Coronary Heart Disease & Stroke Programme
NEWSLETTER
(Quarterly)
Issue: 20
September 2009
In this issue: Introduction, National Dataset Development in CHD and Stroke, NHS
QIS, SCI-CHD ACS, Scottish Stroke Care Audit, ISD Online, Conferences, Useful
Links, European Society of Cardiology report.
Introduction
Welcome to the September 2009 edition of our CHD & Stroke Newsletter. The eNewsletter 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.
Although we’re referred to as the Coronary Heart Disease & Stroke Programme
we have traditionally included information on other forms of heart disease so will
be changing our programme name to ‘heart disease & stroke’ to reflect this. This
is also a reflection of the broader remit of the Scottish Government’s strategy
“Better Heart Disease and Stroke Care Action Plan” to include other heart
diseases such as inherited cardiac conditions.
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 moved to NHSMail from 25th June 2009 so previous “@isd”
email addresses no longer work. You can check ISD contacts’ email addresses in
the NHSMail directory at http://www.nhs.net (from this web site choose “Search
Directory” at the top of the NHSMail home page). You don’t need to log in to
NHSMail to do this.
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 for NCDDP queries are available at
http://www.isdscotland.org/isd/4998.html .
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NHS Quality Improvement Scotland (QIS)
We continue to work with NHSQIS in their national audits of acute coronary
syndromes (ACS) and cardiac rehabilitation in Scotland.
Programme analysts have discussed, with NHSQIS, the details of the analyses
required and are preparing computer programs in advance of the audit data being
collected and sent to ISD.
See http://www.nhshealthquality.org/nhsqis/6009.html and
http://www.nhshealthquality.org/nhsqis/files/HeartDisease_CHDResourcePack_M
ay09.pdf for further details about these audits from NHSQIS. Also, see NHSQIS
draft standards document, for coronary heart disease prevention and treatment,
at:
http://www.nhshealthquality.org/nhsqis/files/HeartDisease_CHDDraftStandards_F
EB09.pdf
Information on cardiac rehabilitation in other parts of the UK (England, Wales and
Northern Ireland) is available from the 2009 report of the National Audit of
Cardiac Rehabilitation, based at the University of York. See their web site at
http://www.cardiacrehabilitation.org.uk/nacr/ (specifically
http://www.cardiacrehabilitation.org.uk/nacr/docs/2009.pdf) for details.
Scottish Care Information – Coronary Heart Disease (SCI-CHD)
Acute Coronary Syndrome (ACS)
Version 5.3 (2009.2)
This version of SCI-CHD ACS was released on 17th June 2009. This version
included:


NHS QIS functionality to allow electronic collection of the ACS QIS
dataset
a small number of other prioritised change requests and bug fixes.
Version 2009.3
This version of SCI-CHD ACS includes a number of prioritised change requests
that will improve usability of the discharge letter and associated data fields. Most
of these changes have been highlighted during the initial use of the system in the
Golden Jubilee National hospital. This version is scheduled for release to the live
server on 17th November 2009.
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
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achieved Phase 1 of the model will be switched on which will allow the "viewing"
of episodes from other hospitals within a regional network framework.
The analysis of Phase 2 is continuing. This will allow the sharing of edit rights
between hospitals involved in the care of a patient. The intention is to commence
development on this work as soon as Caldicott Guardian approval has been
achieved.
Implementation
Since the Golden Jubilee National Hospital commenced use of SCI-CHD for the
production of immediate discharge documents, the system is now being used in
28 hospitals across NHS Scotland.
NHS Lanarkshire continues to work toward switching on SCI-CHD ACS in autumn
2009.
ISD CHD & Stroke Programme & SCI-CHD-ACS
Having tested the process of obtaining a SCI-CHD-ACS extract and uploading
this to version 7 of MINAP, we have converted the process to deal with the new
version 8 of MINAP which will replace its predecessor from October 2009.
SCI-CHD-ACS users with an interest in having their data contribute to MINAP can
request this. We are arranging to discuss, with the Clinical Technology Centre at
Ninewells Hospital, exactly how the process will work but, in theory, users can
request that their data be exported from SCI-CHD-ACS and passed to ISD for
MINAP upload. They can then log in to MINAP to view the results of the upload,
assuming they have been set up by MINAP to do this.
