Heart Disease & Stroke

Quarterly newsletter

March 2010 - Issue 22

Introduction

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

As mentioned in the September 2009 newsletter, we’re changing our name to the Heart Disease & Stroke Programme to reflect the broader remit of our work and its alignment with the Scottish Government’s strategy "Better Heart Disease and Stroke Care Action Plan”.

Cheuk Ming Yuen joined the Programme in January 2010. Lorna Jackson became our Head of Programme following the retirement of Mary Sweetland in September 2009. Adam Redpath’s connection with the Programme reduces to half-time and we hope to involve a further information analyst as a result.

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 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

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

We continue with the creation and testing of analysis programs in preparation for the second round of measurement that is due to commence in April 2010.  Analysed data will be distributed by NHS QIS over the autumn of 2010.

See the NHSQIS heart disease newsletter for further information.

SCI-CHD-ACS

Version 2009.3

This version was released on 11th January 2010. The release included improvements to the data entry screens and discharge letter format including a more streamlined method of recording Discharge Medications.

Version 2010.1

Changes to the NHS QIS data entry form have been received from QIS in line with the next round of audit taking place April – June 2010. These changes will be incorporated into the system and released prior to 14th April 2010 for use by NHS boards wishing to use SCI-CHD to collect QIS data.

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.

Implementation

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

For further information please contact Lynne Buttercase, SCI-CHD-ACS Operational Project Manager, Tel: 0138 263 2466 or e-mail lynne.buttercase@nhs.net

Scottish Stroke Care Audit (SSCA)

www.strokeaudit.scot.nhs.uk

Developments are continuing within SSCA. The new core datasets, definitions and proformas for inpatient, outpatient and thrombolysis were introduced to all centres on 1st January 2010. Prospective data collection commenced in all centres on 1st January 2010 and data from all centres across Scotland are now being held centrally within ISD.

Initial analysis of this data is ongoing. Centres are now submitting data on a monthly basis and ISD will be producing monthly reports focusing on the QIS standards for stroke. They will be distributed to all Managed Clinical Networks in order to promote a more timely approach to measuring performance against standards and allowing centres to act upon findings more quickly.

The first monthly reports are due to be issued to centres at end Feb/ beginning of March 2010.

A pilot audit of Carotid Interventions will commence on 1st April 2010 and run through to 30th September 2010. It will be completed in two centres and findings will be reported towards end 2010/ beginning 2011.

It is planned to publish this year’s SSCA Annual Report (containing 2009 data) on 29th June 2010 (3 months earlier than last year), again providing more timely information to centres, NHS Boards and the Scottish Government Health Department.

Patient/carer information leaflets highlighting SSCA and informing patients that their information will be used for audit purposes were distributed to all centres in December 2009. They will be evaluated in May 2010 and an updated version issued in June/July 2010. The new version will be an Easy Access Version for patients and carers.

Patient/carer posters were issued to all centres in December 2009 to be posted in relevant wards and departments highlighting to patients who have had a stroke that information is being collected about them and their treatment over the course of their care and giving them the option to be excluded from this audit.

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

Clinical Coding of Myocardial Infarction

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 be 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).

SLiDE

SLiDE (Studies using Linked ISD Data for Epidemiology) is a collaboration between ISD staff, university researchers and clinicians and aims to use centrally held ISD data for research purposes. A list of published papers from those involved in SLiDE appears as an appendix to this newsletter.

For further information about SLiDE please contact: Adam Redpath, Programme Principal, ISD Heart Disease & Stroke Programme, adam.redpath@nhs.net or tel 0131 275 6704.

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.

General Register Office Scotland (GROS)

The General Register Office Scotland (GROS) maintains a database of death registrations data. The Registrar General for Scotland published his latest annual report in August 2009 on the demographic trends affecting Scotland’s population.

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.

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).

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.

Published papers from the SLiDE collaboration

Sex Differences in Incidence, Mortality, and Survival in Individuals With Stroke in Scotland, 1986 to 2005
Lewsey JD, Gillies M, Jhund PS, Chalmers JW, Redpath A, Briggs A, Walters M, Langhorne P, Capewell S, McMurray JJ, Macintyre K.
Stroke. 2009 Apr;40(4):1038-43.

This study showed lower rates of stroke incidence and stroke mortality in younger women than men. However, higher numbers of older women in the population mean that the absolute burden of stroke is greater in women. Short-term case-fatality is greater in women of all ages and, worryingly, these differences have increased from 1986 to 2005.

Age- and Sex-Specific Trends in Fatal Incidence and Hospitalized Incidence of Stroke in Scotland, 1986 to 2005
Lewsey JD, Jhund PS, Gillies M, Chalmers JW, Redpath A, Kelso L, Briggs A, Walters M, Langhorne P, Capewell S, McMurray JJ, MacIntyre K.
Circ Cardiovasc Qual Outcomes. 2009 Sep;2(5):475-83.

This study showed that the overall incidence of stroke declined steadily and substantially between 1986 and 2005, with a relative reduction in the risk of stroke of 31% in men and 42% in women. Reductions in rates of both hospitalized and nonhospitalized fatal stroke contributed to this overall decline. An increase in incident stroke rates in young people is concerning.

