Pan-London Cardiovascular Review
The aim of the project is to improve services for patients across London and further details about the project can be found here by clicking here. The project is split into three distinct workstreams:
Arrhythmia
Evidence shows that patients with uncorrected heart rhythm defects have a higher risk of heart failure and death. In the UK, fewer corrective devices (such as pacemakers) per million population are recorded when compared to other western European nations. In addition, London data shows that there is significant variation in the rates of device implantation from area to area.
In order to achieve the best outcomes, the project will ensure that in London more patients with heart rhythm defects are identified for these corrective procedures. Poor access to the relevant expertise has been identified as a factor responsible for the low rates of intervention in the UK.
Objectives for the project therefore are:
- Hospitals should work in networks to deliver these services, working closely to provide a coordinated service, with more cross-unit working of staff.
- Complex electrophysiological procedures should be delivered at units that meet the quality standards.
- Clinical expertise should be available in every hospital in the network to ensure patients receive the highest levels of care.
- Activity should be audited – performance and outcomes of services should be a mandatory for all units.
Central units should also be encouraged to offer specialist expertise to their referring hospitals. They should:
- Provide clinical support 24 hours a day, seven days a week so that urgent and emergency arrhythmia cases are managed promptly and appropriately by a specialist
- Offer to undertake clinics in referring local units.
Non-ST elevation acute coronary syndrome (NSTECS)
There is a robust pathway for London patients who experience an acute heart attack or ST-elevation myocardial infarction (STEMI). The majority of patients on this pathway receive treatment within 150min of calling an ambulance. The speed of treatment is largely due to the ability to diagnose a heart attack from a simple diagnostic test.
Diagnosis of non ST-elevation acute coronary syndromes (NSTEACS) is more complicated and patients suspected of having a NSTEACS are currently taken to the nearest emergency department for medical assessment for confirmation of their diagnosis. On the current pathways, patients are often admitted to their local hospital first and many need transfer to a more specialist unit to have an angiogram or angioplasty/PCI. This often results in a delay of a number of days before access to angiogram or angioplasty.
For these patients, the current process is inequitable, unnecessarily lengthy and inconvenient. Furthermore, recent evidence has demonstrated that outcomes for patients with NSTEACS, particularly those at higher risk, can be improved by early (24-72 hours) angiogram and coronary revascularisation (PCI), where appropriate.
The proposed model of care recommends improvements to streamline the current patient pathway by fast-tracking high risk NSTEACS patients from local hospital A&E directly to a specialist NSTEACS centre able to provide angiogram and PCI within 24 hours of presentation to A&E.
In NCL the revascularisation task group is implementing this project in NCL. By March 2012, the Heart Hospital and the Royal Free Hospital will become NSTECSspecialists providers with patients from Barnet/Chase Farm Hospital, the North Middlesex Hospital and the Whittington Hospital A&Es directly transferring high risk NSTEACS patients to the specialists providers.
Cardiac Surgery
The Cardiovascular Review’s Model of Care outlines how key changes to service provision, patient pathways and improvements to the way units work together to deliver cardiac surgery, could ensure better outcomes for patients. It recommends improvements to the patient pathway for non-elective cardiac surgery; to service provision to treat major cardiothoracic aortic disease; and to the delivery of mitral valve surgery.
The proposals in the model align with national recommendation regarding the further specialisation of surgeons performing cardiac surgery and developing a multidisciplinary approach to patient assessment and treatment.
In North Central London a subgroup of cardiac surgeons has formed to implement the Cardiovascular Review Model of Care for non-elective cardiac surgery and mitral valve surgery.