Coronary Heart Disease & Stroke Programme

Issue Number 20— September 2009

Introduction

Welcome to the September 2009 edition of our CHD & Stroke Newsletter. The e-Newsletter has been formatted for monochrome printing should you wish a paper copy. Choose the “print this page” option at the top right of the e-Newsletter.

Although we’re referred to as the Coronary Heart Disease & Stroke Programme we have traditionally included information on other forms of heart disease so will be changing our programme name to ‘heart disease & stroke’ to reflect this. This is also a reflection of the broader remit of the Scottish Government’s strategy "Better Heart Disease and Stroke Care Action Plan” to include other heart diseases such as inherited cardiac conditions.

We’d be interested to hear your views. If you have any comments or queries about this newsletter please contact:

David Murphy
Tel: 0131 275 6624
Email:david.murphy2@nhs.net.

Please note that ISD moved to NHSMail from 25th June 2009 so previous "@isd" email addresses will no longer work. NHS staff can check ISD contacts’ email addresses in the NHSMail directory at http://www.nhs.net (choose "Search Directory" from the top of the NHSMail home page). You don’t need to log in to NHSMail to do this.

National Clinical Dataset Development Programme (NCDDP)

There are no data standards out for consultation at present. The list of approved data standards for CHD & Stroke currently appearing in the Data Dictionary are

Coronary Heart Disease:

  • CHD Core Data Standards
  • Acute Coronary Syndrome
  • Cardiac Rehabilitation
  • Electrophysiology
  • Heart Failure

Stroke:

  • Stroke Core Data Standards
  • Stroke Inpatient Dataset
  • Stroke Outpatients Data Standards
  • AHP Stroke Assessment

Further information and contact details related to NCDDP are available from their web site at: http://www.isdscotland.org/isd/4998.html

Scottish Care Information – Coronary Heart Disease (SCI-CHD) Acute Coronary Syndrome (ACS)

Version 5.3 (2009.2)

This version of SCI-CHD ACS was released on 17th June 2009. This version included:

  • NHS QIS functionality to allow electronic collection of the ACS QIS dataset

  • a small number of other prioritised change requests and bug fixes.

Version 2009.3


This version of SCI-CHD ACS includes a number of prioritised change requests that will improve usability of the discharge letter and associated data fields. Most of these changes have been highlighted during the initial use of the system in the Golden Jubilee National hospital. This version is scheduled for release to the live server on 17th November 2009.

National Networking Model

Work is still ongoing to achieve Caldicott Guardian Approval for the National Networking Model to be implemented in SCI-CHD ACS. When this has been achieved Phase 1 of the model will be switched on which will allow the "viewing" of episodes from other hospitals within a regional network framework.

The analysis of Phase 2 is continuing. This will allow the sharing of edit rights between hospitals involved in the care of a patient. The intention is to commence development on this work as soon as Caldicott Guardian approval has been achieved.

Implementation

Since the Golden Jubilee National Hospital commenced use of SCI-CHD for the production of immediate discharge documents, the system is now being used in 28 hospitals across NHS Scotland.
NHS Lanarkshire continues to work toward switching on SCI-CHD ACS in autumn 2009.

ISD CHD & Stroke Programme & SCI-CHD-ACS

Having tested the process of obtaining a SCI-CHD-ACS extract and uploading this to version 7 of MINAP, we have converted the process to deal with the new version 8 of MINAP which will replace its predecessor from October 2009.

SCI-CHD-ACS users with an interest in having their data contribute to MINAP can request this. We are arranging to discuss, with the Clinical Technology Centre at Ninewells Hospital, exactly how the process will work but, in theory, users can request that their data be exported from SCI-CHD-ACS and passed to ISD for MINAP upload. They can then log in to MINAP to view the results of the upload, assuming they have been set up by MINAP to do this.

The intention is that the MINAP report, once established, will form the basis of routine STEMI audit reporting, replacing the existing arrangements where STEMI reports are prepared, either on an Excel template or exported from SCI-CHD-ACS, and sent to ISD for compilation in to an ‘all contributors’ summary. The development of the NHSQIS acute coronary syndrome audit has become the focus of attention with regard to information on STEMI patients.

