Key facts
- Coronary heart disease (CHD) is a preventable disease.
- It kills more than 110,000 people in England every year.
- The death rate from heart disease and related diseases among the under-75s has fallen by 47% since 1996.
What does the NSF mean for you?
If you are at risk of developing CHD, or already have it, the national service framework (NSF) for CHD has marked a huge turning point in the quality, effectiveness and fairness of the care you receive in the NHS.
Launched in 2000, the NSF is a 10-year strategy to reduce CHD and stroke-related deaths by 40% by March 2010. This target was met five years ahead of schedule.
Based on clear evidence, the NSF sets out formal standards of care that local health communities are expected to achieve.
The framework helps NHS organisations focus on treatments proven to be the most clinically effective and that represent the best value for money.
The NSF also promotes regional networking across health communities and encourages health professionals, including GPs, nurses, hospital doctors and social care professionals, to work more closely in multi-disciplinary teams. This means patients benefit from integrated healthcare that is based on their needs rather than on professional or organisational boundaries.
Evaluation
The NSF for CHD has helped raise standards for the detection, treatment and management of all heart disease. The NSF's clear focus in the treatment of heart disease has delivered improvements in most areas of cardiac services.
March 2010 did not mark the end of the NSF’s implementation. Much of what was set in the NSF is as relevant now as it was nine years ago, and will still be relevant in 10 years' time. However, now is the time to evaluate why there has been such excellent progress in some areas but not in others. Cardiac rehabilitation and the treatment of heart failure, for example, are areas that have developed more slowly than others and we need to understand why.
Also, the NHS has changed a lot since the national service framework for CHD was first published. Working practices in cardiology and patient expectations have changed and technology has advanced. However, there is still room for improvement and the NHS will need to continue to focus on improving quality and productivity.
NHS Health Checks
Collectively, vascular disease (heart disease, stroke, diabetes and kidney disease), affects the lives of more than four million people and kill 170,000 in the UK every year. These conditions also account for more than half the mortality gap between rich and poor. Modelling work undertaken by the Department of Health has found that offering NHS Health Checks to all people between 40 and 74, and recalling them every five or 10 years would be a cost-effective and clinically beneficial programme.
Health checks assess people’s risk of heart disease, stroke, kidney disease and diabetes by looking at their age, sex, family history, height, weight, as well as blood pressure and cholesterol levels.
Everyone will receive a personal assessment, setting out personal levels of risk and strategies to reduce it. For those at low risk, this might be no more than general advice on how to stay healthy, weight management programmes or stop smoking services. Those at the highest risk might also require preventive medication with statins or blood pressure treatment.
Primary care trusts (PCTs) began phased implementation of the NHS Health Check programme in April 2009. It has the potential to prevent, on average, 1,600 heart attacks and strokes and save up to 650 lives each year. It could prevent over 4,000 people a year from developing diabetes and detect at least 20,000 cases of diabetes or kidney disease earlier, allowing better management of individuals and an improved quality of life.
Cutting the risk of CHD
Smoking, obesity and a physically inactive lifestyle are among the top risk factors for developing CHD. In 2007, over 20,000 deaths from cardiovascular disease in England were related to smoking. That's why the NSF has driven forward major developments in prevention. These include:
- Free NHS Stop Smoking Services available across the country. Between April 2008 and March 2009, 671,259 people using the service had set a quit date and the four-week follow-up showed that half of those (337,054) managed to stay smoke free. Research shows that smokers are up to four times more likely to stop if they use NHS support. The Smokefree legislation, introduced in 2007 to reduce exposure to secondhand smoke in enclosed public places, continues to see high levels of compliance and public support.
- Work to increase the level of awareness regarding the harms of secondhand smoke will continue as part of the government's new Tobacco Control Strategy.
- Help to maintain a healthy weight, individuals and families can sign up to Change4Life. They’ll receive simple tips to eat healthy, be more active and live longer.
- More support to be physically active. The DH promotes all types of physical activity such as walking, cycling, swimming, dancing or gardening. Since April 1 2009, almost 300 local councils provide free swimming sessions for people aged 60 and over. Also, more than 200 councils offer free sessions to those aged 16 and under.
Faster diagnosis and treatment
Whether you develop new symptoms, experience a heart attack, or are living with CHD, you will now get the life-saving care and treatment you need much faster. Well over 90% of people experiencing chest pain for the first time are now seen by a specialist within two weeks. In addition:
- If you develop new symptoms, you may be directed to one of a network of rapid access chest pain clinics set up specifically to assess patients within two weeks of reporting symptoms to their GP.
- Or you may be diagnosed in your GP surgery without having to visit hospital. GP surgeries and primary care trusts (PCTS) are increasingly investing in the skills and equipment to diagnose CHD in community settings.
- If you do have an emergency and need an ambulance, new emergency response-time targets mean it's more likely to arrive within eight minutes of your call.
- More than 80% of heart attack patients now receive potentially life-saving clot-dissolving drugs within 30 minutes of arrival at hospital. Ambulance crews are also being trained to administer the drugs during emergency calls.
- If you do need surgery, your maximum wait should be three months and you will be offered a choice of two hospitals for this surgery. (Also read A guide to waiting times)
Cardiac rehabilitation
Although there is a chapter in the NSF for CHD about rehabilitation, the Healthcare Commission (now the Care Quality Commission) review of the NSF, published in March 2005, reported that there are some aspects of cardiac rehabilitation that need further improvements. The Vascular Programme is working together with the NHS Improvement and the Cardiac Networks to spread good practice and to help increase the quantity and quality of the rehabilitation provided.
National Audit of Cardiac Rehabilitation (NACR) has addressed the need to achieve better information about services provided and their use by patients. There is now emphasis across England to provide stronger evidence on quality and effectiveness and to encourage local areas to appraise and improve their provision of cardiac rehabilitation.
Improving quality of life
Because of the UK's ageing population and the increasingly effective care for people who have heart attacks, more and more people are living with heart failure. With no cure for this progressive condition, the NSF places particular emphasis on helping people live longer, more independent and active lives.
- Growing numbers of specialist heart failure nurses are helping people with heart failure to live fuller, longer lives, retain independence in their own homes, and reduce the likelihood of a hospital admission.
- Many people getting help and support through the Expert Patient Programme, now a mainstream service run by primary care trusts. The programme is aimed at people with long-term conditions and helps individuals to manage and cope with their condition on a daily basis.
Growing with the times
In March 2005, strategies for arrhythmias and sudden cardiac death were added to the NSF. Arrhythmias (irregular heart beats) affect more than 700,000 people and cause up to 400 sudden, unexplained cardiac deaths a year.
Since the first publication of the NSF for CHD, there have been significant improvements in technology and in clinical skills that enhance care for people with heart conditions. The new additions to the NSF aim to ensure that people with arrhythmias quickly receive an assessment and effective treatment. It also aims to ensure that when sudden unexpected cardiac death occurs, NHS services have systems in place to identify family members at risk and provide personally tailored, sensitive and expert support.
