Specialist Cardiology

Translating Innovation into Practice:The Cardiology Unmet Needs Project

Professor Stuart Pringle and Alison HumeCo-Clinical Leads for the Cardiology Unmet Needs Project

Is there evidence of greater need in deprived communities?

• Yes

What impact does this have on health status and outcome?

• Poorer outcomes• Higher morbidity • Reduced survival.

CABG and angioplasty operations: all ages: rate per 100,000

034

404447

5575

87888989

949899

115144148149

158164

183184

0 50 100 150 200

DD1 3

DD4 0

DD4 6

DD3 0

DD1 4

DD5 2

DD2 4

DD4 7

DD5 3

DD2 2

DD1 2

Inequality (based on 2001 ISD data)

76

140

020406080

100120140

Intervention Control

CABG and Angioplasty rates per 100,000

(Average of deprived intervention group compared to average of affluent control group)

Aim of the project:

1. To improve access to cardiology

2. To deliver services in deprived communities

Modelling and re-modelling of clinical activity

1. Delivery of Specialist Cardiology Clinic (including investigation) in a community venue or the clinical mobile unit

2. Identification of potential ‘patients’ from opportunistic cardiology assessment at local events (e.g. local gala days, bingo, shopping centres, the mosque)

Deprived Communities

Example of venues:The Community Heart Clinic

The Clinical Mobile Unit

Cardiology clinic in Mark Henderson Centre

Local Gala days

Engaging with Ethnic Minority Groups

Radio Ramadhan 107.5

Lochee Baptist Church

Results

• A total of 1781 people have engaged with clinical project activity

• 1632 have self presented for an opportunistic cardiology assessment (Specialist nurse led)

• 161 have had a specialist clinical consultation (Cardiologist led)

• 91 people have had a heart failure clinical review

• 17 people have had a heart failure telephone clinical review

10% of the above are of South Asian ethnicity

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

Breakdown by deprivation category

05

10152025303540

%

1 2 3 4 5 6 7Deprivation category

Area of residence ofpeople who haveengaged with projectclinical activity

Gender

0

10

20

30

40

50

60

70

%

assessment clinicalreview

heartfailurereview

telephonereview

malefemale

The Specialist Cardiology Clinic

161 people have had a clinical consultation

• 73 of these had a diagnosis of CHD• 82 had no known CHD but described significant

symptoms • 6 people believed they had CHD but this diagnosis

was not confirmed following specialist consultation

Investigations as a result of specialist cardiology consultation145

115

248 5

0

20

40

60

80

100

120

140

number of patients

ECG ECHO ETT ANGIO TETSCAN

Some people included in these figures are awaiting Some people included in these figures are awaiting further tests and investigationfurther tests and investigation

Medication management following specialist cardiology consultation

Of the 161 people who were seen by the cardiologist, 77 (48%) had a recommendation for medication management to optimise their treatment

What have we learned so far?

• Feasible• Acceptable – patient and HCP• Opportunistic assessments are popular• Clinical Diagnosis• Interventions – may be quite low tech e.g. up-titrating or

optimising medication• Engagement / re-engagement• Valuable• Cost-effective?• Educational