Coronary Heart Disease & Stroke Programme

Issue Number 18 —March 2009

Introduction

We have revised the production of the CHD & Stroke Newsletter to reflect the transition, by many of ISD’s programmes and projects, to e-Newsletters. This means there won’t be a PDF copy of the newsletter available. 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 development please contact:

David Murphy
Tel: 0131 275 6624
Email: David.Murphy@isd.csa.scot.nhs.uk or david.murphy2@nhs.net.

National Clinical Dataset Development Programme (NCDDP)

The Cardiac Surgery and Percutaneous Cardiac Interventions Data Standards were approved in December 2008 by the NCDDP Board and will be incorporated into ISD’s Health and Social Care Data Dictionary in the near future.

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

If you have any queries or comments regarding NCDDP please contact:
Leigh Brown
tel: 0141 282 2245
email: leigh.brown@isd.csa.scot.nhs.uk

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

Version 5.2

User Acceptance Testing of V5.2 is currently underway in Ninewells Hospital. This version concentrates on furthering the functionality relating to the production of the electronic discharge letter and the transferral of this to GPs through SCI Gateway.

In detail this includes:

  • 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.

This version is scheduled for live release late March 2009.

Catheter Laboratory/MINERVA Data Import

Work is continuing on the Cath Lab/MINERVA link to SCI-CHD-ACS. This link will involve exporting data items from MINERVA (and the potential to do this from other third party Cath Lab systems) and have this available in SCI-CHD-ACS for viewing and merging into the patient record and discharge letter. Currently the team are looking at the technical solution for this work.

National Networking Model

The National Networking Model was released to the live server in December 2008.

This functionality will allow users to view data on individual patients from other hospitals and it will greatly aid clinicians where patients are transferred to multiple hospitals during the same episode of care. The functionality is currently unavailable until regional agreement between hospitals can be reached to allow this to be switched on. Presentations are currently being made to the three regional Cardiology Planning Groups to further these discussions.

Into the Future

The plans for SCI-CHD-ACS in the future include a number of exciting initiatives such as:

  • possibility of electronic inter-hospital referrals
  • Scottish Ambulance Service (SAS) link - transfer of data on CHD patients treated in the ambulance to be received by SCI-CHD-ACS. Discussions will continue with the SAS to move this initiative forward although there are currently essential dependencies on this link that are not yet in place
  • National Accident & Emergency System link - transfer of data on CHD patients treated in the A&E setting from national A&E system. Discussions with the A&E community will continue on this link.

Implementation

Planning toward going live is continuing with NHS Lanarkshire and the Golden Jubilee National Hospital. It is hoped that the system will be switched on in these areas in spring 2009.

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)

Starting in January 2008, the SSCA began collecting data for the Scottish Hyperacute Stroke Activity Register and Evaluation (SHARE) Project. The SHARE project is led by Peter Langhorne, Professor of Stroke Medicine at Glasgow Royal Infirmary. The objective of SHARE is to establish a system to allow the monitoring of hyperacute stroke services in Scotland to ensure such services are safe, effective, equitable and efficient. Funding has been obtained for SHARE for two years. After that we expect thrombolysis audit to be a routine part of SSCA.

Data for the 2009 SSCA National Report will be sent to Robin Flaig by 31st March 2009. A draft report will be available on the 31st May 2009. The next National Meeting for the SSCA will be on Monday 15th June 2009 at the Royal College of Physicians in Edinburgh. The draft report will be discussed at the meeting.

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

Ms Robin Flaig
Audit Coordinator
Scottish Stroke Care Audit
University of Edinburgh
Bramwell Dott Building
Western General Hospital
Crewe Road
Edinburgh EH4 2XU UK
tel: +44 (0)131 537 3127 or
e-mail: robin.flaig@ed.ac.uk

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.

An example chart, based on published data, is presented below showing the trend in age-sex standardised discharges rates for each of coronary artery bypass and angioplasty and illustrates the shift toward the latter over the last few years.

The source web pages were last updated in November 2008 and are due for their annual update in November 2009. The last publication took cognisance of disclosure control issues by suppressing table cells with small numbers. This affected tables with age/sex distributions for Island NHS boards, council areas and community health partnerships.

ISD’s need to tackle disclosure control is driven by the Office for National Statistics (ONS) guidance on the dissemination of health statistics. Further details of this guidance can be found by clicking this link.

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

David Murphy
Tel: 0131 275 6624
Email: David.Murphy@isd.csa.scot.nhs.uk or david.murphy2@nhs.net.

Discharge rates for Coronary Artery Bypass Graft and Percutaneous Transluminal Coronary Angioplasty, years ended 31 March: 1999-2008 (2008 provisional)

Discharge rates for Coronary Artery Bypass Graft and Percutaneous Transluminal Coronary Angioplasty, years ended 31 March: 1999-2008 (2008 provisional)

(Source: http://www.isdscotland.org/files/Operations_type_Board_OC1.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.

