cardiology case - bacpr
TRANSCRIPT
BACPR 2016
Wales: The state of the nation
Rachel Owen
James Barry
Overview
• Prevention• A history of Wales
• Challenges faced
• Trends and progress
• Targeted interventions
• Rehabilitation• What we do
• What we are going to do
Wales a land of opportunity...
...and unmet need
James Barry
Cardiologist
Cardiac Centre, Swansea University
James Barry
Cardiac Centre, Morriston
Hospital
HTTA grant from AliveCor in conjunction with WAG.
Research grant from Boston Scientific
Travel bursaries and honoraria from SJM, Medtronic, Boston Scientific, Boehringer, AZ, Ingelheim
Chief Investigator UK for ‘GENTLE Registry’ Boston Scientific
A history lesson
• Julian Tudor Hart
• GP in Glyncorrwg
• Unsuccessful Communist Party Candidate for Aberavon 1964. 1966 & 1970
• Author
• Pioneering research practice
• Preventative medicine (Lancet 1970; 296 :223)
Inverse Care Law
“The availability of good medical
care tends to vary inversely to the
needs of the population served”Lancet 1971;297:405
Cardiovascular morbidity in
Wales• High levels
• Historically under treated
• Progressive improvement in access and
outcomes
CVD deaths per
100,000
All data from ‘Health Maps Wales’ WG.https://www.healthmapswales.wales.nhs.uk
CVD deaths per
100,000
CCF deaths per
100,000
CVD deaths per local authority
ward
Trends
• Decline in CVD deaths
• Decline throughout Wales
• Areas of worse outcomes still lagging
behind
• ??lead in time, ?? Low lying fruit
• Areas to improve
– Late diagnosis (too
many emergency
presentations)
– Improve access and
waiting times
– Improve access to
rehab
• Tackling lifestyles
19% of adults
are regular
smokers
Inverse Care Law Project
“The aim of the Inverse Care Law
Programme is to improve the life and
healthy life expectancy for those areas
with the highest levels of deprivation. It is
seeking to do this by reducing premature
mortality and emergency admissions from
cardiovascular disease by improving the
identification and management of
cardiovascular risk factors.”
Inverse Care Law Project
“The aim of the Inverse Care Law
Programme is to improve the life and
healthy life expectancy for those areas
with the highest levels of deprivation. It is
seeking to do this by reducing premature
mortality and emergency admissions
from cardiovascular disease by
improving the identification and
management of cardiovascular risk
factors.”
• Funded by 3 delivery implementation
groups• Heart disease
• Stroke
• Diabetes
• Aim is to identify cardiovascular risk
• Initial efforts targeted at areas of greatest
deprivation
• Building on work initiated in Aneurin Bevan
and Cwm Taf HBs
• Peripatetic health care workers
• Non clinical environments
• Structured interview re life style
• Point of care testing
• Motivational interview techniques
• Risk scores provided
• Communication to GPs
Outcomes
• 5000 patients seen
• 30% had new health issues identified
• 2% seen to be high risk and referred to GP
• 14% intermediate risk and offered lifestyle
interventions/services
Patient identified goals
0
5
10
15
20
25
30
35
40
45
weight loss Increase activity
Improve Cholesterol
stop smoking decrease ETOH intake
Decrease BP
Outcomes
• 5000 patients seen
• 30% had new health issues identified
• 2% seen to be high risk and referred to GP
• 14% intermediate risk and offered lifestyle
interventions/services
Intervention referrals
0
50
100
150
200
250
National Exercise Programmereferralgory 1
adult weight management refferal Gwent Drug and alcohol service Epert patient programme
Smokers......
• Only 30 % referred to Smoking Cessation
services
The future
• Rolling out to other health boards
• Mentoring from the initial project teams
• Increasing availability of community Ix (cf
ambulatory BP)