Heart disease: action plan

8. Appendix A: Progress report – Heart Disease Improvement Plan (2014).

The Heart Disease Improvement Plan (2014) set out a number of priority areas and actions to support improved prevention, diagnosis and management of heart disease in Scotland. These Priorities were;

• Prevention: To champion focused work on inequalities and people at high risk of developing cardiovascular disease.
• Mental Health: To improve wellbeing for patients with heart disease and reduce risk of further clinical deterioration.
• Secondary and Tertiary Care: To ensure patients receive the right investigation and treatment.
• Management and Rehabilitation: To support patients with heart disease to live longer, healthier and independent lives.
• Heart Failure: To improve the journey of care for patients with heart failure by developing a whole system approach to the delivery of care.
• Arrhythmias: To improve the journey of care for patients with arrhythmias.

These key priorities were underpinned by a further two overarching areas of focus which were;

• Patient Information and Engagement: ensure patients and carers have the opportunity to be equal partners.
• Data: deliver high quality data.

8.1 Key progress and achievements within each priority area

Prevention

• The National Advisory Committee on Heart Disease championed the Keep Well project which sought to address health inequalities within heart disease.

Mental Health

• A robust mental health assessment is now embedded within cardiac rehabilitation programmes.
• Establishment of a pilot project in NHS Lothian which was then fully adopted into routine practice, establishing the 'house of care' philosophy within cardiac rehabilitation services. The House of Care model supports the design of services around patients' physical, mental and emotional needs, in a more integrated way.
• The Heart Failure Hub has worked to include a mental health assessment and delivery corresponding delivery of level one and two psychological interventions within heart failure nursing services across Scotland. All Scottish Heart failure services report that they undertake assessment of psychological distress (Scottish Heart Failure Nurse Forum report 2019). Heart failure teams in many Boards have additional access to expert psychology services for onward referral.
• Heart Failure Hub national conference included a presentation by Psychologist from University of Strathclyde on "Psychologically Informed Heart Failure care" to enable knowledge exchange.
• Psychosocial support needs feature in the Scottish Congenital Heart Disease Specialist Standards which will guide the delivery of these services in Scotland.
• Information, education and sign posting for healthcare workers and patients/carers is accessible via the public facing Heart Failure Hub website.
• Heart Education Awareness and Training e-learning – HeartE Phase II include modules in Psychological Impact of Cardiac Disease to support health care professionals in identifying and addressing the psychological needs of people with heart disease.

Secondary and Tertiary Care

• Regional pathways developed and implemented for Transcatheter Aortic Valve Replacement and optimal reperfusion in STEMI (acute myocardial infarction).
• Referrals to Scottish Health Technologies Group for Mitraclip and Left Atrial Appendage Closure concluded. National Services Division now commissioning both as a national service.

Management and Rehabilitation

• Cardiac Rehabilitation Champion supported redesign of cardiac rehabilitation services across Scotland in line with SIGN guideline 150.
• Heart Failure Hub worked with the REACH-HF team to test an evidence based, 'home-based' cardiac rehab programme that will provide an appropriate rehabilitation for people living with heart failure. HRUK grant won in October 2019 to test the REACH-HF cardiac rehab programme in five NHS Scotland Boards.
• Covid-19 recovery and restoration. Cardiac Rehabilitation worked collaboratively with third sector partners to establish and promote a rapid implementation of virtual assessment and intervention. Short life working group created to provide guidance/consensus on virtual CR assessment and safe and effective tools regarding risk assessment. Draft framework presented at CRIGS conference in November 2020.
• Building on the success of the series of national webinars, an MS Teams communication channel was developed and launched in December 2020 for all Cardiac Rehabilitation professionals to share examples of best practice and latest research.
• Ongoing participation in British Association for Cardiovascular Prevention and Rehabilitation and Cardiac Rehabilitation Interest Group Scotland to contribute to knowledge exchange and shaping standards and practice across the UK.

Heart Failure

• Promoted awareness of heart failure among health care professionals and within health boards. The Heart Failure Hub has representation from every Scottish Health Board and members actively participate on local Board level and regional planning committees to ensure that needs of people with heart failure are represented in local decisions.
• A National "Ensuring Success in Heart Failure" conference delivered for healthcare professionals in Jan 2020 saw a Scotland – Ireland collaboration being initiated for the first time.
• Promoted general awareness of heart failure in a number of ways, including initiatives undertaken throughout European Heart Failure Awareness week (May 2019), and the delivery of annual National 'Living Well with Heart Failure' conferences delivered for patients and carers.
• The Heart Failure Hub website provides an education platform for health professionals, patients and carers.
• Increased access to Brain Naturietic Peptide testing, a blood test which can rule out a diagnosis of heart failure for people who present with breathlessness. All Boards now have access to BNP in primary and or secondary care, nine health boards currently provide access to BNP in primary care.
• Publication of National Heart Failure guidelines for diagnosis of Heart Failure (SIGN 147).
• Supporting all Health Boards to develop pathways to diagnose heart failure
• Improving access to palliative care for people with heart failure through the Heart Failure Hub's 'Supportive and Palliative Care in Heart Failure' project undertaken in collaboration with BHF.
• Pilot projects supported to understand the potential use of novel innovation to improve earlier disease detection (using artificial intelligence driven techniques including machine learning risk stratification algorithms) and facilitate better/quicker access to diagnostic investigations.

Arrhythmias

• Report for AF in development by Public Health Scotland. This is designed to support optimisation of anticoagulation rates within primary care.
• Network for Inherited Cardiac Conditions Scotland (NICCS) established pathways and guidelines for the treatment of people with inherited cardiac conditions (including arrhythmias) in Scotland.
• National Atrial Fibrillation Steering Group established to drive improvements in detection and management of AF in Scotland.

Patient Information and Engagement

• The National Advisory Committee and the Heart Failure Hub have patient, carer and 3^rd sector representation.

Data

• Worked with NHS GG&C eHealth to develop an eRegistry for heart disease data collection across all Boards. ERegistry now functional with data storage in local SafeHaven.
• The HF Hub have engaged 5 NHS Scotland Boards to undertake a scoping exercise around HF data linkage.
• The HF Hub worked closely with ISD to produce a HF platform on NSS Discovery. Platform went live in 2019. Data includes HF admission rates, 30 day readmission rates, 30 day and 1 year mortality rates, length of stay and accuracy of HF coding. These data can now be viewed at National, Board and Hospital level.
• The HF Hub worked closely with Scottish Atlas of Variation team and a heart failure map of HF hospitalisation rates was published in 2019.
• Improvement in heart failure coding through raising awareness of issues, education and working with coders to include the use of echocardiography when coding hospital discharge letters.