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Coronary heart disease
Coronary heart disease (CHD) is a preventable disease that kills more than 110,000 people in England every year. More than 1.4 million people suffer from angina and 275,000 people have a heart attack annually. CHD is the biggest killer in the country. The Government is committed to reducing the death rate from coronary heart disease and stroke and related diseases in people under 75 by at least 40% (to 83.8 deaths per 100,000 population) by 2010.
The National Service Framework for Coronary Heart Disease (NSF CHD), published in March 2000, set out a strategy to modernise CHD services over ten years. It details 12 standards for improved prevention, diagnosis, treatment and rehabilitation and goals to secure fair access to high quality services.
The National Service Framework chapter for arrhythmias and sudden cardiac death was published on 4 March 2005.
Reports detailing the progress made in implementing the Coronary Heart Disease National Service Framework since its publication.
Giving patients more choice about how, when and where they receive treatment is one cornerstone of the government's health strategy. From December 2005, patients needing elective treatment will be offered a choice of appointment and four or five hospitals once their GPs has decided that a referral is required.
Key lifestyle risk factors for CHD include smoking, poor diet and lack of exercise. About ten million people in England smoke - over one in four people. Approximately 20% of CHD related deaths in men and 17% of CHD cases in women are attributable to smoking. The incidence of CHD is highest amongst people who are obese. Overall, 22% of men and 23% of women in England are now obese. Regular physical activity reduces the risk of cardiovascular disease mortality in general and of coronary heart disease mortality in particular. Physically inactive people have about double the risk of CHD.
The CHD NSF and the new GMS contract state that GPs and primary care teams should develop a register of CHD patients, through which they can review medication, offer advice on diet and lifestyle, and maintain the necessary contact with patients most at risk of suffering renewed heart problems. Those at risk should be prescribed statins; these are drugs that reduce the levels of cholesterol (also sometimes called lipids) in the blood.
The shorter the wait the better the outcome for the patient. The NHS delivered a maximum three month wait for heart surgery in March 2005, a vast improvement on the situation in 1996 where some patients in England waited over two years for surgery. A new target has been set for reducing waiting times even further. From 2008 no-one should wait more than 18 weeks from GP referral to hospital treatment, including all diagnostic procedures and tests.
A £600m programme of hospital building is continuing to provide new or expanded heart surgery hospitals in Papworth, Wolverhampton, South Tees, Bristol, Blackpool, Liverpool, Manchester, Southampton, Sheffield, Leeds, Essex, Leicester, Nottingham, Plymouth, Dorset and Somerset, Newcastle, Kent and Hull – the places where they are most needed most.
Approximately 275,000 people in the United Kingdom suffer a heart attack each year. The main treatment for heart attack is the administration of clot dissolving drugs (thrombolysis) which help to restore blood supply in the coronary arteries to the affected part of the heart. A small number of mainly urban centres offer angioplasty as the first treatment for acute myocardial infarction (known as primary angioplasty). DH has set aside £1million to test the feasibility of offering this service more widely.
The National Defibrillator Programme provides automatic external defibrillators (AEDs) in busy public places, such as airports, railway and underground stations, coach stations, as well as to train and retrain employees in life support techniques. Each year over 12,000 people suffer a cardiac arrest in a public place and the programme aims to increase the proportion of people who survive.
CHD affects people in certain sections of society more than in others. It is more prevalent in lower socio-economic groups and certain ethnic minorities. Rates are also higher in certain geographic areas. The CHD NSF requires the NHS and partners to reduce the prevalence of coronary risk factors in the population, and reduce inequalities in risks of developing heart disease. The NSF also requires all NHS organisations to ensure that the services they provide are accessible and acceptable to the people they serve, regardless of their ethnicity. This includes accessing and meeting people’s needs in ways that are culturally, religiously and linguistically appropriate.
Cardiac rehabilitation can improve health outcomes and quality of life in people with coronary heart disease. The evidence suggests that when people are offered comprehensive and tailored help with lifestyle modification, involving education and psychological input as well as exercise training, cardiac rehabilitation can make a substantial difference, perhaps reducing mortality by as much as 20% to 25% over three years. The NSF states that prior to leaving hospital, all heart patients should be invited to participate in a multidisciplinary programme of secondary prevention and cardiac rehabilitation.
Comissioning guide for services for adults with congenital heart disease
Comissioning guide for services for adults with congenital heart disease
Congenital heart disease services are outside the scope of the Department of Health’s National Service Framework for Coronary Heart Disease. An External Reference Group established by the Department of Health has therefore produced guidance specifically for NHS services for adults with congenital heart disease.
Workforce is a key factor in determining successful delivery of the National Service Framework for Coronary Heart Disease. June 2005 figures indicate there are now 231 cardiothoracic surgeons, compared to 182 in 1999-2000, an increase of 27%. Since 1999 the number of cardiologists has grown from 467 to 740.
NewsBeat is a joint Heart Improvement Programme and Department of Health publication. Issued three times a year, it shares policy and service improvement news with the NHS staff working in the cardiac sector.
The most recent DH press releases published on the Government News Network (GNN) website.
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