Heart Disease Improvement Plan

2. Heart Disease in Scotland

History and Progress to Date

19. Although coronary heart disease (CHD) is a largely preventable disease, there are approximately 8,000 deaths in Scotland each year (7,541 people in 2012) where CHD is the underlying cause. It is estimated that around 7.3% of men and 5.7% of women are living with CHD in Scotland (Scottish Health Survey 2012).

20. The disease is caused when the heart's blood vessels, the coronary arteries, become narrowed or blocked and cannot supply enough blood to the heart. Scotland has a high prevalence of the risk factors associated with heart disease such as smoking, poor diet and physical inactivity. Treating and preventing heart disease is a national clinical priority for Scotland.

21. The 2009 Better Heart Disease and Stroke Action Plan set out a series of actions across both disease areas that required focus and attention from a variety of partners within the respective clinical communities. In relation to Heart Disease, local Managed Clinical Networks (MCNs) were asked to take forward the actions identified.

22. As a result of variation across Scotland in the way which progress was reported, and some of the Actions being superseded by other developments, representatives from Heart Disease MCNs were invited to a national workshop in May 2011. The focus of this workshop was on how the outcomes in the Action Plan could be met, while recognising the challenges that NHS Boards faced. The process identified eight key priorities with corresponding 'measurements of success' reflecting the issues within heart disease at that time, but ensuring strong continuity with the original ethos behind the previous actions.

23. The MCNs have provided continual updates on progress to the NACHD in relation to the eight priority areas, thus providing the NACHD with the intelligence to focus national consideration and support as required.

24. Considerable progress has been made over recent years:

• NHSScotland reducing mortality rates from coronary heart disease by over 43% in the last 10 years (2003-2013).
• A decrease in the number of new cases of CHD (incidence) over the past decade. The age and sex standardised incidence rate decreased from 361.7 per 100,000 in 2003/04 to 262.8 in 2012/13, a decrease of 27.3%.
• For those admitted to hospital as an emergency with their first heart attack, the chances of surviving at least 30 days have improved over the last 10 years from 84.4% to 91.8%.
• A reduction in heart attack mortality rates in the most deprived areas faster than anywhere else. The percentage reduction in deaths in the most deprived category (37.6%) over the last 10 years is larger than that in the least deprived category (29.0%).
• A decrease in the overall costs of prescriptions dispensed for cardiovascular drugs in 2012/13 to £111.7 million, a reduction of 29.1% on the previous year. This is the lowest cost for these drugs over the last ten years (since 2003/04).

25. The Heart Disease agenda has been advanced by a number of initiatives which includes:

Optimal Reperfusion Service

The primary PCI service (pPCI) in Scotland has undergone significant investment and expansion in recent years. Scotland has an outstanding optimal reperfusion/emergency angioplasty service with the NHS introducing services for patients with a heart attack in six regional centres across Scotland (Lothian, Golden Jubilee, Grampian, Lanarkshire, Tayside and Highland). In 2012 the British Cardiovascular Intervention Society reported that levels of access in Scotland were 1618 per million people compared to England (1423) and Wales (1363).

HEARTe - Heart Education Awareness Resource and Training through E-learning

Launched in November 2013 HEARTe is a free heart disease educational resource comprising 7 core modules aligned to the priorities detailed in the Better Heart Disease & Stroke Care Action Plan (2009). The resource can be accessed by health and social care professionals as well as patients, carers and other members of the general public. The success of the eLearning tool is evidenced not only by its use but also the detailed quantitative and qualitative data which is indicative of real and positive impacts for people in Scotland.

Improving Heart Failure Services: Heart Failure Hub

Heart Failure remains an identified priority area for improvement by the NACHD. This is reflected in the establishment of a Heart Failure Hub to take forward a national programme of work in relation to heart failure. The group brings together clinicians, managers, the voluntary sector and patients to ensure a co-ordinated approach to tackling the many challenges facing heart failure teams in NHS Boards across Scotland. The Heart Failure Hub is working with the Scottish Patient Safety Programme to improve reliable delivery of the Heart Failure Bundle which is a package of evidence based interventions and a key mechanism for improving the quality of care received by heart failure patients.

Resuscitation Rapid Response Unit - 3RU

In 2014 the Scottish Government provided £200,000 of funding to support the wider roll out of the 24/7 on scene resuscitation service - which specifically responds to patients in cardiac arrest. A joint project between the Scottish Ambulance Service and the Resuscitation Research Group at the University of Edinburgh the approach has significantly increased survivability rates for out of hospital cardiac arrests (OHCA) in Edinburgh. Piloted in Lothian it demonstrated improved survival rates for OHCA in the Edinburgh area of 33% in comparison with 15 - 20% in the rest of Scotland. The 3RU team - a small team of paramedics supported by doctors, nurses, dispatchers, medical students and a resuscitations officer - won emergency medicine team of the year at the British Medical Journal (BMJ) awards in 2014 for its lifesaving efforts.

Refreshing the Priorities

26. Given progress to date the NACHD took the opportunity to ensure that the existing priorities reflected current needs. Accordingly, a series of six national and regional workshops were held between August and October 2013, engaging with approximately 140 delegates from across the heart disease community. The workshops were designed to afford delegates the opportunity to influence future direction by determining the new actions within the refreshed priorities.

27. The initial outcomes of this work were submitted to the NACHD and presented in outline at the Heart Disease Learning Forum in November 2013. The proposed refreshed Heart Disease Improvement Plan continues to provide a strong thread of continuity with previous versions, while setting challenging but realistic actions to drive forward the future direction of heart disease across Scotland.

28. It was greatly reassuring to note the level of enthusiasm and engagement demonstrated throughout the national and regional workshops, which produced staggering amount of feedback and dynamic suggestions for taking forward heart disease in a manner that fundamentally underpins the quality ambitions. Following collation and review of this feedback, it is interesting to note, that although there were a few regional specific issues identified, on the whole, there was a surprisingly high level of consistency across Scotland.

29. The following chapter details the refreshed priorities and focus on future quality improvement activities.