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West Herts Cardiology Herts NSF for CHD Study Day
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West Herts Cardiology Herts NSF for CHD Study Day



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  • 10 Atherosclerotic disease is a progressive disease as shown in this slide. Many therapeutic interventions are aimed at specific cardiovascular conditions. These interventions may be directed at alleviating symptoms or preventing progression to more serious stages or both. Angiotensin-converting enzyme (ACE) inhibitors have been studied, for example, in patients with hypertension, who are at the top of this progression pathway. These studies looked only at the effects on blood pressure, however, and did not address the long-term question of risk reduction. Other clinical trials with ACE inhibitors have been designed to investigate the effects of these agents on the morbidity and mortality following an acute myocardial infarction.
  • The NSF is built upon twelve standards in the seven broad categories shown. In reducing heart disease in populations, much emphasis is placed upon smoking cessation. All agencies (HA, LA, PCG/Ts and trusts) are asked to give high priority to setting and measuring the results of CHD related policies – the Health Improvement Programme is the activity that binds these agencies into actions on CHD. In all work to improve heart health the NSF asks us to reduce inequities (equity as equal service for equal needs in a population). Primary care is asked to put more risk reduction and treatment reviews in place for people with a high risk of developing CHD and patients with symptoms of CHD. Emphasis is placed upon modifiable risk factors such as smoking, physical activity, overweight, diabetic control, blood pressure control and alcohol consumption. Better care for people heart attacks includes attention from a trained person within 8 minutes with defibrillator. Revascularisation should be initiated, where appropriate, within 60 minutes. Emphasis is also placed upon continuing care after discharge from hospital, guidance is given on medication and risk reduction, including rehabilitation. Detailed models are put forwards. Ambulance trusts have some quite tough targets. Risk reduction and standardised NHS care for people with stable angina is set out. Agreed protocols and practice level CHD registers are required. A maximum two week wait for specialists assessment for revascularisation is announced (in place nationally from 2002-3). Angioplasty should be completed within three months and revascularisation should be done within three months of the decision to treat (most cases). Heart failure diagnosis and treatment is to be standardised. The role of specialist nurses is put forward as a way of offering outreach and closer monitoring of treatment in the community. Trusts are requested to put systematic multi-disciplinary rehabilitation programmes in place. Particular emphasis is put on continuity of care from hospital to community. Informal carers and support groups should be involved.


  • 1. Herts NSF for CHD Study Day 14 Jan 2003 Happy Birthday Katie ! NSF for CHD CHD Collaborative Improving the Patient’s experience
  • 2. Clinical & Organisational Obstacles to the Care of the CHD Patient
    • Local constraints to CHD developments
    • National priority for CHD
    • (NSF targets)
    • £££ to improve
    • £££ to improve
    • Networking
    • Networking (clinical & planning)
    • Management of change
    • Change
    • Information Systems
    • Information Exchange
    Limited Capacity Increasing Demand
    • Time & Information
    • Clinical Governance
    • Staff for more interactions
    •  (appropriate) GP referrals
    • Time for better interactions
    •  Patient expectation
  • 3. Progressive Development of Cardiovascular Disease Prevention Stable Angina MI Heart Failure Cardiac Rehab Improving the patient’s experience Endstage Heart Disease Chronic Heart Failure Ventricular Dilation Arrhythmia & Loss of Muscle ACS / MI Coronary Thrombosis Myocardial Ischaemia CHD Atherosclerosis Endothelial Dysfunction Risk Factors Plaque instability
  • 4. National Service Framework Coronary Heart Disease
  • 5. National Service Framework Coronary Heart Disease Quality framework: “A First Class Service” Professional self regulation Lifelong Learning National Performance Framework Commission for Health Improvement National Patient and User Survey National Service Frameworks (NSF) National Institute for Clinical Excellence (NICE) Clinical Governance PATIENT & PUBLIC INVOLVEMENT CLEAR STANDARDS OF SERVICE DEPENDABLE LOCAL DELIVERY MONITORED STANDARDS
  • 6. NSF for CHD
    • Reducing heart disease in the population
    • Preventing CHD in high-risk patients
    • Heart attack and acute coronary syndromes
    • Stable angina
    • Revascularisation
    • Heart failure
    • Cardiac rehabilitation
    NSF for CHD : 1.28 Seven Chapters
  • 7. NSF for CHD: Four Important Principles
    • Reducing the burden of CHD is not just the responsibility of the NHS. It requires action right across society
    • Quality of care depends on:
      • ready access to appropriate services
      • the calibre of the interaction between individual patients and individual clinicians
      • the quality of the organisation and environment in which care takes place
    • Excellence requires that important, simple things are done right all the time
    • Delivering care in a more structured and systematic way will substantially improve the quality of care and reduce undesirable variations in its provision.
    NSF for CHD : 1.18
  • 8. Excellence requires that important, simple things are done right all the time …
  • 9. CHD Collaboratives
  • 10.
    • To improve the experience and outcomes
    • of patients with suspected or diagnosed CHD
    • by optimising care and delivery systems
    • across the whole integrated pathway of care
    CHD Collaborative Goal
  • 11. Learning from the CHD Collaborative
    • Messages from patients
    • Lack of information at the right time
    • Need support for both patients and carers
    • High levels of anxiety
    • Lack of involvement
    • Impact on peoples lives
  • 12. 5 th Report on the Provision of Services for Patients with CHD Nov 2002
    • Implementation of NSF
    • Patient involvement
    • Staffing
    • Information technology
    • Reorganisation
    • Maintaining standards & quality
  • 13. Herts NSF for CHD Study Day
    • Prevention
    • Stable Angina & MI
    • Improving the patients’ experience
    • Heart Failure
  • 14. Herts & Beds Cardiology Integrated Network of Care Health Promotion Practice Nurses Tertiary Centres GPs DGHs Cardiac Specialty Nurses Cardiac Rehabilitation Primary Care Secondary Care Tertiary Care
  • 15. West Herts Cardiology Web site