Excellence in Stroke ManagementPresentation Transcript
Excellence in Stroke Management - North Central Cardiac & Stroke Network - Royal Free Hospital, Hampstead – 30/7/9 Ameet Bakhai – Physician, Cardiologist, Clinical Trials, Health Economics, HTAs Barnet & Chase Farm NHS Trust Royal Free NHS Trust, University of Hertfordshire Bushey Spire Conflict of Interest: Consultant to companies, Research Grants Advisor to NICE, Director AMORE Health, CSO Health Smart UK
Education Support - North Central London Cardiac and Stroke Network
Education Grant without conditions - Sanofi-Aventis & BMS
Educational Facilitation - Barnet Hospital Cardiology Research & Education Team
Brianna Davidson, Lai Lim, Susan Collett & Catering
Close of the meeting 9.45pm Thank you & Summary from the Chair Return Evaluation Forms 9.30pm Panel Discussion Stroke services development - progress and barrier breaking Previous Speakers as well as: Dr Robert Luder Stroke Physician & Stroke Strategy Lead North Middlesex Hospital Dr Bal Athwal Neurologist and Stroke Strategy Barnet & Chase Farm Hospital NHS Trust Ms Margaret Bruce North Central London Cardiac and Stroke Network Director (Interim) Dr Gerry Coghlan Cardiologist & Clinical cardiac lead - North Central London Cardiac and Stroke Network & Royal Free Hospital 8.45pm Dr David Werring Old & New Anti-platelets and Anti-thrombotics for stroke reduction 8.15pm Coffee, Drinks, Fruit and Dessert 8.00pm Dr Sheela Shah Transient Ischemic Attacks (TIA) Services Who to refer and what to expect 7.30pm Dr Charles Davie Update on the Stroke Network across North Central London What's happening now? What needs to happen? 7.00pm Dr Ameet Bakhai Welcome, Introductions, Update on Health Checks - Vascular Risk Assessment Program 6.45pm
The Burden of Stroke Continues After the Acute Event
Cost of CardioVascular Disease £14.4 Billion or £250 per head in 2006 £30.7 Billion economic impact. BHF Coronary Heart Disease Statistics 2008 – Chapter 13 www.heartstats.org
Cost of Stroke Care per Rankin Scale Score at Day 10 in France codes I60-64, I67, G45-46 37 965 € 87 Rankin 5 Bedrinned 16 403 € 41 Rankin 4 Assist to walk 12 242 € 73 Rankin 3 Able to walk 4 616 € 122 Rankin 2 Minor disability 3 449 € 111 Rankin 0-1 No - Minimal disability Average Cost at 18/12 N (Sum 434) ECIC Study 2004 Costs
Stroke Has a Major Impact on Quality of Life 1 0
Gage BF et al . JAMA 1995; 274: 1839–1845
Burstrom K et al. Qual Lif Res 2001; 10: 621–635
Best possible health state Death Mild stroke [0.75] 1 Asthma [0.79] 2 Low back pain [0.66] 2 Moderate/severe stroke [0.39] 1 Recurrent stroke [0.12] 1
Europe - 7 main factors leading to death
High blood pressure (25%)
High cholesterol (2/3 – 66%)
Tobacco use (25%)
Overweight or obese (2/3 – 66%)
Low fruit & vegetable intake* (20-50%)
Physical inactivity (2/3 – 66%)
Alcohol excess (38%/24%)
WHO 2004 X
Unal et al BMJ 2005
Atherothrombosis Significantly Shortens Life Expectancy (Prognosis) at 60 Framingham Heart Study Peeters et al. Eur Heart J 2002; 23: 458–466 Healthy History of Angina History of MI History of CVA 0 2 4 6 8 10 12 14 16 18 20 Years 9.2 7.4 12
Reduction 77% 78% 32% 56% 80% 45% 63% 68% 36% 0%
Guidelines recommend preventive treatment in high risk patients
Lifelong treatment. Or not.
Vehicles of Change http://www.improvement.nhs.uk/nhshealthcheck/
Vascular Disease Briefing Pack for Strategic Health Authorities – NHS London Spring 2009
CardioPod launched at NHS Camden All tests are carried out at the point of care and patients receive instant feedback using the QRISK 2 risk assessment tool. Information from the Health Check is uploaded to a secure database for analysis and review. The results of the discussion between patient and care provider are recorded by the CardioPod, with a print out for the patient to take away. The action points can also be stored on the secure server for follow up when the next Health Check is carried out. CardioPods had already been installed in NHS Camden and it had plans to extend installations in the rest of the UK in the coming months. Web link: http://www.ehiprimarycare.com/news/4990/cardiopod_launched_at_nhs_camden Assistive technology company Telehealth Solutions has launched a touch-screen CardioPod which it says will help GP practices and pharmacists deliver the NHS Health Check programme. The CardioPod is a standalone unit that comes with scales and sphygmomanometer to capture basic vital signs information. A Cholestech LDX blood chemistry analyser is available as an option to add a lipid profile and blood glucose measurement in less than five minutes. CardioPod installed in a pharmacy
Of more than 4,000 Which? members found that 30 per cent would consider a private health check to set their mind at ease.
Which? researchers aged 46 to 62, with no known health problems, paid 12 visits to six healthcare companies - Bupa, Nuffield Health and BMI Healthcare and three independent firms.
They bought comprehensive health MoTs, not including scans or X-rays, paying an average of £423, while researchers posing as customers phoned another four companies which offered scans.
In eight cases, researchers - none of whom had a major problem identified - were advised to get further GP tests within six months.
One researcher got conflicting information about his heart disease risk - ranging from higher-than-average to lower - and another had an abnormal urine test at two of her three MoTs.
The report found some companies failed to discuss possible downsides of testing, such as false alarms.
The Which? panel of experts also concluded that consumers were getting too little information about the pros and cons of scans. http://www.dailymail.co.uk/news/article-1201510/The-private-health-checks-bad-you.html#ixzz0Mkhgi0LD