Coronary Heart Disease & Stroke Programme

Issue Number 19 — June 2009

Introduction

Welcome to the June 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.

Please note that ISD moves 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 do this.

For the CHD & Stroke Programme, the current team members and respective email addresses are:

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 5.2 (2009.1)

This version of SCI-CHD ACS was released on 31st March 2009. This version included:

  • Pharmacy Sign Off of discharge medications
  • Ability to clinically amend previously signed-off discharge letters
  • Secretarial role that allows management of the filing and manual sending of the discharge letters
  • enhancements to local configuration of SCI Gateway link
  • other prioritised change requests and bug fixes as appropriate.

Version 2009.2

This version of SCI-CHD ACS includes functionality that will allow the collection of the data items required for the NHS QIS data collection exercise that is scheduled for July/August 2009. This version is scheduled for release to the live server on 16th June 2009.

Version 2009.3

This version is currently scheduled for release in early August 2009 and includes a series of change-requests relating to the discharge letter (in particular the medications screen) that have been requested during the Golden Jubilee’s pilot period.

National Networking Model

Phase I

The National Networking Model Phase I (ability to access records from other hospitals in a ‘View Only’ capacity) was released to the live server in December 2008. This is currently switched off and is awaiting Caldicott Guardian approval before it can be switched on.

Phase 2

Phase 2 of the National Networking Model will allow the ability for hospitals within and outwith Health Board Areas and regions to share the editing rights of single episodes of care as the patient is transferred to different hospitals during the course of treatment. Analysis has commenced on this piece of work and will continue over the coming weeks. Development on this work will not commence until Caldicott Guardian approval has been obtained.

Phase 3

Phase 3 will allow electronic referral and repatriation of patients between hospitals. This work will commence following completion of Phase 2.

Implementation

Golden Jubilee National Hospital commenced piloting SCI-CHD ACS on 27th April 2009. This takes the number of hospitals who have SCI-CHD ACS switched on to 28. NHS Lanarkshire is continuing to plan towards going live in summer 2009.

Areas of work that have been de-prioritised following national discussions:

  • Cath Lab/MINERVA data import to SCI-CHD ACS
  • Link to National Accident & Emergency System
  • Link to Scottish Ambulance Service System

These priorities will be re-examined at the end of this financial year.

ISD CHD & Stroke Programme & SCI-CHD-ACS

ISD tested the submission, to MINAP (Myocardial Ischaemia National Audit Project), of an anonymised SCI-CHD-ACS extract for one hospital. The MINAP database provides summary reports on each hospital submission and we’re appraising these at the moment, comparing the results of our analysis of the extract prior to submission, with the MINAP analysis after submission. 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, 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 draft report for 2009 was circulated for consideration on 26th May 2009 and will be the main topic of discussion at the next SSCA national meeting on Monday 15th June 2009 at the Royal College of Physicians in Edinburgh.

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

Scottish Coronary Revascularisation Register (SCRR) 2007/08 Report

A comparison between SCRR and the central database of inpatient/day case discharge summaries (SMR01) for 2007/8 produced encouraging results. Overall numbers for each of angiography, percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) were comparable although there were pockets of under-recording on SMR01 at specific hospitals, particularly for angiography and PCI. This will be pursued with the hospitals concerned. The SCRR report is available at http://www.scs-online.org.uk/pdf/AR_0708.pdf

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

CHD & Stroke

A variety of analyses are available from our CHD & Stroke web sites at http://www.isdscotland.org/chd and http://www.isdscotland.org/stroke . These include estimated prevalence of coronary heart disease, prescribing, hospital-based incidence, hospital activity (including operations), mortality and survival.

The example below, drawn from the current Stroke web site, demonstrates the gradient in standardised mortality rates for cerebrovascular disease among under 65 year olds between the least and most deprived areas of Scotland as measured by the Scottish Index of Multiple Deprivation (SIMD).

Preparations will begin during June and July 2009 for the annual update to the CHD & Stroke web pages, due for publication on 24th November 2009.

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

Emergency admissions involving a principal diagnosis of stroke, 1999 & 2008
age-sex standardised rates per 100,000 by NHS board of residence (both sexes)

Emergency admissions involving a principal diagnosis of stroke, 1999 & 2008 age-sex standardised rates per 100,000 by NHS board of residence (both sexes)

(Source: http://www.isdscotland.org/files/CVD_discharges_Board_AS1.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)

The annual ESC Congress takes place in Barcelona, Spain, this year from 29th August 2009 to 2nd September 2009. Its focus is “Prevention of Cardiovascular Disease”. ISD CHD & Stroke Programme has submitted two abstracts on the topics of (a) trends in CHD incidence, treatment and mortality and (b) trends in relative CHD mortality risk between males and females. The former paper has been accepted for an oral presentation at the conference. For further details, contact Adam Redpath, CHD & Stroke Programme Principal, tel 0131 275 6704 email adam.redpath@nhs.net

Open University Statistics Group

ISD analysts involved with record linkage participated in a 2 day conference about “Statistics for health registers and linked databases” at the Open University in Milton Keynes on 20th & 21st May 2009. An overview of the conference aims and programme is available at http://statistics.open.ac.uk/hrld/index.htm.

