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  • 1. Identifying people with angina who need extra rehabilitation support Dr Carl Bickler
  • 2. How are we doing in Lothian?
  • 3. Angina in Lothian
    • SIGN guideline
    • All post-myocardial infarction and revascularisation patients should receive rehabilitation
    • Lothian
    • All post-myocardial infarction and surgical patients receive a formal rehabilitation programme
  • 4. Angina in Lothian
    • SIGN guideline
    • All new patients with angina should be considered for rehabilitation
    • Lothian
    • Patients having an angioplasty for angina don’t routinely receive rehabilitation
    Programmes exist for angina……. but few are considered
  • 5. Angina in Lothian
    • SIGN guideline
    • All patients with existing CHD who have a step-change in their condition should have their rehabilitation needs assessed
    • Lothian
    • Patients with existing CHD can have their rehabilitation needs met …….
    … ..but are rarely referred
  • 6. So who is missing out?
  • 7. Angina in Lothian
    • new angina patients who are treated by angioplasty
    • new angina patients who are medically managed
    • chronic angina with worsening symptoms
    • patients discharged with unstable angina.
  • 8. Coming soon …
    • NHS QIS clinical standards for CHD –
    • Patients with the following conditions or having had these procedures, who are assessed and identified as needing cardiac rehabilitation, at the time of diagnosis or procedure, are offered a menu-based programme:
        • acute coronary syndrome
        • coronary by-pass surgery (elective and urgent)
        • angioplasty (elective and urgent)
        • patients with new onset or worsening angina who have not had one of the above
        • heart valve surgery
  • 9. Coming soon …
    • NHS QIS clinical standards for CHD –
    • Patients with the following conditions or having had these procedures, who are assessed and identified as needing cardiac rehabilitation, at the time of diagnosis or procedure, are offered a menu-based programme:
        • acute coronary syndrome
        • coronary by-pass surgery (elective and urgent)
        • angioplasty (elective and urgent)
        • patients with new onset or worsening angina who have not had one of the above
        • heart valve surgery
  • 10.
    • The good news is ….
    • We have the infrastructure to provide for all groups
  • 11. Principles of the angina pathway
  • 12. Angina pathway
    • all patients with angina should be given basic written information eg CHSS booklet
    • all patients should subsequently be assessed for rehabilitation
        • secondary prevention clinics
        • assessment tool
    • those with ongoing needs should receive rehabilitation input
        • angina manual
        • angina management programme
        • individualised input.
  • 13.
    • Aims:
    • identify any factors that need emergency or urgent intervention
    • identify rehabilitation needs that require an intervention
    • angina versus non angina-related needs
    • inform decision on course of action
      • non-intervention
      • in-house intervention, and/or
      • referral.
    Assessment tool
  • 14.
    • Pilot of assessment tool
    • 5 practices - started November 2008
    • tool
        • symptoms
        • quality of life (fitness, activity, feelings, support)
        • beliefs about angina
    • referral options
        • A&E or emergency admission
        • rapid access chest pain clinic
        • cardiology outpatient clinic
        • cardiac rehabilitation
    • results autumn 2009.
    Happening now…
  • 15. Next steps…
    • evaluation of Angina Plan approach
        • within Cardiac Rehabilitation Lothian
        • in general practice
    • roll-out across primary care?
    • support development of training courses for practice nurses.