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Heart disease framework aims to cut deaths in England

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7236.665 (Published 11 March 2000) Cite this as: BMJ 2000;320:665
  1. Susan Mayor
  1. London

    A radical and far reaching programme designed to transform the prevention diagnosis, and treatment of coronary heart disease in England has been announced, with the launch earlier this week of the long awaited national service framework for coronary heart disease.

    The framework sets out a 10 year programme designed to achieve the government target of cutting coronary heart disease and stroke by 40% by 2010. It sets 12 standards for the prevention, diagnosis, and treatment of coronary heart disease; describes service models; and explains how the standards can be delivered and how progress will be monitored, with milestones and goals.

    These standards include general measures (such as the requirement that the NHS and partner agencies should develop, implement, and monitor policies that reduce the prevalence of coronary risk factors in the population) as well as specific measures (such as the recommendation that people with symptoms of a possible heart attack should receive help from an individual equipped with, and appropriately trained in, the use of a defibrillator within 8 minutes of calling for help).

    Service deliverers will have to act promptly; comprehensive local delivery plans for implementing the framework will have to be in place and agreed by October 2000.

    The introduction of this framework is part of the government's strategy to improve the quality of services by setting standards. Coronary heart disease was selected for early development of a national service framework because the burden is higher in England than in many other countries, with more than 110000 deaths each year.

    Announcing the framework, the health secretary, Alan Milburn, said: “Our country has one of the highest [coronary heart disease] rates in the developed world, yet our heart services have suffered from years of neglect. This 10 year programme will, when fully implemented, save 20000 lives a year. It will also narrow health inequalities by laying down for the first time clear national standards for care and treatment for every part of the country.”

    Professor George Alberti, president of the Royal College of Physicians and one of the chairmen of the external reference group that developed the framework, agreed: “We needed a framework for coronary heart disease because we haven't got it right yet. Provision of coronary heart disease services is a disaster area that needs to be gripped with a coherent, logical programme that goes across the board, from prevention through to rehabilitation.”

    Measures in the framework include steps to improve existing services and to create new ones, such as 50 rapid access clinics for people with chest pain (see box).

    The funding implications are enormous. The government is committed to a £50m ($80m) package to kickstart the programme. The money is to be used to fund the development of fast track chest pain clinics; speed up ambulance response times; provide more defibrillators and other cardiac equipment, to speed up diagnosis and treatment; and pilot new ways of reducing delays in services.

    Professor Alberti commented: “The extra funding will get things going, but no more. If the framework is to work in the longer term, major new funding will be needed.” He added that there is a range of other issues to resolve—for example, community smoking cessation clinics are planned, but there is no mention of improving NHS provision of nicotine replacement therapy.

    The National Service Framework for Coronary Heart Disease is available at www.doh.gov.uk/nsf/coronary.htm


    Embedded Image

    When bypass surgery rates are adjusted for death rates, the United Kingdom's position worsens in relation to other European countries

    (Credit: BRITISH HEART FOUNDATION)

    Priorities recommended by England's national service framework for coronary heart disease

    By April 2001

    • Introduction of specialist smoking cessation clinics by health authorities

    • Setting up of 50 rapid access chest pain clinics to ensure that people who develop new symptoms that their GP thinks might be due to angina are assessed by a specialist within two weeks of referral; there will be 100 clinics by April 2002

    • Reduction in the “call to needle” time for thrombolysis for heart attacks (the time from when the initial call is made until thrombolytic treatment begins). This will be achieved by improved ambulance response times (75% of emergency calls will have to receive a response within 8 minutes) and by an increase to at least 75% in the proportion of accident and emergency departments able to provide thrombolysis. The aim is to ensure that 75% of eligible patients receive thrombolysis within 30 minutes of arrival at hospital by April 2002 and within 20 minutes by April 2003

    • Improved use of effective medicines after heart attack—especially aspirin, b blockers, and statins—so that 80-90% of people discharged from hospital after a heart attack will be prescribed these drugs

    • Increase in the total annual number of revascularisation procedures—to provide an extra 3000 nationally

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