Translating Innovation into Practice: The Cardiology Unmet Needs Project

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Translating Innovation into PracticeThe
Cardiology Unmet Needs Project
Alison Hume Co-Clinical Lead for the Cardiology
Unmet Needs Project
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There is evidence of greater need in deprived
communities

• Impact this has on health status and outcome
• Poorer outcomes
• Higher morbidity
• Reduced survival.

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ISD 2001
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Inequality (based on 2001 ISD data)
(Average of deprived intervention group compared
to average of affluent control group)
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Mortality Adjusted ratios for CABG
Angioplasties3 for discharges during period
1-Apr-2003 to 31-Mar-2007 by HBSIMD deprivation
Quintiles, age group and sex CABGs
Angioplasties3 TaysideSIMD Quintiles
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Aim of the project

• To improve access to cardiology
• To deliver cardiology services in deprived
  communities

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Deprived Communities
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Example of venuesThe Community Heart Clinic
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The Clinical Mobile Unit
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Cardiology clinic in Mark Henderson Centre
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Local Gala days
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Engaging with Ethnic Minority Groups
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Radio Ramadhan 107.5
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Results

• A total of 2510 people have engaged with clinical
  project activity
• 2345 have self presented for an opportunistic
  cardiology assessment (Specialist nurse led)
• 181 have had a specialist clinical consultation
  (Cardiologist led)
• 106 people have had a heart failure clinical
  review
• 18 people have had a heart failure telephone
  clinical review
• 10 of the above are of South Asian ethnicity

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Success of engagement with people living in
the deprived communities

• Areas with the highest deprivation in Tayside
  have been targeted for clinical activity
• By delivering services in the deprived areas the
  majority of people who have engaged are from the
  poorest areas of Tayside
• By taking clinical services to places of worship,
  engagement with the ethnic groups has been
  particularly successful

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Breakdown by deprivation category
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Gender
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The Specialist Cardiology Clinic

• 181 people have had a clinical consultation
• 45 of these had a diagnosis of CHD
• 51 had no known CHD but described significant
  symptoms
• 4 people believed they had CHD but this
  diagnosis was not confirmed following specialist
  consultation

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Investigations as a result of specialist
cardiology consultation
Some people included in these figures are
awaiting further tests and investigation
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Medication management following specialist
cardiology consultation

• Of the 181 people who were seen by the
  cardiologist, 48 had a recommendation for
  medication management to optimise their treatment
  

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ASSIGN RISK CALCULATION COMPLETE 1424
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ASSIGN CVD risk of ? 20
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17 of people living in Depcat 1 have a CVD risk
of ? 20
28 of people living in Depcat 7 have a CVD risk
of ? 20
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High risk Males
1777 taxi drivers in Dundee are being invited for
assessment

• Demographics
• 470 invited 118 responded, 18 wrong addresses
  (some dead!)
• Response rate of 26.1
• 51 attended (10), 12 declined, 32 dropped in
  to the session
• 58 live in depcat 5,6 or 7
• 82 males and 1 female
• Mean age 53.4 years

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Referrals

• 53 required further referral
• 39 were referred to GP for follow up (BP, high
  glucose, cholesterol, overall CV risk of ?20)
• 4 were referred for specialist cardiology
  consultation (symptoms)
• 1 referred to cardiac rehab (supervised exercise
  programme)

31 have an ASSIGN cardiovascular risk of ? 20
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Further activity with taxi drivers

• A further 277 have been invited
• 15 of these have presented at a session last week
• Two more sessions including an evening session
  this week and next
• Ethical issues???

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Depcat of the Taxi drivers
Deprivation category
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Other occupational groups

• Bus drivers
• NHS Tayside Ancillary staff

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Case example Cardiovascular risk

• Male
• 64
• White Scottish
• Living in dep cat 1
• Taxi driver
• Presented following invite
• No PM history of note
• No Family History of CHD

• Ex smoker
• TT
• Low activity
• 1 portion of FV
• Total chol 4.86mmol/l
• HDL 0.99mmol/l

ASSIGN cardiovascular risk 25
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Case example with CHD

• Male
• 58
• Pakistani
• Living in dep cat 6
• Bus driver (illiterate)
• Met at the mosque
• Ignoring symptoms suggestive of Angina
• No PM history of note

• Reviewed by Prof Pringle
• ECG /Echo
• ETT positive
• Angiography 3 vessel disease
• CABG (Sept 07)
• Now recovering

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Case example high risk

• Female
• 57 years
• White Scottish
• Civil servant
• Living in dep cat 6
• Met at the inland revenue call centre
• Thought she was healthy
• No PM history of note

• BP 136/84
• Random BG 15.8 mmol/l
• Chol 7.21 mmol/l
• HDL 0.88 mmol/l
• Current smoker
• Low activity
• Low fruit and veg intake

ASSIGN cardiovascular risk 60
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Improvement in biochemistry results
(Chol mmol/l, Trigs mmol/l, HbA1c - )
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ASSIGN cardiovascular risk
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• 35 years
• Female
• White Irish
• Depcat 6
• Self presented at a health fair
• Healthy
• No PMH or FH of note

• BP 116/88
• Random glucose 5.4mmol/l
• Non smoker

Total cholesterol 9.13mmol/l HDL 1.52mmol/l
Familiar Hypercholesterolaemia
Risk calculation not appropriate
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