1. PRIMIS Third National Conference Tuesday 1 April 2003 Birmingham HIP for CHD Jane Matthews Practice Nurse Dr. Dai Evans PRIMIS Regional Clinical Adviser

2. PRIMIS Third National Conference Tuesday 1 April 2003 Birmingham Coronary Heart Disease The size of the problem Kills more than 110,000 people a year in England Of these, 41,000 are under the age of 75 years 1.4 million people in the UK have angina 300,000 people have an MI each year 46% CHD related deaths occur in people with established disease 3–5% of GP population have CHD

3. PRIMIS Third National Conference Tuesday 1 April 2003 Birmingham Coronary Heart Disease Exemplifies inequalities in health Ethnic variations Research has led to better evidence to guide the treatment of CHD Many patients do not receive treatment of proven effectiveness Huge variations in quality and access to services

4. PRIMIS Third National Conference Tuesday 1 April 2003 Birmingham NSF for CHD Launched March 2000 Established national standards for prevention and treatment of CHD Defined targets and goals to be achieved within agreed timescales Progress can be measured against performance indicators

5. PRIMIS Third National Conference Tuesday 1 April 2003 Birmingham NSF for CHD Standards 1 and 2 reducing Heart Disease in the population Develop, implement and monitor policies that reduce the prevalence of CHD risk factors in the population, and reduce inequalities in risk of developing CHD Contribute to a reduction in the prevalence of smoking in the local population

6. PRIMIS Third National Conference Tuesday 1 April 2003 Birmingham NSF for CHD Standard 3 preventing CHD in high risk patients Secondary prevention General Practitioners and Primary Health Care Teams should identify all people with established cardiovascular disease, and offer them comprehensive advice and appropriate treatment to reduce their risks

7. PRIMIS Third National Conference Tuesday 1 April 2003 Birmingham NSF for CHD Standard 4 preventing CHD in high risk patients Primary prevention General Practitioners and Primary Health Care Teams should identify all people at significant risk of cardiovascular disease who have not developed symptoms, and offer them appropriate advice and treatment to reduce their risk

8. PRIMIS Third National Conference Tuesday 1 April 2003 Birmingham NSF for CHD Standards 5 - 12 Standards 5,6 and 7 Heart attacks and other acute coronary syndromes Standards 8 and 9 Stable angina Standard 10 Revascularisation Standard 11 Heart failure Standard 12 Cardiac rehabilitation

9. PRIMIS Third National Conference Tuesday 1 April 2003 Birmingham NSF for CHD Immediate priority – changing behaviour Smoking Stop smoking advice Nicotine replacement therapy Include advice on reduction of CHD risk

10. PRIMIS Third National Conference Tuesday 1 April 2003 Birmingham NSF for CHD Use of effective treatment Anti-platelet therapy / anticoagulation IHD / CVD / AF Lowering cholesterol Dietary advice Statins Control of B/P <140/85 Beta-blockers post MI ACE inhibitors post MI / LV dysfunction

11. PRIMIS Third National Conference Tuesday 1 April 2003 Birmingham NSF for CHD Effective use of clinical systems To identify people with CHD disease register To identify people at high risk of developing CHD To assist in the regular review of patients with CHD record lifestyle data / advice record events / changes in management document prescribing practice manage concurrent disease

12. PRIMIS Third National Conference Tuesday 1 April 2003 Birmingham NSF for CHD Primary Care milestones and goals April 2001 A systematically developed and maintained practice-based CHD register is in place, and actively used to provide structured care to people with CHD

13. PRIMIS Third National Conference Tuesday 1 April 2003 Birmingham NSF for CHD Primary Care milestones and goals April 2002 A protocol describing the systematic assessment, treatment, and follow up of people with CHD has been agreed locally, and is used to provide structured care

14. PRIMIS Third National Conference Tuesday 1 April 2003 Birmingham April 2003 Clinical audit data no more than 12 months old which describes use of relevant effective interventions in primary care, angina and heart failure which records the offer of advice about the specific interventions to those in whom they are indicated NSF for CHD Primary Care milestones and goals

15. PRIMIS Third National Conference Tuesday 1 April 2003 Birmingham NSF for CHD Computer templates Data entry screens which allow the user to record specific information to be used in the management of health and disease processes Can be set to be activated by the use of specific Read codes

16. PRIMIS Third National Conference Tuesday 1 April 2003 Birmingham NSF for CHD Templates Advantages consistent efficient prompts the need for management change Disadvantages time consuming inflexible complicated

17. PRIMIS Third National Conference Tuesday 1 April 2003 Birmingham NSF for CHD Making it happen Team approach regular meetings annual audit annual plan decision making CHD specialist nurse co-ordinates care IT is a tool