The intention is that the MINAP report, once established, will form the basis of
routine STEMI audit reporting, replacing the existing arrangements where STEMI
reports are prepared, either on an Excel template or exported from SCI-CHDACS, and sent to ISD for compilation in to an ‘all contributors’ summary. The
development of the NHSQIS acute coronary syndrome audit has become the
focus of attention with regard to information on STEMI patients.
Although a web based system to allow access to MINAP reports (on door-toneedle time, discharge medication etc.) is being developed, at present users can
only view their results using the Lotus Notes application (see
http://www.ic.nhs.uk/services/national-clinical-audit-support-programmencasp/heart-disease/myocardial-infarction/getting-started-data). We're aware
there are issues with the implementation of Lotus Notes in NHSScotland and
we're investigating alternative solutions.
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 about SCI-CHD-ACS, please refer to the SCI-CHD-ACS
web site http://scichd.scot.nhs.uk or contact Lynne Buttercase, SCI-CHD-ACS
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Operational Project Manager Tel: 01382 632 466, e-mail:
lynne.buttercase@nhs.net
Scottish Stroke Care Audit (SSCA)
The latest SSCA National Report is due to be published on 29th September 09
and presents data describing the quality of stroke care in each acute hospital
grouped by NHS Board from 2007 to 2008.
The report also allows each hospital and NHS Board not only to compare their
performance with current national standards (2004-2008), but also with new
national standards published in June 2009 and with other organisations. Hospitals
with less satisfactory performance can learn from those where services are of
higher quality. The main report will be circulated widely and will be available
online (http://www.strokeaudit.scot.nhs.uk/).
The SSCA Steering Group is leading developments within SSCA with the first
priority being a review of the core dataset which will be circulated to all centres in
September 09. The core dataset will be significantly reduced and will focus on
key areas.
Following this other aspects of the Audit will be reviewed, e.g. the SSCA
Computer System, proformas, definitions, guidelines etc. as well as development
of project resources to support the audit.
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
ISD Online http://www.isdscotland.org
CHD & Stroke
Work is underway to update our CHD & Stroke web pages at
http://www.isdscotland.org/chd and http://www.isdscotland.org/stroke for their
annual publication on 24th November 2009.
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As with previous years, the publication will include estimated prevalence (of
coronary heart disease), prescribing, hospital-based incidence, hospital activity
(including operations), mortality and survival.
We are currently adapting computer programs to deal with this annual publication
in preparation for the October 2009 monthly update to the source data used to
generate the web site analyses.
The example below, drawn from the current CHD web site, shows the trend in the
number of prescriptions issued by general practitioners and the costs associated
with these. The reduction in costs in later years is attributed to these drugs
moving ‘off patent’ as cheaper generic versions become available.
Cardiovascular Drugs ; Cost and Number of Prescriptions
25
250
20
200
15
150
10
100
5
50
0
0
1998
1999
2000
2001
2002
2003
Number of Prescriptions (Millions)
2004
2005
2006
2007
Cost (£ millions)
(Source: http://www.isdscotland.org/files/CV_drug_prescriptions_G1.xls)
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 .
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.
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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)
Adam Redpath, our CHD & Stroke Programme Principal, participated in the 2009
conference of the European Society of Cardiology in Barcelona from 29th August
2009 to 2nd September 2009. Adam presented a paper on the trends in the
incidence, mortality and treatment of coronary heart disease in Scotland over the
period 1998-2008. Adam’s report of the conference appears at the end of this
newsletter.
CHD & Stroke Programme & British Heart Foundation (Scotland)
ISD and BHF Scotland staff met on 7th September 2009 to share knowledge and
information from our respective work in the heart disease and stroke spheres.
BHF Scotland Director, Marjorie Burns, provided a brief overview of their work in
Scotland, and the UK, and then more detailed discussions occurred with BHF
staff on the topics of prevention and care, policy and public affairs and the BHF’s
statistical publications from their Business Unit. ISD staff offered presentations on
trends in the incidence, mortality and treatment of coronary heart disease in
Scotland (Adam’s Barcelona talk) and the use of routine ISD data to predict
subsequent mortality for patients undergoing coronary artery bypass graft.
Opportunities for joint working were also discussed and this will be pursued at
future meetings.
Scottish Health Informatics Programme (SHIP), 17th to 19th September 2009
at St Andrew’s
Programme members, David Clark and John Quinn, have had abstracts accepted
for presentation at the SHIP conference at St Andrew’s on 19th September 2009.
