has passed along the question to senior management.

Reactions and Revised Reactions

Reactions to the controversy run the gamut from support for qualified ANPs learning new skills to accusations that senior leadership, including cardiology leaders, are championing the training of nonphysicians at a time when junior doctors seeking structural training are being turned aside.

The British Cardiovascular Society (BCS) and the British Cardiovascular Intervention Society (BCIS) both issued carefully worded statements to TCTMD last week that seemed to leave a door open for nonphysicians—with the right training—to take leadership roles in complex procedures.

“The BCS supports all cardiovascular healthcare workers to deliver the best care to their patients, whether this be physicians, allied health professionals, or clinical scientists,” the BCS statement read. “Cardiology has always been at the frontier of new models of healthcare delivery and new device therapies to ultimately improve patient symptoms and quality of life.”

The BCIS statement was similarly cautious, stating: “ANP involvement in TAVI should be seen as complementary rather than competitive with trainees. As medicine has changed so there has increasingly been a role for advanced nurse practitioners to take on responsibilities that were previously considered to be the domain of doctors.”

Of note, however, BCIS issued a public statement today containing much of the same language provided to TCTMD, but with the addition of some sterner wording, including the reminder that TAVI procedures “carry a mortality” risk. The word “cardiologist” supplants the word “physician” as the person responsible for TAVI procedures, and there’s now mention of “various” complications that can arise during or after the interventions.

Also added to the BCIS statement: “Cardiology trainees have the full support of BCIS as regards their career aspirations.” This is a nod, perhaps, to the concerns of junior doctors who waded into the fray with the reminder to their peers and senior colleagues that amid all the other things they for which they have been fighting (and striking) are the declining career opportunities and deteriorating quality in training.

A flurry of new tweets by the British Junior Cardiologists’ Association calls out hospitals for failing to prove that they are providing safe, high-quality training environments—the Glenfield Cardiology fracas being a key example. “Training has consistently been shown to be [reducing] in quality and quantity,” one tweet reads. “We have highlighted this issue repeatedly using @TheBJCA survey data. . . . We are raising this specific issue with @bcis and @BritishCardioSo and expect them to support trainees obtain the required training opportunities to become the highly trained cardiology consultants that the UK needs and deserves.”