The National Refractory Angina Centre

Royal Liverpool and Broadgreen University Hospital, Liverpool, UK

Professor Mike Chester, Director

www.angina.org

The National Refractory Angina Centre

Royal Liverpool and Broadgreen University Hospital, Liverpool, UK

Professor Mike Chester, Director

www.angina.org

“Cardiology’s best kept secret”

National Refractory Angina Centre

(NRAC)

Established 1996

Post code L14 3PE Western end of the M62

•The UK’s first patient-centred

angina clinic

• National Nye Bevan award 2000• National NHS Hospital Doctor

award 2002• Health Service Journal King’s

Fund Safety ward highly commended 2003

• UK Customer Experience award 2009

National Awards

“The ongoing development of the NRAC as a national and international centre of excellence for the treatment and management of refractory angina, …

Ann Keen Health Minister, HANSARD 15 Oct 2008

means that we have not only the best possible service to which people in this country can be referred for that condition,……

….. but a blueprint for the development of other such services elsewhere.”

And the revolutionary concept was……

Ask patients what they want..

Ask patients what they want..

…then explain the options

John Bridson, Clare Hammond, Austin Leach & Michael R Chester

BMJ 2003;327;1159-1161

doi:10.1136/bmj.327.7424.1159

“Making consent patient-centred”

Commission for Health

Improvement report

Jan 2003

“NRAC’s involvement of

patients and carers at every

stage of the development of

their care……

“NRAC’s involvement of

patients and carers at every

stage of the development of

their care……. is something

from which the rest of the

NHS could learn ”

Patient empowerment &

patient engagement

Depend onPatient education

Most patients don’t really understand what is wrong with them

Most blame themselves for being ignorant

Few would think of criticizing their doctor for being poor teachers

What makes a good doctor?

“Always finds time tolisten and............ the really good ones explain”

What makes a good doctor?

The problem

“Because the presentation

of ischaemic heart disease

is often dramatic……

“Because the presentation

of ischaemic heart

disease is often

dramatic……

..and because of

impressive recent

technological

advances………

….. healthcare providers tend

to focus on diagnostic and

therapeutic interventions…..

……. often overlooking critically

important aspects of high-

quality care.

……Chief among these

neglected areas is the education

of patients.”

……Chief among these

neglected areas is the education

of patients.”

Joint American Cardiology associations’ Stable Angina guidelines

http://www.americanheart.org/presenter.jhtml?identifier=3004542

Educating patients…..

• improves quality of life1

• reduces angina frequency and severity1

• improves function2

• reduces hospital admissions3

• reduces incidence of MI3

1. Moore R et al., Eur J Pain. 2005 Jun;9(3):305-10) 2. Moore R et al., J Pain & Symptom Management;33(3):310-316 3. Furze J et al., Psychosomatic Res 2005 59: 323-29

• reduces demand for palliative cardiac procedures (bypass and stents)1,2,3

1. Eur Heart J 1997;18:394-4132. Lewin et al. British Journal of Cardiology 1995; 2(8):

221-2263. Ornish D. Am J Cardiol. 1998 Nov 26;82(10B):72T-76T.

Jon Develing Specialist Cardiac Commissioner in

2002

“I believe that the patient centred treatment approach being offered presents a real alternative to other forms of treatment…

… including revascularisation, catheterisation and other invasive procedures including the high cost treatments such as DES (drug eluting stents)”

“The economic savings and impact on activity and waiting list targets have the potential for efficiencies and modernisation”

Bob Ricketts (Head of Access

Policy Development and

Capacity Planning at the DoH) to

Duncan Selbie, (Director General

of Commissioning DoH) 2006

“I heard Mike [Chester] present at

Harrogate and have also discussed with

Ian Rutter and others the underpinning

evidence. This is deeply impressive work

which could generate substantial benefits

in terms of improved patient care and

value for money.”

“I heard Mike [Chester] present at

Harrogate and have also discussed with

Ian Rutter and others the underpinning

evidence. This is deeply impressive work

which could generate substantial benefits

in terms of improved patient care and

value for money.”

‘NRAC is the NHS experience that the

patient has been waiting for”

Judge of Judges UK Customer Experience Award 2009

But…only if

drugs have failed and operations are technically unfeasible

Or...

you would prefer to avoid an operation unless it is ‘life or death’

Most angina patients

wrongly believe that

angioplasty and stent

procedures prevent heart

attacks

The properly educated know

better

Dr Martin Thomas

President of the British Association

of Interventional Cardiologist’s

Aug 2007.

“It has never been the interventionist’s claim that PCI impacts on mortality”

Medical version

“We never never said that unblocking arteries with a balloon makes patients live longer”

Patient version

So why do so many

patients think it does?

……Chief among these

neglected areas is the education

of patients.”

Joint American Cardiology associations’ Stable Angina guidelines

http://www.americanheart.org/presenter.jhtml?identifier=3004542

Over 99% of NRAC patients agree with the

authorities and think patients should beproperly educated before operations

www.angina.org

Thanks for taking the time