Correction to published tables DC1 and DS1 – CHD & Stroke mortality rates by deprivation category

An adhoc analysis of the source data used to create CHD & Stroke web site tables DC1 and DS1 brought to light a small error in these tables. In each case, the formula used to obtain the respective figures in cell E17 of the tables used the wrong denominator to calculate the crude rates for all ages. The correction for each table produces a slightly lower crude death rate for SIMD2006 decile 10, changing from 1255.3 to 1186.0 per 100,000 population for table DC1 and from 595.9 to 563.0 per 100,000 population for table DS1. The standardised mortality ratios remain unaffected. A note has been added to the relevant web pages to highlight this revision. See http://www.isdscotland.org/isd/3090.html and http://www.isdscotland.org/isd/2427.html.

Predicting cardiac surgery mortality from routine administrative data

Since the publication of the paper by Aylin et al ("Use of administrative data or clinical databases as predictors of risk of death in hospital: comparison of models" in BMJ 2007;334;1044), ISD CHD & Stroke Programme undertook a similar analysis using hospitalisation and deaths data for Scotland.

Initial results are promising and we’re investigating the possibility of producing routine reports for circulation to individual hospitals and perhaps extending the analysis to cover other coronary heart disease diagnoses or interventions.

For further information contact:
Adam Redpath
CHD & Stroke Programme Principal
tel: 0131 275 6704
email: Adam.Redpath@isd.csa.scot.nhs.uk.

Published Research

ISD data has shown that treatment for heart failure is improving. ISD were involved in a piece of research published recently in the US journal “Circulation”. The research demonstrated that, although the prognosis for coronary heart failure remains poor, the case fatality rate has declined, probably due to the increase in effective treatments. The paper, by Jhund et al, is available at http://circ.ahajournals.org/cgi/content/abstract/119/4/515 and is entitled “Long-Term Trends in First Hospitalization for Heart Failure and Subsequent Survival Between 1986 and 2003”.

A second paper, by Lewsey et al and also involving collaboration with ISD, was published in the journal “Stroke” in February 2009. The topic of the research was gender differences in the incidence, mortality and survival of stroke patients and an abstract is available at http://stroke.ahajournals.org/cgi/content/abstract/STROKEAHA.108.542787v1

Conferences & Workshops

Institute for Healthcare Improvement (IHI)

An IHI event was held on 26 February 2009 with NHS Quality Improvement Scotland (NHS QIS) and the Scottish Patient Safety Programme running a training session for cardiac services staff at the Lighthouse in Glasgow. The aim was to introduce staff to the service improvement methodologies, pioneered by the Institute for Healthcare Improvement, which are now being applied in Scotland. Two of the central aims of the patient safety programme relate to coronary heart disease: care for heart attack patients and heart failure patients.

See http://www.patientsafetyalliance.scot.nhs.uk/ and http://www.patientsafetyalliance.scot.nhs.uk/programme/aims/ for additional details.

Royal Statistical Society (RSS)

The RSS 175th Anniversary Conference will take place in Edinburgh in September 2009. The call for contributed papers is now out and details can be found at http://www.rss.org.uk/main.asp?page=3021

The conference sessions are expected to cover a range of topics, with health components including: medicine, public health, complex interventions in primary care and bioinformatics.

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.

NHS Quality Improvement Scotland (QIS)

NHS QIS launched draft clinical standards for the prevention and treatment of coronary heart disease as part of a programme of work in relation to CHD. The wider programme also includes national audits and the development of clinical indicators. These standards and clinical indicators are linked to the ongoing work of the Scottish Patient Safety Alliance.

The draft standards document is available at: http://www.nhshealthquality.org/nhsqis/files/HeartDisease_CHDDraftStandards_FEB09.pdf

Useful Links

ISD’s CHD and Stroke web sites:

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

Scottish Parliament’s Cross Party Working Group on Coronary Heart Disease & Stroke – see http://www.scottish.parliament.uk/msp/crossPartyGroups/groups/cpg-chd.htm - meets on 11th March 2009. The purpose of the Group is to provide a forum for discussion on prevention, care and treatment of heart disease and stroke, between Members of the Scottish Parliament, people living with these conditions, the charities working in the field, and the health professionals involved.

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).

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

Chief Medical Officer’s latest report “Health in Scotland 2007” was published on 2nd December 2008. An electronic copy (PDF) may be downloaded at http://www.scotland.gov.uk/Publications/2008/11/26155748/8

Cardiovascular Coalition (a national coalition of 36 voluntary and professional organisations with an interest in promoting and protecting cardiovascular health in England) publishes a consultation document on cardiovascular health strategy for 2010-2020 and a report about modelling the UK burden of cardiovascular disease to 2020. These documents can be downloaded from http://www.bhf.org.uk/cvc/strategy_for_2010-2020.aspx and http://www.bhf.org.uk/cvc/resources.aspx respectively.

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