Long-term trends in first hospitalization for heart failure and subsequent survival between 1986 and 2003: a population study of 5.1 million people.
Jhund PS, Macintyre K, Simpson CR, Lewsey JD, Stewart S, Redpath A, Chalmers JW, Capewell S, McMurray JJ.
Circulation. 2009 Feb 3;119(4):515-23.

This study of hospital discharges for heart failure in the Scottish Morbidity Record Scheme showed that first hospitalisations for heart failure are decreasing. This has been accompanied by improvements in 30 day, 1 year and 5 year survival in both men and women.

Discordant short- and long-term outcomes associated with diabetes in patients with heart failure: importance of age and sex: a population study of 5.1 million people in Scotland.
MacDonald MR, Jhund PS, Petrie MC, Lewsey JD, Hawkins NM, Bhagra S, Munoz N, Varyani F, Redpath A, Chalmers J, MacIntyre K, McMurray JJ.
Circ Heart Fail. 2008 Nov;1(4):234-41.

Using Scottish Morbidity Record Scheme data we reported that diabetes was associated with lower case fatality amongst those with heart failure at 30 days but by 1 year those with diabetes had a higher case fatality. This risk was greatest in the young and particularly women.

Long-term outcome of low-risk patients attending a rapid-assessment chest pain clinic.
Taylor GL, Murphy NF, Berry C, Christie J, Finlayson A, MacIntyre K, Morrison C, McMurray J.
Heart. 2008 May;94(5):628-32.
This study of individuals attending a rapid access chest pain clinic to identify coronary heart disease were linked to the Scottish Morbidity Record Scheme database to identify adverse outcomes (a death from coronary heart disease or myocardial infarction). The individuals labelled as “low risk” at the clinic were unlikely to have and adverse coronary outcome.

An epidemiological study of pulmonary arterial hypertension.
Peacock AJ, Murphy NF, McMurray JJ, Caballero L, Stewart S.
Eur Respir J. 2007 Jul;30(1):104-9. Epub 2007 Mar 14.

This paper describes the epidemiology of pulmonary arterial hypertension in Scotland between 1986-2001.

Prognostic impact of pulmonary arterial hypertension: a population-based analysis.
Carrington M, Murphy NF, Strange G, Peacock A, McMurray JJ, Stewart S.
Int J Cardiol. 2008 Feb 29;124(2):183-7. Epub 2007 Apr 11.

This study used Scottish Morbidity Record Scheme data to examine the prognosis of people discharged with a diagnosis of pulmonary arterial hypertension. Survival improved over time but women and the most deprived were at highest risk.

Short-term and long-term outcomes in 133,429 emergency patients admitted with angina or myocardial infarction in Scotland, 1990-2000: population-based cohort study.
Capewell S, Murphy NF, MacIntyre K, Frame S, Stewart S, Chalmers JW, Boyd J, Finlayson A, Redpath A, McMurray JJ.
Heart. 2006 Nov;92(11):1563-70. Epub 2006 Jun 14.

This analysis of the Scottish Morbidity Record Scheme reported that in patients discharged with a diagnosis of angina or myocardial infarction that case fatality was around 5% per year in either group highlighting the need for aggressive secondary prevention in both of these groups.

Hospital burden of suspected acute coronary syndromes: recent trends.
MacIntyre K, Murphy NF, Chalmers J, Capewell S, Frame S, Finlayson A, Pell J, Redpath A, McMurray JJ.
Heart. 2006 May;92(5):691-2. No abstract available.
This report highlighted the increasing burden on the health service of rising hospitalizations for chest pain and angina. It also reported a three fold increase in the rate of coronary revascularization procedures over the period 1990-2000.

Primary care burden and treatment of patients with heart failure and chronic obstructive pulmonary disease in Scotland.

Hawkins NM, Jhund PS, Simpson CR, Petrie MC, Macdonald MR, Dunn FG, Macintyre K, McMurray JJ.
Eur J Heart Fail. 2010 Jan;12(1):17-24.
This study demonstrated that in primary care, chronic obstructive pulmonary disease was a frequent comorbidity in those with heart failure and increases the burden on health care resources. Furthermore, the comorbidity reduced the odds of receiving treatment with beta-blockers which improve survival in heart failure.
A national survey of the prevalence, incidence, primary care burden and treatment of atrial fibrillation in Scotland.
Murphy NF, Simpson CR, Jhund PS, Stewart S, Kirkpatrick M, Chalmers J, MacIntyre K, McMurray JJ.
Heart. 2007 May;93(5):606-12.

In a study of atrial fibrillation in primary care this paper reported that it was more common in men than women but that deprived individuals were less likely to have the diagnosis, raising concerns about socioeconomic gradients in detection. Recommended therapies were also underused in women and older age groups.

Prevalence, incidence, primary care burden and medical treatment of angina in Scotland: age, sex and socioeconomic disparities: a population-based study.
Murphy NF, Simpson CR, MacIntyre K, McAlister FA, Chalmers J, McMurray JJ.
Heart. 2006 Aug;92(8):1047-54. Epub 2006 Jan 6.

This study reported that in primary care angina is a common condition. It occurs more frequently in men and more socioeconomically deprived individuals. Women and older patients were less likely to receive guideline recommended treatments. 

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In this issue

Current Membership

Contact

David Murphy
ISD Scotland
Gyle Square
1 South Gyle Crescent
Edinburgh
EH12 9EB
0131 275 6624
david.murphy2@nhs.net

 

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