Healthcare systems around the world are facing a plethora of new pressures; most notably, an increase in chronic and more complex diseases such as cardiovascular disease (CVD), the leading cause of mortality globally (1). As healthcare shifts away from population-based care to more patient-centered approaches, there is also a concomitant shift in the management of disease processes. One aspect is a greater emphasis on precision medicine: an emerging healthcare model that factors in individual variability in genes, environment and lifestyles, of particular relevance in CVD (2,3). This is important given the current climate in cardiovascular medicine where we generate enormous amounts of heterogenous data, including 'omics' data (genomics, proteomics etc.), high resolution medical imaging data, biosensors, wearables, continuous physiologic metrics and electronic health records (EHR) (4) (Figure 1).

Background An ageing population has resulted in a rise in the number of hip and knee replacement surgeries in the UK. The pre-operative pathway is plagued with issues causing long delays and cancellations. Virtual healthcare technologies have a growing evidence base to help solve these issues. One problem of implementing these technologies is the resistance to change mentality from healthcare professionals. By getting their opinions on the place of these technologies within the pre-operative pathway, a united front can be formed to help deliver change. Methods Sixteen semi-structured interviews were conducted with key stakeholders within the orthopaedic pre-operative pathway at Imperial College Healthcare NHS Trust. General topics included the different technologies that could be used within the pathway, their uses and associated benefits and problems. Interviews were audio-recorded, before being manually transcribed and then analysed to form categories and themes. Results Various uses, benefits and problems were identified by healthcare professionals for each modality of technology. E-forms were seen as a high reward, low-risk intervention. Remote patient monitoring and teleconsultations had their bonuses, but feasibility was a primary concern. Web-based interventions were seen as an intervention of the past, whereas virtual reality was seen as perhaps being ahead of its time. M-health was very positively viewed due to its all-encompassing nature. Digital illiteracy emerged as a consistent problem for most technologies. Conclusions Current literature, the results from this study and technology trends within society highlight both M-health and E-forms as the 2 most promising virtual healthcare technologies for use in the pre-operative pathway for orthopaedics. Areas such as pre-operative assessment, triaging and prehabilitation are prime candidates for virtual intervention. Future research should also consider including patient opinions on any proposed interventions, as well as taking into account barriers to implementation.

Objectives: Despite the benefits of rapid deployment aortic valve prostheses (RDAVR), conventional sutured valves (cAVR) are more commonly used in the treatment for aortic stenosis. Given the paucity of randomized studies, this study aimed to synthesize available data to compare both treatment options. Methods: A systematic search of Pubmed, OVID, and MEDLINE was conducted to retrieve comparative studies for RDAVR versus cAVR in the treatment of aortic stenosis. Out of 1773 returned titles, 35 papers were used in the final analysis, including 1 randomized study, 1 registry study, 6 propensity-matched studies, and 28 observational studies, incorporating a total of 10,381 participants (RDAVR n = 3686; cAVR n = 6310). Results: Random-effects meta-analysis found no difference between the two treatment groups in terms of operative mortality, stroke, or bleeding (p > .05). The RDAVR group had reduced cardiopulmonary bypass (standardized mean difference [SMD]: −1.28, 95% confidence interval [CI]: [−1.35, −1.20], p < .001) and cross-clamp times (SMD: −1.05, 95% CI: [−1.12, −0.98], p < .001). Length of stay in the intensive care unit was also shorter in the RDAVR group (SMD: −0.385, 95% CI: [−0.679, −0.092], p = .010). The risk of pacemaker insertion was higher for RDAVR (odds ratio [OR]: 2.41, 95% CI: [1.92, 3.01], p < .001) as was the risk of paravalvular leak (PVL) at midterm follow-up (OR: 2.52, 95% CI: [1.32, 4.79], p = .005). Effective orifice area and transvalvular gradient were more favorable in RDAVR patients (p > .05).Conclusions: Despite the benefits of RDAVR in terms of reduced operative time and enhanced recovery, the risk of pacemaker insertion and midterm PVL remains a significant cause for concern.

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The NHS faces challenges today that it was not designed to tackle at its conception in 1948. The UK demographic has changed considerably with higher life expectancy and 'an ageing population'. Keeping this demographic healthy through prevention and management of age-related degeneration is crucial to their independence and improving resource utilisation. The Department of Health and Social Care's agenda for digital transformation of the NHS is facilitating a move towards preventative healthcare and greater community care, which will likely be supported by virtual healthcare delivery models. Despite views on digital illiteracy in the older population, this demographic may stand to benefit the most. Research has shown that the older demographic adopts technology in line with the technology acceptance model if their needs are carefully considered. Executed successfully, the deployment of virtual healthcare could save transformational costs to the NHS and support better quality of life for the senior members of society. This is particularly relevant in the current COVID-19 pandemic with patients facing challenges in accessing outpatient appointments. With many hospitals kickstarting virtual outpatient clinics to ensure continuity of care during a time of social isolation; we await to see the ingenuities that arise from the current pandemic.