Although a web based system to allow access to MINAP reports (on door-to-needle time, discharge medication etc.) is being developed, at present users can only view their results using the Lotus Notes application (see
http://www.ic.nhs.uk/services/national-clinical-audit-support-programme-ncasp/heart-disease/myocardial-infarction/getting-started-data). We're aware there are issues with the implementation of Lotus Notes in NHSScotland and we're investigating alternative solutions.

For further details please contact either Adam Redpath, tel 0131 275 6704 email adam.redpath@nhs.net or David Murphy, tel 0131 275 6624, email david.murphy2@nhs.net.

For further information, about SCI-CHD-ACS please refer to the SCI-CHD-ACS web site http://scichd.scot.nhs.uk

or Lynne Buttercase
SCI-CHD-ACS Operational Project Manager
Tel: 0138 263 2466
e-mail: lynne.buttercase@nhs.net

Scottish Stroke Care Audit (SSCA)

The latest SSCA National Report is due to be published on 29th September 09 and presents data describing the quality of stroke care in each acute hospital grouped by NHS Board from 2007 to 2008.

The report also allows each hospital and NHS Board not only to compare their performance with current national standards (2004-2008), but also with new national standards published in June 2009 and with other organisations. Hospitals with less satisfactory performance can learn from those where services are of higher quality. The main report will be circulated widely and will be available online (http://www.strokeaudit.scot.nhs.uk/).

The SSCA Steering Group is leading developments within SSCA with the first priority being a review of the core dataset which will be circulated to all centres in September 09. The core dataset will be significantly reduced and will focus on key areas.

Following this other aspects of the Audit will be reviewed, e.g. the SSCA Computer System, proformas, definitions, guidelines etc. as well as development of project resources to support the audit.

For further information about the report, or the audit more generally, contact:

Hazel A Dodds
Clinical Coordinator for Scottish Stroke Care Audit
Gyle Square (143c)
1 South Gyle Crescent
Edinburgh EH12 9EB UK
tel: +44 (0)131 275 7184 (Mon /Wed/ Thurs)
tel: +44 (0)131 537 3584 (Tues)
e-mail: hazeldodds@nhs.net

Information Services Division Website http://www.isdscotland.org

CHD & Stroke

Work is underway to update our CHD & Stroke web pages at http://www.isdscotland.org/chd and http://www.isdscotland.org/stroke for their annual publication on 24th November 2009.

As with previous years, the publication will include estimated prevalence (of coronary heart disease), prescribing, hospital-based incidence, hospital activity (including operations), mortality and survival.

We are currently adapting computer programs to deal with this annual publication in preparation for the October 2009 monthly update to the source data used to generate the web site analyses.

The example below, drawn from the current CHD web site, shows the trend in the number of prescriptions issued by general practitioners and the costs associated with these. The reduction in costs in later years is attributed to these drugs moving ‘off patent’ as cheaper generic versions become available.

If you are interested in ad hoc analyses of the source data please contact:

David Murphy
Tel: 0131 275 6624
Email: david.murphy2@nhs.net

Cardiovascular Drugs ; Cost and Number of Prescriptions)

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(Source: http://www.isdscotland.org/files/CV_drug_prescriptions_G1.xls)

Note affecting interpretation of some of the existing analyses on our web pages:

In August 2008, following an analysis of emergency admissions, an issue was discovered with NHS Lothian SMR01 data.

This affects the distribution of patients between elective and non-elective admission types for data from late 2006.

The problem relates to IT system changes in NHS Lothian at that time and how the system was subsequently used by staff.

Colleagues from ISD and NHS Lothian investigated the matter and issued, to ISD analysts, an interim solution to reassign these records to the correct admission types whilst NHS Lothian work to correct and re-submit the source data.

Please bear this issue in mind when viewing existing, published information on our CHD & Stroke web pages that is presented at sub-national level.

Conferences & Workshops

European Society of Cardiology (ESC)

Adam Redpath, our CHD & Stroke Programme Principal, participated in the 2009 conference of the European Society of Cardiology in Barcelona from 29th August 2009 to 2nd September 2009. Adam presented a paper on the trends in the incidence, mortality and treatment of coronary heart disease in Scotland over the period 1998-2008. Adam’s report of the conference appears at the end of this newsletter.

