NHS Direct Wales
Welsh Assembly Links
Cardiac Disease
Background
Cardiac disease places a heavy burden of premature death and ill health on the Welsh nation. Tackling this is a Welsh Assembly Government priority for service improvements.
Coronary heart disease (CHD) is caused by the narrowing of the arteries that supply the heart and is due to a gradual build-up of fatty material called atheroma. The narrowing can cause myocardiacl infarction (heart attack), angina (pain or discomfort in the chest or neighbouring parts of the body due to insufficient pxygen reaching the heart) and other forms of chronic heart disease. In Wales in 2004 CHD was responsible for over 6,000 deaths – just under 19% of all deaths. Although the number of people dying from CHD in Wales have been falling over the past three decades, the death rate from CHD varies considerably, with the highest rates in the south Wales valleys and north east Wales. The death rate in the most deprived fifth of wards is almost a third higher than in the least deprived fifth. This variation presents a challenge to all those involved in cardiac care.
Heart Failure is the only major cardiovascular disease with increasing incidence and prevalence mailnly due to the greater numbers of heart attack survivors o the increasingly elderly population.
Arrhthymias are electrical disorders of the heart ; these also place a considerable burden of diesase on Welsh communities accounting for more than 3,000 sudden deaths each year in Wales.
In Wales around 425 children are born each year with congenital heart disease. Survival rates for these children have improved significantly over the last fifty years and as a result there are more adults than children with congenital heart disease.
The Cardiac Disease National Service Framework (NSF) for Wales, published in July 2009 is the key policy document for the delivery and development of services for the range of cardiac disease outlined above.
Strategy and policies
The Cardiac Disease NSF updates the Coronary Heart Disease NSF 2001 and takes into account Designed for Life, Review of Health and Social Care in Wales and Health Evidence Bulletin: CHD, together with developments in clinical practice. It contains seven Standards which are:
- Promoting healthy hearts
- Managing risk factors for cardiovascular disease : Preventing further heart damage in those with high risk factors or established disease
- Managing the care of patients with coronary heart disease
- Managing the care of patients with chronic heart failure
- Managing the care of patients with arrhythmias and families of young victims of cardiac arrest
- Providing cardiac rehabilitation
- Managing the care of adults with congenital heart disease
The ultimate purpose of a National Service Framework is to improve health outcomes. This NSF takes account of the latest scientific and clinical evidence and so provides an up to date basis for planning and developing services for the prevention and treatment of cardiac disease.
The Cardiac Quality Requirements (QRs) have been developed with the service to support the updated Cardiac Disease National Service Framework (NSF). The full set of QRs represents a significant step forward in the quality assurance of cardiac services in Wales. The QRs describe the standards of high quality care that will be in place once the Cardiac Disease NSF has been fully implemented.
A Strategic Framework sets out a cardiac work programme for Walesis underpinned by the Cardiac Disease National Service Framework and the Quality Requirements.
Services
The Cardiac Networks Co-ordinating Group (CNCG) supports the Welsh Assembly government, the Regional Cardiac Networks and other National stakeholders with advice and guidance on the cardiac related strategy, policy and standards, and workforce issues. The Cardiac Networks provide regional focus for the improvement of cardiac services. The Cardiac Networks of Wales website provides links to the regional Cardiac Networks and information on national cardiac clinical audit, publications, national groups and current events.
- The Cardiac Networks of Wales
- Mid and South West Wales Cardiac Network
- North Wales Cardiac Network
- South East Wales Cardiac Network
Service Planning
Public Health Wales Observatory has produced a set of regional cardiac network profiles to assist the Networks in their understanding of the patterns of disease and risk factors and to assess whether the needs of the populations they serve, in respect of cardiac care, are being met appropriately. The reports will also be of interest to others within the health service including those working in local health partnerships.
A report examining the provision of angiography and revascularisation in Wales was published in September 2009. This work was undertaken at the request of the Welsh Cardiac Networks to assist the planning and equitable delivery of cardiac services across Wales.
Public Health Wales also collates data on the levels of coronary heart disease in the Welsh population. Such data allows significant trends and any particular groups of the population affected to be identified, and enables effective delivery of high quality, accessible and appropriate specialist public health services, both in partnership and support of other national and local bodies.
Public Health Wales Wider Determinants and Health Inequalities Team has produced Frameworks for Action on Physical Activity, Nutrition and Tobacco Control. These make recommendations for activity to be delivered by local partners. Through its health improvement programmes, the Trust aims to use evidence based interventions to reduce tobacco smoking and alcohol intake, improve diet and increase physical activity levels for the population of Wales.
- Framework for Action on Physical Activity
- Frameworks for Action on Nutrition
- Frameworks for Action on Tobacco
Public Health Wales has produced a series of interactive tools to help NHS organisations estimate the capacity of cardiac rehabilitation required to meet National institute of Health and Clinical Excellence (NICE) standards. Cardiac rehabilitation has been proved to be effective and has the potential to prevent premature deaths.
National Programmes
Health Challenge Wales has been developed to help contribute towards preventing ill health. It signposts members of the public to information or activity to help them improve their own health.
Physical Activity and Nutrition Networks Cardiovascular page contains information, advice, support and counselling which is provided from a wide range of professional staff on lifestyle changes, diet, exercise, smoking, weight control, symptom recognition, weight control, smoking and stress management.
The Welsh Assembly Government is investing over £4 million over three years (2008 – 2011) to support, develop and evaluate exercise referral schemes in Wales.
Exercise referral or GP referral describes the process by which patients are 'prescribed' a programme of physical activity. This guide details specific advice on setting up, running and evaluating exercise referral schemes
Stop Smoking Wales is the smoking cessation service in Wales and offers free, friendly support for smokers who are ready to stop.
Resources
Map of Medicine provides a visualisation of the ideal, evidence-based patient journey for common and important conditions including CHD. NICE Cardiovascular Guidance is designed to promote good health and prevent ill health. NHS Evidence is a web-based service that provides access to high quality clinical information aimed at health professionals.
- Map of Medicine - Heart Failure (NHS Choices England - patient view)
- NICE Cardiovascular Guidance
- NICE Guidance on the prevention of cardiovascular disease at the population level
- NHS Evidence - Cardiovascular specialist Library
Statistics
The Office for National Statistics ONS produces data on circulatory diseases mortality, the Welsh Health Survey reports on lifestyles and illness in Wales and the Quality and Outcomes Framework includes primary care data by clinical summary (CHD etc) and by Local Health Board.
- ONS circulatory diseases Mortality Statistics
- Welsh Health Survey
- The General Medical Services Contract QOF Achievement Data 2008/2009
Statistics on referral to treatment times for cardiac services are produced by the Welsh Assembly Government according to the arrangements approved by the UK Statistics Authority.
IPU manages and maintains the main NHS Wales repository for all-Wales health data, especially that relating to hospital activity. The Welsh Health Information and Statistics internet site has been developed to help meet the information requirements of NHS, Government and other public bodies, researchers and the general public
Health Maps Wales is an interactive tool that can be used to explore a variety of health indicators grouped under broad categories, such as CHD, common procedures and causes of injury. The first release concentrates on data relating to hospital admissions from the Patient Episode Database for Wales (PEDW)
Annual Patient Episode Database Wales (PEDW) Tables offers Headline figures relating to hospital admissions (inpatient, day case admissions) available for download for in Portable Document Format (PDF).
