Heart Disease & Stroke

Quarterly Newsletter

June 2010 - Issue 23

Current Membership

Contact

David Murphy
ISD Scotland
Gyle Square
Area (122a)
1 South Gyle Crescent
Edinburgh
EH12 9EB
Tel 0131 275 2046
Email david.murphy2@nhs.net

www.isdscotland.org/chd www.isdscotland.org/stroke

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To subscribe or unsubscribe to this newsletter email David Murphy (david.murphy2@nhs.net) or Lynn Girdwood (lynn.girdwood@nhs.net)

Introduction

Welcome to the June 2010 edition of our Heart Disease & Stroke Newsletter. The e-Newsletter has been formatted for monochrome printing should you wish a paper copy.

This month we are keen to learn how you use the information we provide to aid the planning and provision of services for patients. We would be grateful for any feedback you may have on this issue. Perhaps you approached us for an adhoc data analysis or used our web site tables for a particular purpose. Feedback can be directed to Adam Redpath, Heart Disease & Stroke Programme Principal, (adam.redpath@nhs.net) or tel 0131 275 6704.

If you have any comments or queries about this newsletter please contact: David Murphy tel: 0131 275 6624 email (david.murphy2@nhs.net) or Lynn Girdwood tel 0141 282 2046, email (lynn.girdwood@nhs.net).

National Clinical Dataset Development Programme (NCDDP)

www.isdscotland.org/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

NCDDP has developed a new logical/navigation model for its data standards and we would recommend contact with NCDDP before proceeding with any implementation.

For further information about this contact Michael Sibley, Programme Principal – NCDDP, tel 0131 275 7066 email (michael.sibley@nhs.net).

NHS Quality Improvement Scotland (NHSQIS)

www.nhshealthquality.org

NHS QIS launched the latest Heart Disease Clinical Standards at an event in April 2010. These are available from the NHS QIS web site.

ISD continues to work with NHS QIS to support the programme of measurement of cardiac services across Scotland covering cardiac rehabilitation, acute coronary syndrome, heart failure and primary care. Measurement is closely allied to the standards.

Discussions were held between NHS QIS and ISD during April and May 2010 regarding progress with the audits. ISD has created and tested analysis programs in preparation for the second round of measurement which commenced in April 2010.  Analysed data will be distributed by NHS QIS over the autumn of 2010.

The next edition of the NHS QIS heart disease newsletter, ‘UPBEAT’, is due for release shortly and will highlight important dates for the measurement elements and the wider programme over the next six months.

ASSIGN - ISD Data Used to Help Prevent Heart Disease

www.assign-score.com/

The ISD Heart Disease & Stroke Programme has completed a record linkage between the Scottish Heart Health Extended Cohort with subsequent hospital discharges from ISD’s Scottish Morbidity Record (SMR01) data scheme and General Register Office for Scotland (GROS) death registrations which will allow researchers at Dundee University to update the risk scoring tool, ASSIGN.

The ASSIGN score is designed to identify patients at higher risk of developing Coronary Heart Disease (CHD). This calculates the risk of developing cardiovascular disease over a 10 year period taking account of factors such as age, social deprivation, smoking, blood pressure and cholesterol level. See ASSIGN Score website for further details.

SCI-CHD-ACS

Version 2010.1 – NHS QIS

Functionality to support the current round of NHS QIS audit was released to the live system on 13th April 2010.

Current Funding - Care and Maintenance

The Scottish Government has reduced the national funding of SCI-CHD ACS to care and maintenance only for 2010/11. The system will be fully supported to maintain the current service. This will include error investigation and resolution, critical patch builds, post release monitoring plus general system administration and housekeeping. No new functionality or change requests will be incorporated into the system.

National Networking Model – Phase 1 (View only)

Following the initiative to gain Caldicott Guardian agreement on sharing patient records across NHS Scotland within SCI-CHD ACS, Phase 1 of the National Networking Model is now available for switch on in each individual board. This allows users of the system to view records that have been entered in other hospitals/Health Board Areas. This service is configured locally and will require a designated super user to manage the service within each board.