CHD & Stroke Programme & British Heart Foundation (Scotland)

ISD and BHF Scotland staff met on 7th September 2009 to share knowledge and information from our respective work in the heart disease and stroke spheres.

BHF Scotland Director, Marjorie Burns, provided a brief overview of their work in Scotland, and the UK, and then more detailed discussions occurred with BHF staff on the topics of prevention and care, policy and public affairs and the BHF’s statistical publications from their Business Unit. ISD staff offered presentations on trends in the incidence, mortality and treatment of coronary heart disease in Scotland (Adam’s Barcelona talk) and the use of routine ISD data to predict subsequent mortality for patients undergoing coronary artery bypass graft.

Opportunities for joint working were also discussed and this will be pursued at future meetings.

Scottish Health Informatics Programme (SHIP), 17th to 19th September 2009 at St Andrew’s

Programme members, David Clark and John Quinn, have had abstracts accepted for presentation at the SHIP conference at St Andrew’s on 19th September 2009. The topics are (a) the use of administrative databases to predict mortality after coronary artery bypass graft surgery and (b) the development, current uses and future plans for the Scottish Medical Record Linkage System.

NHS Quality Improvement Scotland (QIS)

We continue to work with NHSQIS in their national audits of acute coronary syndromes (ACS) and cardiac rehabilitation in Scotland.

Programme analysts have discussed, with NHSQIS, the details of the analyses required and are preparing computer programs in advance of the audit data being collected and sent to ISD.

http://www.nhshealthquality.org/nhsqis/6009.html and http://www.nhshealthquality.org/nhsqis/files/HeartDisease_CHDResourcePack_May09.pdf for further details. about these audits from NHSQIS. Also, see NHSQIS draft standards document, for coronary heart disease prevention and treatment, at: http://www.nhshealthquality.org/nhsqis/files/HeartDisease_CHDDraft
Standards_FEB09.pdf

Information on cardiac rehabilitation in other parts of the UK (England, Wales and Northern Ireland) is available from the 2009 report of the National Audit of Cardiac Rehabilitation, based at the University of York. See their web site http://cardiacrehabilitation.org.uk/nacr/ (specifically http://www.cardiacrehabilitation.org.uk/nacr/docs/2009.pdf) for details.

Useful Links

ISD’s CHD and Stroke web sites:

http://www.isdscotland.org/chd and http://www.isdscotland.org/stroke .

The Scottish Parliament’s Cross Party Working Group for Heart Disease & Stroke has regular meetings to provide a forum for discussion on prevention, care and treatment of heart disease and stroke. It includes Members of the Scottish Parliament, people living with these conditions, the charities working in the field, and the health professionals involved. It is meeting again on 23rd September 2009. See http://www.scottish.parliament.uk/msp/crossPartyGroups/groups/cpg-chd.htm for further information.

The Scottish Government's policy documents on the future of health and health care in Scotland and subsequent consultation document on CHD & stroke services:

Better health, better care - discussion document. (Aug 2007).
Better health, better care - action plan. (Dec 2007).
Better Coronary Heart Disease and Stroke Care (Jul 2008).
Better Heart Disease and Stroke Care Action Plan (Jun 2009).

The previous Scottish Executive’s public health white paper Towards a Healthier Scotland and Coronary Heart Disease and Stroke Strategy for Scotland

NHS Quality Improvement Scotland (NHSQIS)

ISD Clinical Coding Guidelines newsletters from May 1996.

CHD & Stroke Newsletters from September 2004 are available from either http://www.isdscotland.org/chd or http://www.isdscotland.org/stroke

Myocardial Ischaemia National Audit Project (MINAP) – see http://www.rcplondon.ac.uk/CLINICAL-STANDARDS/ORGANISATION/PARTNERSHIP/Pages/MINAP-.aspx for details and http://www.rcplondon.ac.uk/clinical-standards/organisation/partnership/Documents/Minap-2008.pdf for the 2008 report.