Scottish Health Informatics Programme (SHIP)

SHIP is running an international conference at St Andrew’s during September 2009 on the topic of “Exploiting Existing Data for Health Research”. This will include themes involving record linkage, frequently used in ISD to connect data held by individual research projects with the central linked database of hospital admissions and deaths for Scotland maintained by ISD. Linkage offers the facility to examine, for example, readmission and mortality among cohorts of patients involved in particular research projects.

Preceding the main conference will be a 5-day training workshop on the analysis of linked data examining, among other topics, the use of linkable registry data in health research, evaluating health service outcomes and the theory & practice of risk adjustment.

Further information about the conference is available at http://www.eaps.nl/index.php?module=uploads&func=download&fileId=62
and https://onlineshop.st-andrews.ac.uk/events/eventdetails.asp?eventid=37

Many of the data linkages done by ISD require funding and this is often obtained via a grant from the Chief Scientist’s Office. See http://www.sehd.scot.nhs.uk/cso/ for further information if you are interested in funding a particular research project.

ISD has submitted abstracts for the St Andrew’s event on the topics of (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.

Scottish Health Information Service for Research (SHIS-R)

Scottish Health Information Service for Research is a new programme of work which began in April to provide researchers with access to national data. The project will create an infrastructure for access and linkage to national data ensuring that all technical, security, disclosure and governance controls are in place.

SHIS-R will be the backbone to the establishment of the Scottish Health Informatics Programme (SHIP), a collaboration between ISD and the academic research community. This programme will provide a Scotland-wide research platform for the collation, management, dissemination and analysis of health records. Building on SHIS, the project will work to deliver a modernised information service to support research, addressing the access, security and governance issues and provide an information portal for linked health data.

SHIS-R and SHIP will use a series of exemplar research programmes to develop a framework for providing patient level data, both linked and unlinked, for research purposes and will build on methods currently in place.

For further details, contact Jennifer Bishop, SHIS-R Programme Principal, tel 0131 275 6063, jennifer.bishop@nhs.net.

ASSIGN (Assessing cardiovascular risk using SIGN guidelines to ASSIGN preventive treatment)

SIGN guideline 97 “Risk estimation and the prevention of cardiovascular disease” (see http://http://www.sign.ac.uk/pdf/sign97.pdf) introduced the ASSIGN risk score, developed by researchers at the University of Dundee, but with involvement of ISD record linkage staff linking heart health survey data with ISD’s medical record linkage database. The performance of ASSIGN was compared to other cardiovascular risk scoring methods, Framingham and QRISK, and was found to be better at identifying patients at risk of developing cardiovascular disease. In particular ASSIGN better addressed the problem of inequity of access to preventative treatment across areas with different levels of deprivation. A recent article in Pulse (see http://www.pulsetoday.co.uk/story.asp?sectioncode=23&storycode=4121967) makes mention of the comparison and the proposed publication of the research comparing these risk scores.

NHS Quality Improvement Scotland (QIS)

During July to September 2009 NHSQIS will be involved with CHD audits as part of their national audit programme. Information on acute coronary syndromes (ACS) and cardiac rehabilitation will be gathered, either on paper or electronically via SCI-CHD-ACS. See http://www.nhshealthquality.org/nhsqis/6009.html and http://www.nhshealthquality.org/nhsqis/files/HeartDisease_CHDResourcePack_May09.pdf for further details.

NHS QIS launched draft clinical standards for the prevention and treatment of coronary heart disease as part of their programme of work in relation to CHD. The draft standards document is available at: http://www.nhshealthquality.org/nhsqis/files/HeartDisease_CHDDraftStandards_FEB09.pdf

ISD CHD & Stroke Programme will be involved in analysing the results of the ACS and cardiac rehabilitation audits.

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. Its meeting on 10th June 2009 had cardiac rehabilitation as its focus. 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).

There was a consultation event held in December 2008 to discuss the document Better Coronary Heart Disease and Stroke Care and the strategy update document is due for publication by the Scottish Government in the coming weeks.

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

e-Library Shared Space for CHD and Stroke:

http://www.elib.scot.nhs.uk/portal/elib/pages/SharedSpaces.aspx

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.

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