01.05.10
The heart of the problem
The quality of cardiac care in Britain has risen dramatically over the last decade due in no small part to the publication of the national service framework for coronary heart disease in 2000, reports Richard Mackillican
Since the publication of the national service framework for coronary heart disease in 2000, there has been a huge improvement in the care of patients with heart disease, particularly ischemic heart disease.
So says Dr Mike Knapton, associate medical director of the British Heart Foundation.
“Examples of these improvements include the opening of rapid access chest pain clinics and the eight minute response target for the ambulance service, which both allow people to have access to life saving treatments more quickly.”
Rapid access chest pain clinics were set up to allow patients who present to their GP with symptoms suggestive of new onset angina to be seen by a specialist nurse within two weeks. The eight minute ambulance response target means that from the moment a call hits an ambulance service’s switch, it has eight minutes to reach a category A incident (life threatening).
“More recent improvements include access to primary percutaneous angioplasty which is simply sending people straight into the catheterization laboratory, which was a major development over and above thrombolysis. These have all led to an enormous change in the way that care is managed.”
Dr Knapton cites treating heart attack patients at home during his early career as another example of how fundamentally cardiac care has changed over the last quarter century.
“Treatment has changed because of both an increase in the quality of services and their responsiveness along with technological advancements.”
Another step change in the NHS’s approach towards treating heart conditions has been the advancement of preventative cardiology, principally the management of hypertension and the exponential growth in the prescription of statins, drugs used to reduce cholesterol.
“Over the last thirty years there has been a steady drop in the numbers of people dying prematurely of heart disease and preventative cardiology has played a part in that, as the has the steady reduction in the number of smokers.”
The idea of preventative treatment, along with the notion of the public taking responsibility for their own health, has become a priority for a government keen to reduce the strain on the health service.
But despite advances in the treatment of coronary conditions, there has been a worrying rise in the cases of obesity.
“Although in general people are not eating as much as they used to in the past, because their physical activity levels have dropped considerably, they are still eating too much. This means that obesity is a major challenge for the health service.”
This challenge was partly addressed by the Foresight Report which attempted to predict what the levels of obesity would be over the next fifty years, along with predicting the impact of those obesity levels on conditions such as heart disease, diabetes and cancer.
One way in which the government has sought to address the obesity problem is through social marketing campaigns such as Change4Life which seek to inform the public on leading healthier lifestyles. This is all part of a shift instigated by Lord Darzi’s Next Stage Review to move the NHS from being a service which fixes people when they are sick to one which maintains their health.
Despite this, Dr Knapton has his reservations about the role which the health service has to play in instructing people’s life style choices.
“I think that it is essential that the NHS has at its heart the notion of keeping people well and plays a part in their choices to maintain their health,” he says.
“But if this becomes overstated, then the NHS may actually undermine the role of individuals, families and communities in keeping themselves healthy. The NHS by itself cannot keep the nation healthy. It is up to everyone to make an effort.”
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