If you wish to have a local user assigned with the ability to configure this service please contact Lynne Buttercase, SCI-CHD Operational Project Manager (lynne.buttercase@nhs.net). A copy of the Data Sharing Protocol signed by the Boards Caldicott Guardian will be required prior to user accounts being distributed.

SCI-CHD-ACS and UK Myocardial Ischaemia National Audit Project (MINAP)

In the September 2009 Programme newsletter we indicated that a service exists to allow the extraction of SCI-CHD-ACS data for submission, via ISD, to the UK Myocardial Infarction Audit Project (MINAP). The process was updated some months ago to reflect an update of MINAP to version 8 from October 2009. The service remains available and if you wish your hospital’s SCI-CHD-ACS data to be extracted and submitted you can approach ISD in the first instance and we will liaise with SCI-CHD-ACS team to arrange the initial data extract.

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).

Scottish Stroke Care Audit (SSCA)

www.strokeaudit.scot.nhs.uk

The SSCA Annual National Report (presenting data from 2005-2009) will be published on 29th June 2010 (3 months earlier than last year), providing more timely information to centres, NHS Boards and the Scottish Government Health Department.

A Public Summary version of the report will also be published this year which will give patients, carers and members of the public a clearer understanding of the audit, standards and outcomes. It is planned to evaluate this version of the report in collaboration with relevant Patient Associations, i.e. Chest, Heart and Stroke Scotland and The Stroke Association.

Monthly data is now being routinely submitted by all centres, analysed and reports returned to Stroke Managed Clinical Networks within NHS Boards within 3 weeks focussing on outcomes relating to the NHS QIS stroke standards. This process promotes a more timely approach to measuring performance against standards and allows centres to act upon findings more quickly.

Pilot audit of Carotid Interventions commenced on 1st April 2010 and will run through to 30th September 2010. It will be completed in two centres and findings will be reported early 2011.

Patient/ carer information leaflets were evaluated in May 2010 and an updated version will be issued to all centres in July 2010. The new version will be an Easy Access Version for patients and carers. Patient/ carer posters were also evaluated and will be re-issued to all centres in July 2010.

Other aspects of the audit continue to be reviewed/ developed, e.g. the SSCA Computer System, redesign of the SSCA website and development of quarterly newsletters as well as work to begin linking data with other sources, e.g. pre-hospital – Scottish Ambulance Service and NHS24.

For further information about the audit, contact:

Hazel A Dodds
Clinical Coordinator for Scottish Stroke Care Audit
Gyle Square (143c)
1 South Gyle Crescent
Edinburgh EH12 9EB UK
0131 275 7184 (Mon /Wed/ Thurs)
0131 537 3584 (Tues)
07825 933083 (Mon – Thurs)
hazeldodds@nhs.net

Heart Disease & Stroke Online

ISD’s Heart Disease and Stroke websites 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.

The annual update to these web pages is likely to be delayed by around 3 months or so (e.g. February 2011) because of staff resource issues within the Heart Disease & Stroke Programme and our current focus on the NHS QIS audits.

There will be one addition to the web site during the coming months as we host information about the HEAT target on Inequalities Targeted Cardiovascular Health Checks. HEAT is a web-based Business Objects dashboard system to allow the Scottish Government and NHS Boards to monitor Boards’ performance against Local Delivery Plans.

The HEAT targets are aligned with the National Performance Framework. See the Scotland Performs for further information.

If you are interested in details about our Heart Disease & Stroke web pages please contact either of: David Murphy Tel: 0131 275 6624 email: david.murphy2@nhs.net or Lynn Girdwood tel 0141 282 2046, email lynn.girdwood@nhs.net.

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 related 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. The majority of day case records affected by this issue have been corrected by NHS Lothian but a number of inpatient records remain unresolved.
  • Please bear this issue in mind when viewing existing, published information on our Heart Disease & Stroke web pages that is presented at sub-national level.

