sign chd l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
SIGN CHD PowerPoint Presentation
Download Presentation
SIGN CHD

Loading in 2 Seconds...

play fullscreen
1 / 33

SIGN CHD - PowerPoint PPT Presentation


  • 243 Views
  • Uploaded on

SIGN CHD. In Scotland in the year ending 31 March 2006 over 10,300 patients died from CHD and 5,800 from cerebrovascular disease, with almost 49,000 hospital admissions for CHD and a further 22,050 for cerebrovascular disease. Coronary Heart Disease. SIGN CHD.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'SIGN CHD' - phaedra


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
sign chd
SIGN CHD

In Scotland in the year ending 31 March 2006 over 10,300 patients died from CHD and 5,800 from cerebrovascular disease, with almost 49,000 hospital admissions for CHD and a further 22,050 for cerebrovascular disease.

www.isdscotland.org

sign chd4
SIGN CHD

SIGN is a collaborative network of healthcare professionals and SIGN guidelines are developed by multidisciplinary groups using a standard methodology based on a systematic review of the evidence.

sign chd8
SIGN CHD
  • PREVENTION
  • STABLE ANGINA
  • ACUTE CORONARY SYNDROMES
  • ARRHYTHMIAS
  • CHRONIC HEART FAILURE
sign chd prevention
SIGN CHD: prevention

Prevention of CHD - Risk Estimation

  • Individuals with symptomatic manifestations of cardiovascular disease or diabetes should be considered at high risk (≥ 20% risk over 10 years) of cardiovascular events D
  • All adults over the age of 40 who have no history of cardiovascular disease or diabetes and who are not being treated for blood pressure or lipid reduction should have their cardiovascular risk estimated at least once every five years D
sign chd prevention11
SIGN CHD : prevention

Simvastatin 40 mg/day recommended as part of the management in those patients over age 40 with a 10 year risk of CVS events of > 20% A

slide12

Event

Clinical benefit over 4.3 years

Annual bed days saved

Annual cost savings (million)

Major vascular

6,217

17,050

£5.9

All cause mortality

2,303

Total

8,520

17,050

£5.9

Potential events avoided and related resources saved from treating 435,000 asymptomatic individuals at high CVD risk with a statin

ASCOT-LLA/CARDS

potential events and resources saved from treating 95 000 symptomatic individuals with a statin

Events

Events avoided

Annual bed days saved

Annual cost savings (million )

Major vascular

9,437

19,770

£6.8

All cause mortality

718

Total

10,155

19,770

£6.8

Potential events and resources saved from treating 95,000 symptomatic individuals with a statin

HPS

slide14
SIGN has commissioned the development of a score to include social deprivation as a risk variable. ASSIGN tends to classify more people with a positive family history and who are socially deprived as being at high risk. When used in its own host population, it abolished a large social gradient in future CVD victims not identified for preventative treatment by the Framingham score: it therefore improved social equity. http://assign-score.com

Heart 2007;93:172-176

sign chd stable angina
SIGN CHD: Stable Angina
  • Patients with left main stem disease should undergo coronary artery bypass grafting to improve coronary heart disease prognosis A
  • Patients with triple vessel disease should be considered for coronary artery bypass grafting to improve coronary heart disease prognosis but where unsuitable be offered percutaneous coronary intervention A
  • Patients with single or double vessel disease where optimal medical therapy fails to control symptoms should be offered percutaneous intevention or where unsuitable, be considered for coronary bypass surgery A
sign chd acs
SIGN CHD: ACS
  • Patients with ST elevation acute coronary syndrome should be treated immediately with primary percutaneous coronary intervention A
  • Where primary percutaneous coronary intervention cannot be provided within 90 minutes of diagnosis, patients with ST elevation acute coronary syndrome should receive immediate thrombolytic therapy D
  • Patients with ST elevation acute coronary syndrome within 6 hours of symptoms who fail to reperfuse following thrombolysis should be considered for rescue percutaneous coronary intervention B
sign chd acs19
SIGN CHD: ACS
  • A
  • ABA

In addition to long term aspirin, clopidogrel therapy should be continued for three months in patients with non-ST elevation acute coronary syndromes B

sign chd arrhythmias
SIGN CHD: arrhythmias
  • Patients with impaired LV ejection fraction in NYHA Class I – III after previous myocardial infarction should be considered for ICD therapy A
  • Patients with spontaneous non-sustained ventricular tachycardia, severely depressed ejection fraction (<0.25) or prolonged QRS duration (>0.12 sec) should be prioritized for ICD implantation B
sign chd heart failure
SIGN CHD : heart failure

BNP should be checked prior to commencing therapy for suspected heart failure A

sign chd heart failure25
SIGN CHD: Heart failure

Heart Failure - Interventional procedures

In patients in sinus rhythm with drug refractory symptoms of heart failure due to left ventricular systolic function (LVEF < 35%) and who are in NYHA Class III and IV and who have a QRS duration of > 120 m/s, cardiac resynchronisation therapy (CRT) should be considered A

sign chd heart failure27
SIGN CHD: Heart failure

Heart Failure - Discharge planning

  • Comprehensive discharge planning to ensure links with post discharge services should be available to all those with symptomatic heart failure. A nurse-led, home based element should be included A
  • Telephone follow-up by specialised heart failure nurses should be considered for patients with stable heart failure. Nurses should have the ability to alter diuretic dose, telephone schedules and recommend emergency/non-scheduled medical contact A
sign chd28

SIGN CHD

What are the potential clinical events avoided by implementation?

sign chd implementation benefits

Recommendation by guideline

Mortalityavoided over 5 years

Events avoided over 5 years

Bed days saved per year

Savings per year(£ million)

Statins – primary prevention

2,678

7,229

17,052

5.9

Statins – secondary prevention

718

9,437

19,770

6.8

Antihypertensive drugs

950

2,761

9,108

2.5

Prevention - other

750

2,672

5,414

2.0

Prevention - total

5,096

22,099

51,344

17.2

Acute Coronary Syndromes guideline

896

2,176

2,394

1.2

Arrhythmia and Heart Failure guidelines

1,232

2,851

7,074

2.3

Total events

7,224

27,126

60,812

20.7

SIGN CHD implementation benefits
estimated annual cost of implementing key recommendations by guideline

Cost (£ million)

Year 1

Year 6

ACS

5 (5)

5 (5)

Arrhythmias

4 (5)

4 (5)

Heart Failure

7 (7)

7 (7)

Prevention

25 (27)

54 (62)

Total

41 (44)

70 (79)

Estimated annual cost of implementing key recommendations by guideline
sign chd31
SIGN CHD

The recommendations on statins and hypertension account for over 90% of the costs and the savings

sign chd32
SIGN CHD

Over the next five years, it is estimated that over 7,200 premature deaths from CVD and over 27,000 vascular events could be avoided. This is equivalent to a 9% reduction from the current CVD mortality rate and an 8% reduction from the current CVD event rate.