Coronary Heart Disease & Stroke Programme

Issue Number 21— December 2009

Introduction

Welcome to the December 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.

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.

National Clinical Dataset Development Programme (NCDDP)

There are no new heart disease & stroke related 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 please contact NCDDP queries.

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

Version 2009.3


The release of this version has been stalled until early January 2010. This will avoid the introduction of new functionality into clinical areas shortly after a new rotation of medical staff and prior to Christmas to minimise the impact this would have on those areas utilising the Discharge Letter functionality. The release includes improvements to the data entry screens and discharge letter format including a more streamlined method of recording Discharge Medications.

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 framework.

The analysis of Phase 2 is nearing completion and clinical sign off of the specification will be expected in January 2010. The intention is to commence development on this work as soon as Caldicott Guardian approval has been achieved.

Implementation

SCI-CHD ACS is now switched on in 28 hospitals across NHS Scotland..

For further information, about SCI-CHD-ACS please refer to the SCI-CHD-ACS web site

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 was published on 29th September 2009 presenting data describing the quality of stroke care in each acute hospital grouped by NHS Board from 2007 to 2008. The report has been circulated widely and is available online.

Developments are continuing within SSCA, as previously noted the first priority was to review the core dataset. The core datasets for inpatient, outpatient and thrombolysis focusing on key areas were signed off by the Steering Group in September 2009. The project team have been reviewing and updating the data definitions for these datasets in collaboration with the Steering Group and Audit Co-ordinators. They will be finalised and distributed to all centres in December 2009 and will be utilised in all centres from January 2010.

In accordance with the changes made to the core dataset, new proformas are also being developed and as above, will be finalised and distributed in December 2009 and will also be utilised from January 2010.

The project team have developed posters and patient/ carer information leaflets highlighting SSCA and informing patients that their information will be used for audit purposes. These are with the printers and will be distributed to all centres in December 2009.

Other aspects of the audit continue to be reviewed/ developed, e.g. the SSCA Computer System, building of the central repository for the storage of SSCA data at ISD, changes to the National Report and the development of Monthly Reports.

Members of the project team presented a poster at the Scottish Stroke Nurses Forum in September 2009 and will be presenting a poster at the UK Stroke Forum Conference in Glasgow in December 2009.

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

The ISD Heart Disease and Stroke websites at http://www.isdscotland.org/chd and http://www.isdscotland.org/stroke were updated on 24th November 2009. The publications cover mortality, incidence, hospital activity, prescribing and prevalence (for CHD). Mortality data include deaths registered in 2008 and the analyses involving hospital activity data cover the year ending 31st March 2009. Some of the key points from the publication are outlined below.

Heart Disease

The statistics show a continuing decline in the CHD mortality rate for the under 75s. However the number of emergency admissions for acute myocardial infarction (AMI or heart attack) increased by 11.8%. This is probably due to recent changes in the definition of AMI, which uses more sensitive tests (i.e. troponin). The trend in mortality from AMI, and for CHD as a whole, remains downward.

The incidence rate for CHD (total number of people diagnosed with CHD per 100,000 population, standardised by age and sex) decreased. The number of revascularisation procedures (Coronary Artery Bypass Grafts and Coronary Angioplasties) performed by NHSScotland decreased fractionally between 2007/08 and 2008/09 but has remained stable over the last 3 to 4 years. Reductions in coronary artery bypass operations are offset by increases in the number of coronary angioplasties being performed.

Over the decade 1999/00 - 2008/09 the numbers of prescriptions dispensed for cardiovascular related drugs continued to rise although the overall costs fell following a peak in the middle of the decade. Costs often reduce as medicines become available in generic form once drug patents expire.

Stroke/ cerebrovascular disease (CVD)

Standardised mortality rates for CVD (for those under 75) have fallen from 37.5 per 100,000 population in 1995 to 19.6 per 100,000 population in 2008. However the under 75 standardised mortality has risen by 4.5% from 2007; this may only be a “blip” in the long term downward trend. The incidence rate for CVD for under 75s, and for all ages, also increased slightly from 2007/08 to 2008/09, although it has fallen by over 20% since 1999/00.

The number of carotid endarterectomy operations performed decreased between 2007/08 and 2008/09, from 529 to 467. The age-sex standardised rates for Scotland have remained fairly consistent over the last 5 years at around 7-8 per 100,000 population.

An example chart from the CHD website is shown which demonstrates the overall reduction in premature mortality for coronary heart disease over the past 14 years, approaching the Scottish Government’s target of a 50% reduction over the period 1995-2010.

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

Coronary Heart Disease; Ages Under 75; European Age Standardised Mortality Rates per 100,000 Population

(Source: http://www.isdscotland.org/files/CHD_mortality_targets_MC2.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

Scottish Health Informatics Programme (SHIP), 17th to 19th September 2009 at St Andrew’s  - “Exploiting Existing Data for Health Research 2009”.

The Scottish Health Informatics Programme (SHIP) is an ambitious inter-disciplinary, multi-institutional research programme that will result in high impact research findings, and create a legacy platform for research using electronic patient records (EPRs) in the United Kingdom.

Programme team members John Quinn and I attended this international conference to give presentations on the topics of “The Scottish Medical Record Linkage System: Past, Present and Future” (DC) and “Using Scottish Administrative Databases to Predict Mortality after Coronary Artery Bypass Graft Surgery” (JQ & DC).  

Sessions were organised around the topics of Resources, Epidemiology/Health Service Research and Methodology and there were also demonstrations of the MILA (multi-institutional linkage algorithm) method of record linkage and the Connecting for Health Research Capability Programme. Keynote speakers were Baroness Onora O’Neill, on “personal information and confidential communication”, Professor D’arcy Holman from, University of Western Australia, raising a point for debate on “Should health data integration for research develop separately from integration for patient care?”, and Professor John Frank, Director of the Scottish Collaboration for Public Health Research and Policy, with “Thoughts from Scotland on measuring health inequalities, and the critical role of linkage”.

Our presentation on CABG mortality demonstrated how linked routine hospital admission and registered deaths could be used to construct robust predictive models and could potentially be used to monitor case-mix adjusted hospital level performance. This session was focussed around heart disease research and included talks by Professor Ian Ford, on “Acquired aortic heart valve disease in Scotland”, and Dr Murray Smith, on “Heart disease and intensity of smoking”. These studies, in common with a good number of others presented over the 3 days, all utilised linked ISD data!

Finally, there was also the opportunity to join in a breakout meeting of the International Health Data Linkage Network to discuss opportunities for multi-centre collaborative projects.”

Use the hyperlinks below for copies of our presentations.

Record Linkage in Scotland past present future

Predicting mortality after CABG

David Clark, ISD Heart Disease & Stroke Programme

NHS Quality Improvement Scotland (QIS)

ISD has been working closely with NHSQIS to support the programme of audits of cardiac services across Scotland. ISD developed analyses of audit and SMR01 data which were piloted in two Health Board areas in October 2009. The data covered cardiac rehabilitation, treatment of acute coronary syndrome and primary care.  Analyses of the other Health Boards’ data are currently being circulated by NHSQIS as part of the feedback from the first round of audit.

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 had a further meeting planned for 3rd December 2009 (including its AGM). 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_public_report_2009.pdf for the 2009 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