General Register Office Scotland (GROS) - in August 2009, the Registrar General for Scotland published his annual report on the demographic trends affecting Scotland’s population. See http://www.gro-scotland.gov.uk/files2/stats/scotlands-population-2008-the-registrar-generals-annual-review-of-demographic-trends-154th-edition/scotlands-population-2008-the-register-generals-annual-review-154th-edition.pdf for details.

Scottish Public Health Observatory (ScotPHO)

The ScotPHO web site at http://www.scotpho.org.uk/home/home.asp; includes information related to coronary heart disease and stroke in its “Scotland and European Health for All (HfA) Database 2007” at http://www.scotpho.org.uk/home/Comparativehealth/InternationalComparisons/Scotland_
and_European_HfA.asp

ISD’s Clinical Indicators Support Team (CIST) publishes information on 30-day survival following emergency hospital admission for acute myocardial infarction and stroke. See their respective web pages http://www.indicators.scot.nhs.uk/TrendsJuly09/AMI.html and http://www.indicators.scot.nhs.uk/TrendsJuly09/Stroke.html or their home page at http://www.indicators.scot.nhs.uk/ for further details.

We welcome your feedback, comments and ideas.

Please contact
David Murphy
CHD & Stroke Programme ISD Scotland
Gyle Square
South Gyle
Edinburgh EH12 9EW

You can send an e-mail to: david.murphy2@nhs.net or telephone on 0131 275 6624

European Society of Cardiology report

European Society of Cardiology (ESCARDIO) Congress

Barcelona, 29 August - 2 September 2009

Report from ISD’s delegate - Adam Redpath

(Programme Principal Heart Disease and Stroke Programme

Summary

I attended the congress to deliver a paper on ‘Changes in the incidence, mortality and treatment of CHD in Scotland- 1998-2008’ . The event was huge - with around 30,000 delegates from a variety of specialisms - i.e. general cardiologists, interventional specialists, cardiac surgeons, radiologists, general practitioners and public health professionals. The tension between the need to spend money to prevent CHD (both primary and secondary prevention) and the development of high-tech, expensive drugs, scanners and devices (e.g. Implantable Cardiac Defibrillators) has become more acute as the economic downturn hit health budgets across Europe. Full details, including presentations, papers etc can be found at - http://www.escardio.org/CONGRESSES/ESC-2009/Pages/welcome.aspx.

Prevention & politics

The EUROASPIRE surveys across Europe show that hardly any CHD patients have achieved all the target levels for BP, cholesterol, smoking and BMI. The UK was top of this particular league table, apparently due to greater efforts made by GPs rewarded by the QOF (Quality & Outcomes Framework) scheme. Although we have amongst the lowest intervention rates in Western Europe we have the best prevention strategy.

The ESC aims to persuade the EU, under the Spanish Presidency in 2010, to give Cardiovascular Disease prevention an EU Council Recommendation. This would encourage member states to adopt policies designed to promote heart health.

Preventative aspirin for the non-symptomatic at-risk population was shown to offer more disbenefits (bleeding complications) than benefits. The study was presented by Professor Gerry Fowkes of Edinburgh University -
http://www.guardian.co.uk/society/2009/aug/31/aspirin-british-heart-foundation

Smoke-free legislation

Professor Jill Pell presented data from the STOPIT study at the Smokefree Conference in Edinburgh in 2007 and showed a 17% decline in emergency admissions for acute myocardial infarction (AMI) following the introduction of the smoke-free legislation in March 2006. The BBC published a review of the study casting some doubts on her results, but recent data from France and Italy has found similar results to the STOPIT study - http://www.escardio.org/congresses/esc-2009/news/pages/smoking-bans.aspx

Scanning


Advances in CT scanning continue, although not everyone was convinced that mass scanning of at-risk populations is desirable. The downsides included worries about radiation doses. Health technology to reduce this is advancing and there are doubts about whether a scan provides definitive evidence of a patient’s need for angioplasty. The upside is, of course, that CT scans are not invasive, as angiographies are. See
http://www.escardio.org/about/press/press-releases/pr-08/pages/ct-scan-versus-angiography-statement.aspx

Risk scores

The ESC is promoting the Systematic Coronary Risk Evaluation (SCORE) system to predict 10 year risk. See http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-SCORE-FT.pdf. England is promoting the QRISK score and Scotland the ASSIGN score.

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