Clinical Coding of Myocardial Infarction

This section repeats content from the March 2010 newsletter as a reminder that definitional changes will be publicised in the coming months.

The web pages above and many other published statistics use the World Health Organization’s International Classification of Diseases 10th revision (ICD10) to record information on diagnoses.

The recording of myocardial infarction (MI) is important for many purposes, including, for example, comparisons of post MI mortality between hospitals and the planning of services (e.g. planning levels of provision of cardiac rehabilitation).

The introduction of more sensitive tests has meant an increase in numbers being diagnosed as having had a myocardial infarction. There is a need to distinguish the more severe type of MI (ST elevated MI or STEMI) and the other type of MI (non-ST elevated MI or NSTEMI) as they have different treatment protocols and prognoses.

ISD proposes, with the agreement of the CHD Audit & Indicators Steering Group, to introduce a code suffix for use with the ICD10 codes for MI to distinguish between the different types of MI on SMR01 data.

The planned implementation date for the new codes is October 2010. Instructions and guidance will circulated by ISD well in advance.

If you have any queries please contact Adam Redpath tel 0131 275 6704 or email (adam.redpath@nhs.net).

British Heart Foundation (BHF)

BHF publish information on heart disease in their annual UK statistical compendium (Heartstats) and BHF staff met ISD last month (May) to discuss the issue of the inclusion of information from Scotland in future publications.

Useful Links

ISD’s Heart Disease and Stroke web sites. These include archive copies of our quarterly newsletter from September 2004.

The Scottish Government

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.

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)

NHS Quality Improvement Scotland (NHSQIS)

ISD Clinical Coding Guidelines

ISD Clinical Coding Guidelines newsletters from May 1996.

Myocardial Ischaemia National Audit Project (MINAP)

Myocardial Ischaemia National Audit Project (MINAP) publishes an annual report of results of the audit. The Royal College of Physicians website contains further information about MINAP.

SIGN Guidelines

Scottish Intercollegiate Guidelines Network (SIGN) launched, in June 2010, two guidelines related to stroke:

No.118 Management of patients with stroke: rehabilitation, prevention and management of complications, and discharge planning

No.119 Management of patients with stroke: Identification and management of dysphagia

Scottish Public Health Observatory (ScotPHO)

The ScotPHO web site includes information related to coronary heart disease and stroke in its “Scotland and European Health for All (HfA) Database 2009” and is a valuable source of international comparisons.

ISD’s Clinical Indicators Support Team (CIST)

ISD’s Clinical Indicators Support Team (CIST) publishes information on 30-day survival following emergency hospital admission for acute myocardial infarction and stroke.

ISD - Heart Disease & Stroke Presentation

Our Programme Principal, Adam Redpath, gave a presentation to nurses at Edinburgh’s Royal Infirmary in April 2010, providing an overview of the work of Heart Disease & Stroke Programme and describing some of the sources of information available on the topic and the results of their analysis in relation to heart disease.

ISD - Record Linkage

ISD’s Record Linkage staff were involved in the provision of analyses resulting in the publication, in the British Medical Journal, of a study examining self reported toothbrushing behaviour and its association with cardiovascular disease and markers of inflammation.

Feedback

We welcome your feedback, comments and ideas.
Please contact either of:
David Murphy
ISD Heart Disease & Stroke Programme
ISD Scotland
Gyle Square (122a)
South Gyle
Edinburgh
EH12 9EW

Lynn Girdwood
ISD Heart Disease & Stroke Programme
ISD Scotland
Cirrus House
Glasgow Airport Business Park
Paisley
PA3 2SJ

You can send an e-mail to: david.murphy2@nhs.net (telephone 0131 275 6624) or lynn.girdwood@nhs.net (telephone 0141 282 2046).

You have received this because your contact details are part of our Heart Disease & Stroke Programme circulation list. If any of these details are wrong, please let us know.

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