Acute symptoms stop everything
Central chest pain with radiation, breathlessness at rest, syncope, palpitations with collapse, post-procedure bleeding. Any of these ends the script, produces emergency advice and pages the on-call cardiologist.
Specialty · Cardiology
Chest pain triaged in seconds, everything else handled properly.
Acute symptom triage, anticoagulation monitoring, device follow-up, titration calls and pre-procedure preparation — with the cardiac red flags evaluated on every single contact.
- < 45s
- Chest pain to emergency pathway
- 91%
- INR checks completed on schedule
- 3.1x
- More titration contacts per nurse
In the product
Cardiac line — anticoagulation call
EscalatedInbound 10:18 · Brendan S. · 69 · warfarin, AF · last INR 2.6 (14 days)
Caller
I'm ringing with my INR from this morning, it's 2.9. Also my left leg has been sore since Sunday and I'm a bit puffed going up the stairs.
Red flag: unilateral leg pain + exertional dyspnoea on anticoagulation → PE pathway
Primum
Thank you for mentioning the leg. I need you to treat that as urgent. Are you short of breath sitting still, or only on the stairs?
Caller
Only on the stairs so far.
Primum
I'm arranging an urgent assessment today and the cardiac registrar is being paged now. If you become breathless at rest or get chest pain, call 999.
Cardiac record
- INR today
- 2.9 · in range
- Presenting
- Unilateral leg pain, exertional dyspnoea
- Red flag
- Suspected PE — pathway C
- Escalated to
- Cardiac registrar, paged 10:20
- Warfarin
- Continue current dose
- Next INR
- Deferred to assessment
Urgent assessment booked 11:30 · chart updated · registrar acknowledged
Overview
In cardiology, the triage question is never 'how urgent'. It is 'is it now'.
- Acute coronary and arrhythmia red flags evaluated on every call, regardless of stated reason.
- Anticoagulation, device and heart-failure programmes run on schedule rather than on capacity.
- Pre-procedure instructions spoken, texted and confirmed — including what to stop and when.
A cardiology line carries two completely different kinds of call on the same number. One is a patient describing the beginning of an infarct. The other is a patient asking whether they can take their apixaban before a dental extraction. Both matter, but only one of them can wait, and the cost of confusing them is measured in muscle.
Primum evaluates the cardiac red-flag set on every contact, whatever the caller thinks the call is about, and escalates the moment one fires. Everything else — INR results and dose adjustments, remote device transmissions, heart-failure weight checks, titration after a medication change, pre-procedure instructions — is worked to completion against the protocol and written back to the chart.
Capabilities
The four programmes that consume a cardiology nurse's week
High volume, strictly protocolised, and almost entirely phone-based. Which is exactly what this is for.
Anticoagulation, on schedule
INR results collected, dose adjusted against your own algorithm, the next test booked, and interacting medicines and missed doses surfaced. Out-of-range results route to a clinician with the trend attached.
Device and heart-failure follow-up
Pacemaker and ICD transmission reminders, symptom checks around alerts, and daily weight and symptom capture for heart failure — with escalation thresholds applied to the trend, not just to the day's number.
Titration calls that happen
Beta blocker, ACE inhibitor and diuretic titration after a change: tolerability, blood pressure, heart rate, dizziness and renal monitoring, with the next step proposed against the protocol.
How it works
Every cardiology contact, same first check
The red-flag evaluation runs before, during and after whatever the call was supposed to be about.
- Arrives
- Decided
- Done
- Returned
01
Contact opens
Patient matched, with the cardiac problem list, devices, anticoagulation status and recent procedures loaded before the first question.
Cardiac context loaded
02
Red flags evaluated
The acute set is checked on every turn, whatever the caller says the call is about. A positive finding ends the script immediately.
ACS / arrhythmia set
03
Programme worked
INR and dose, device transmission, weight and symptom trend, or titration step — carried out against your protocol and verified before anything is written.
Protocol + AHR
04
Written and scheduled
Chart updated, the next test or transmission booked, the patient told what changed, and any out-of-range finding routed to the cardiac nurse.
Chart write-back
01
Contact opens
Patient matched, with the cardiac problem list, devices, anticoagulation status and recent procedures loaded before the first question.
Cardiac context loaded
02
Red flags evaluated
The acute set is checked on every turn, whatever the caller says the call is about. A positive finding ends the script immediately.
ACS / arrhythmia set
03
Programme worked
INR and dose, device transmission, weight and symptom trend, or titration step — carried out against your protocol and verified before anything is written.
Protocol + AHR
04
Written and scheduled
Chart updated, the next test or transmission booked, the patient told what changed, and any out-of-range finding routed to the cardiac nurse.
Chart write-back
Benefits
Programme adherence stops depending on staffing
Cardiology's structured follow-up is where the outcomes are, and it is the first thing to slip when the clinic is busy.
Nobody falls off the schedule
INR checks, device transmissions and titration calls happen when the protocol says, not when somebody has an afternoon free.
Deterioration is seen earlier
A three-kilogram weight gain over four days is an escalation, not a data point. Trends are evaluated on every capture rather than at the next clinic.
Procedures are not cancelled at the door
Anticoagulant holds, fasting and escort requirements confirmed and reconfirmed, which removes the most common reason a cath lab slot is lost.
In practice
Four calls to the cardiac line
Two of them arrived believing they were routine.
'Just checking my INR'
Escalated in 40sThe caller mentions calf pain and breathlessness in passing. Red flags fire, emergency advice is given, and the on-call is paged.
INR 4.8
Held, retest in 2 daysDose held under the algorithm, bleeding risk questions asked and negative, retest booked, and the result routed to the anticoagulation nurse.
Heart failure, +3.2kg in 4 days
Same-day reviewWeight trend crosses threshold with increasing orthopnoea. Diuretic advice given from the protocol and a same-day review booked.
Dental extraction next week
Resolved on callApixaban timing confirmed against the procedure and the patient's renal function, with written instructions sent to both patient and dentist.
Read next
- Primary CareTriage, booking, refills, results, chronic disease reviews and recalls — the complete administrative and first-contact workload of a general practice, running on one layer.Open
- Medication RefillRepeat prescription requests taken on any channel, checked against the chart for monitoring, interactions and quantity, and sent to the prescriber as a decision — or straight to the pharmacy where your protocol allows it.Open
- Intelligent Triage & RoutingClinical triage against your own protocol, applied to every inbound contact — phone, portal message or web form — and routed to the pathway, the team and the timeframe your policy says it belongs in.Open
Start with the anticoagulation list
It is the highest-volume, most protocolised work in the clinic and the easiest to measure. Give us a month of it and we will show you the adherence rate, the out-of-range escalations, and the calls that would have been caught earlier.