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
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