The topics are (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.
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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 is meeting again on 23rd September
2009. See http://www.scottish.parliament.uk/msp/crossPartyGroups/groups/cpgchd.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 Newsletter 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/CLINICALSTANDARDS/ORGANISATION/PARTNERSHIP/Pages/MINAP-.aspx for details
and http://www.rcplondon.ac.uk/clinicalstandards/organisation/partnership/Documents/Minap-2008.pdf for the 2008
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/scotlandspopulation-2008-the-registrar-generals-annual-review-of-demographic-trends154th-edition/scotlands-population-2008-the-register-generals-annual-review154th-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
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http://www.scotpho.org.uk/home/Comparativehealth/InternationalComparisons/Sc
otland_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.
FeedbackWe welcome your feedback, comments and ideas.
Please contact:
David Murphy
CHD & Stroke Programme
ISD Scotland
Gyle Square (122a)
South Gyle
Edinburgh
EH12 9EW.
You can send an e-mail to: david.murphy2@nhs.net or telephone on 0131 275
6624.
You have received this because your contact details are part of our CHD & Stroke
Programme circulation list. If any of these details are wrong, please let us know.
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European Society of Cardiology (ESCARDIO) Congress
Barcelona, 29 August – 2 September 2009
Report from ISD’s delegate - Adam Redpath
(Programme Principal Heart Disease and Stroke Programme)
Summary
I attended the congress to deliver a paper on ‘Changes in the incidence, mortality
and treatment of CHD in Scotland- 1998-2008’ . The event was huge - with
around 30,000 delegates from a variety of specialisms - i.e. general cardiologists,
interventional specialists, cardiac surgeons, radiologists, general practitioners and
public health professionals. The tension between the need to spend money to
prevent CHD (both primary and secondary prevention) and the development of
high-tech, expensive drugs, scanners and devices (e.g. Implantable Cardiac
Defibrillators) has become more acute as the economic downturn hit health
budgets across Europe. Full details, including presentations, papers etc can be
found at - http://www.escardio.org/CONGRESSES/ESC2009/Pages/welcome.aspx.
Prevention & politics
The EUROASPIRE surveys across Europe show that hardly any CHD patients
have achieved all the target levels for BP, cholesterol, smoking and BMI. The UK
was top of this particular league table, apparently due to greater efforts made by
GPs rewarded by the QOF (Quality & Outcomes Framework) scheme. Although
we have amongst the lowest intervention rates in Western Europe we have the
best prevention strategy.
The ESC aims to persuade the EU, under the Spanish Presidency in 2010, to
give Cardiovascular Disease prevention an EU Council Recommendation. This
would encourage member states to adopt policies designed to promote heart
health.
Preventative aspirin for the non-symptomatic at-risk population was shown to
offer more disbenefits (bleeding complications) than benefits. The study was
presented by Professor Gerry Fowkes of Edinburgh University http://www.guardian.co.uk/society/2009/aug/31/aspirin-british-heart-foundation
Smoke-free legislation
Professor Jill Pell presented data from the STOPIT study at the Smokefree
Conference in Edinburgh in 2007 and showed a 17% decline in emergency
admissions for acute myocardial infarction (AMI) following the introduction of the
smoke-free legislation in March 2006. The BBC published a review of the study
casting some doubts on her results, but recent data from France and Italy has
found similar results to the STOPIT study http://www.escardio.org/congresses/esc-2009/news/pages/smoking-bans.aspx
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Scanning
Advances in CT scanning continue, although not everyone was convinced that
mass scanning of at-risk populations is desirable. The downsides included
worries about radiation doses. Health technology to reduce this is advancing and
there are doubts about whether a scan provides definitive evidence of a patient’s
need for angioplasty. The upside is, of course, that CT scans are not invasive, as
angiographies are. See
http://www.escardio.org/about/press/press-releases/pr-08/pages/ct-scan-versusangiography-statement.aspx
Risk scores
The ESC is promoting the Systematic Coronary Risk Evaluation (SCORE) system
to predict 10 year risk. See http://www.escardio.org/guidelines-surveys/escguidelines/GuidelinesDocuments/guidelines-SCORE-FT.pdf. England is
promoting the QRISK score and Scotland the ASSIGN score.
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